NR547 Midterm Exam
Questions and Answers
differential diagnosis
✓~ The provider's initial hypothesis
-a working list of potential problems that can be associated with the initial or chief complaint
-Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• provides guidance for identifying psychiatric diagnoses
Psychiatric assessment: History taking
✓~ -History of Present Illness
-How long have you been feeling this way?
-Did something happen in your life that may have triggered these emotions?
-How is this current situation impacting your life?
The Psychiatric History
-Have you ever been hospitalized for any mental health issues?
-Have you ever had counseling or psychotherapy?
-Have you ever taken medications for your mental health in the past?
-Are you currently on any medications for mental health or sleep?
Medical History/Screening for General Medical Conditions
,-Do you have a primary care provider?
-Do you have any medical illnesses?
-Are you currently taking any medications or herbal supplements?
-Do you have any allergies to medications?
-Have you ever been hospitalized for any reason?
-Have you ever had surgery?
Family Psychiatric History
-Has any relative of yours ever been hospitalized for a mental health issue?
-Has any blood relative of yours ever been diagnosed with a mental health issue?
-Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
Social and Developmental History
-Tell me a little bit about your childhood and how you grew up.
-How was your experience in school when you were younger? Did you enjoy school?
-How do you support yourself with your finances?
-Do you have a good support system? Are you currently in a relationship? Where do you
live? Who do you live with?
-What do you do in your free time? What activities do you enjoy?
Screening and Psychiatric Rating Scales
,✓~ Evidence-based screening tools and psychiatric rating scales
-can help the provider identify symptoms and assess their severity and can assist with the
evaluation of response to treatment
A 52-year-old client presents to the emergency department following a car accident.
The emergency department (ED) physician is concerned that the client may have
intentionally crashed her car and requests a stat PMHNP consult. In speaking with
the PMHNP, the client describes persistent feelings of sadness and hopelessness.
She states that she often wonders if her husband would be happier if she wasn't
around anymore since she's never happy and sometimes thinks about what it would
be like to just take a handful of sleeping pills and go to sleep forever. The client
reports a previous suicide attempt when she was 16 but denies that she is
considering killing herself right now.
Based on the client's ASQ score, what is the most appropriate response?
No action is necessary as the client is not currently considering suicide.
Provide a brief suicide safety assessment.
Alert the client's primary care physician.
Provide a ST
✓~ Provide a brief suicide safety assessment.
Rationale: While the client's responses do not indicate a need for a stat full safety
and mental health evaluation, the client requires a brief suicide safety assessment to
, determine whether a full mental health evaluation in necessary. It is also important to
notify the client's physician or the clinician responsible for the client's care.
Diagnostic Testing when diagnosing mental health disorders
✓~ -Diagnostic tests and labs are most used to rule out physical conditions that may cause
psychiatric symptoms and to evaluate the effects of treatment
Basic Laboratory Interpretation
✓~ Complete Blood Count
Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
Toxicology Screen
Urinalysis (UA)
Basic Laboratory Interpretation: Complete Blood Count
✓~ -measures RBCs, WBCs, hemoglobin, hematocrit, and platelets
-includes a differential of the WBCs
-In mental health, the CBC is used to rule out medical conditions that may present
with symptoms that can be attributed to both medical and psychiatric diagnoses
Questions and Answers
differential diagnosis
✓~ The provider's initial hypothesis
-a working list of potential problems that can be associated with the initial or chief complaint
-Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• provides guidance for identifying psychiatric diagnoses
Psychiatric assessment: History taking
✓~ -History of Present Illness
-How long have you been feeling this way?
-Did something happen in your life that may have triggered these emotions?
-How is this current situation impacting your life?
The Psychiatric History
-Have you ever been hospitalized for any mental health issues?
-Have you ever had counseling or psychotherapy?
-Have you ever taken medications for your mental health in the past?
-Are you currently on any medications for mental health or sleep?
Medical History/Screening for General Medical Conditions
,-Do you have a primary care provider?
-Do you have any medical illnesses?
-Are you currently taking any medications or herbal supplements?
-Do you have any allergies to medications?
-Have you ever been hospitalized for any reason?
-Have you ever had surgery?
Family Psychiatric History
-Has any relative of yours ever been hospitalized for a mental health issue?
-Has any blood relative of yours ever been diagnosed with a mental health issue?
-Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
Social and Developmental History
-Tell me a little bit about your childhood and how you grew up.
-How was your experience in school when you were younger? Did you enjoy school?
-How do you support yourself with your finances?
-Do you have a good support system? Are you currently in a relationship? Where do you
live? Who do you live with?
-What do you do in your free time? What activities do you enjoy?
Screening and Psychiatric Rating Scales
,✓~ Evidence-based screening tools and psychiatric rating scales
-can help the provider identify symptoms and assess their severity and can assist with the
evaluation of response to treatment
A 52-year-old client presents to the emergency department following a car accident.
The emergency department (ED) physician is concerned that the client may have
intentionally crashed her car and requests a stat PMHNP consult. In speaking with
the PMHNP, the client describes persistent feelings of sadness and hopelessness.
She states that she often wonders if her husband would be happier if she wasn't
around anymore since she's never happy and sometimes thinks about what it would
be like to just take a handful of sleeping pills and go to sleep forever. The client
reports a previous suicide attempt when she was 16 but denies that she is
considering killing herself right now.
Based on the client's ASQ score, what is the most appropriate response?
No action is necessary as the client is not currently considering suicide.
Provide a brief suicide safety assessment.
Alert the client's primary care physician.
Provide a ST
✓~ Provide a brief suicide safety assessment.
Rationale: While the client's responses do not indicate a need for a stat full safety
and mental health evaluation, the client requires a brief suicide safety assessment to
, determine whether a full mental health evaluation in necessary. It is also important to
notify the client's physician or the clinician responsible for the client's care.
Diagnostic Testing when diagnosing mental health disorders
✓~ -Diagnostic tests and labs are most used to rule out physical conditions that may cause
psychiatric symptoms and to evaluate the effects of treatment
Basic Laboratory Interpretation
✓~ Complete Blood Count
Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
Toxicology Screen
Urinalysis (UA)
Basic Laboratory Interpretation: Complete Blood Count
✓~ -measures RBCs, WBCs, hemoglobin, hematocrit, and platelets
-includes a differential of the WBCs
-In mental health, the CBC is used to rule out medical conditions that may present
with symptoms that can be attributed to both medical and psychiatric diagnoses
