Week 4 Midterm Exam: NR547 / NR-547 (Latest 2025/2026)
Differential Diagnosis in Psychiatric-Mental Health across
the Lifespan Practicum | Questions & Correct Detailed
Answers (Verified Answers) | Already Graded A
Subject: Differential Diagnosis in Psychiatric-Mental Health – Psychiatric Assessment (History Taking,
HPI, Medical/Family/Social History, Screening Scales); Basic Laboratory Interpretation (CBC, CMP,
TFTs, B12, Vitamin D, Toxicology, UA); Treat or Refer Scenarios (TSH, Hemoglobin, UA Leukocyte
Esterase, Vitamin D, T3, B12, Creatinine/BUN); SNAPPS Method; Social Determinants of Health;
Legal/Ethical Issues; Anxiety Disorders (GAD, Social Anxiety, Panic Disorder, Phobias, Agoraphobia,
Adjustment Disorder with Anxiety); Obsessive-Compulsive and Related Disorders (OCD, Body
Dysmorphic, Hoarding, Trichotillomania, Excoriation); Psychotic Disorders (Schizophrenia,
Schizoaffective, Schizophreniform, Brief Psychotic Disorder, Delusional Disorder, Catatonia);
Antipsychotic Medications (FGAs, SGAs – Pines, Dones/Rone, Pips/Rip, Dosing, Monitoring, Clozapine
ANC, Olanzapine Smoking Interaction, Ziprasidone ECG); Sleep-Wake Disorders (Insomnia,
Narcolepsy, Breathing-Related Disorders, Circadian Rhythm Disorders, Parasomnias, OTC Sleep Aids,
Z-Drugs, Melatonin Agonists, Orexin Antagonists); Sexual Dysfunction (Female Interest/Arousal
Disorder, Genito-Pelvic Pain, Orgasmic Disorder, Male Hypoactive Sexual Desire Disorder, Erectile
Disorder, Delayed/Premature Ejaculation).
Source: NR547 Midterm Exam 2025/2026, DSM-5-TR, APA Practice Guidelines.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
52-year-old client after car accident, ED physician suspects intentional crash. Client describes
persistent sadness, hopelessness, wonders if husband would be happier if she wasn't around,
thinks about taking sleeping pills. Reports previous suicide attempt at 16 but denies current
suicidal ideation. Based on ASQ score, most appropriate response?
Correct Answer: Provide a brief suicide safety assessment.
1. ASQ (Ask Suicide-Screening Questions) positive requires brief suicide safety assessment to
determine level of risk and need for full mental health evaluation.
2. Even with denial of current intent, history of attempt and passive ideation warrant further assessment.
Notify clinician responsible for client's care.
Toni, 58-year-old with fatigue. TSH is 6.3 mIU/L. Treat or refer?
Correct Answer: Refer (hypothyroidism – TSH >4.0).
1. Normal TSH 0.4-4.5 mIU/L. TSH 6.3 indicates hypothyroidism, which causes fatigue. Refer for
treatment. Reevaluate fatigue after TSH normalized.
Terri, 79-year-old with confusion. Positive urine leukocyte esterase. Treat or refer?
Correct Answer: Refer (UTI causes confusion in elderly).
1. Positive leukocyte esterase indicates UTI, which often presents with acute mental status changes
(delirium) in older adults. Refer for UTI treatment.
, Harold, 32-year-old, fatigue, difficulty concentrating, difficulty falling asleep, constant worry
about finances/work/relationship for 8 months, impacting relationship. Does he meet GAD
criteria?
Correct Answer: Yes
1. GAD criteria: excessive worry more days than not ≥6 months, ≥3 symptoms (fatigue, difficulty
concentrating, sleep disturbance), clinically significant distress/impairment.
Fabrizia, 27-year-old, ED visit for chest pain, palpitations, nausea, dizziness during movie
lasting 15 minutes. ECG/cardiac enzymes normal. One episode, worried about recurrence. Does
she meet panic disorder criteria?
Correct Answer: No
1. Panic disorder requires recurrent unexpected panic attacks plus ≥1 month of persistent concern about
additional attacks or change in behavior. She had one attack; concern about recurrence not persistent.
Ella, 17-year-old, afraid of basement due to spiders, will take punishment over facing spiders,
fear since childhood. Most appropriate ICD-10-CM code?
Correct Answer: F40.218 Specific phobia – animal
1. Specific phobia (animal type) – persistent fear of a specific object (spiders) causing avoidance and
impairment.
Sigourney, 47-year-old, anxious using subway, attending concerts/movies, going to bodega.
Fears being trapped in emergency. Changed behaviors (walking, grocery delivery). Does she
meet agoraphobia criteria?
Correct Answer: Yes
1. Agoraphobia criteria: marked fear/anxiety in ≥2 of 5 situations (public transportation, open spaces,
enclosed spaces, crowds, outside home alone), avoidance, impairment.
Callie, 18-year-old college student, anxiety about law school admission, assumed she won't be
accepted, decided not to apply. Diagnosis?
Correct Answer: Generalized anxiety disorder
1. Persistent anxiety with restlessness, irritability, unrealistic thoughts (predetermined she is not good
enough without evidence).
Jeremy, 44-year-old, anxiety before announcing layoffs, physical symptoms (heart pounding,
nausea, dizziness) during meeting, unable to answer question. Diagnosis?
Correct Answer: Panic attack
1. Panic attack – discrete episode of intense fear with ≥4 physical symptoms (palpitations, nausea,
dizziness, derealization).
Sari, 34-year-old, anxious about meeting fiancé's teens, concerned they won't accept her
because she is not their mother, avoided meeting. Diagnosis?
Correct Answer: Social anxiety disorder
1. Social anxiety disorder – fear of being judged negatively by others, avoidance of social situations
(meeting teens).
Differential Diagnosis in Psychiatric-Mental Health across
the Lifespan Practicum | Questions & Correct Detailed
Answers (Verified Answers) | Already Graded A
Subject: Differential Diagnosis in Psychiatric-Mental Health – Psychiatric Assessment (History Taking,
HPI, Medical/Family/Social History, Screening Scales); Basic Laboratory Interpretation (CBC, CMP,
TFTs, B12, Vitamin D, Toxicology, UA); Treat or Refer Scenarios (TSH, Hemoglobin, UA Leukocyte
Esterase, Vitamin D, T3, B12, Creatinine/BUN); SNAPPS Method; Social Determinants of Health;
Legal/Ethical Issues; Anxiety Disorders (GAD, Social Anxiety, Panic Disorder, Phobias, Agoraphobia,
Adjustment Disorder with Anxiety); Obsessive-Compulsive and Related Disorders (OCD, Body
Dysmorphic, Hoarding, Trichotillomania, Excoriation); Psychotic Disorders (Schizophrenia,
Schizoaffective, Schizophreniform, Brief Psychotic Disorder, Delusional Disorder, Catatonia);
Antipsychotic Medications (FGAs, SGAs – Pines, Dones/Rone, Pips/Rip, Dosing, Monitoring, Clozapine
ANC, Olanzapine Smoking Interaction, Ziprasidone ECG); Sleep-Wake Disorders (Insomnia,
Narcolepsy, Breathing-Related Disorders, Circadian Rhythm Disorders, Parasomnias, OTC Sleep Aids,
Z-Drugs, Melatonin Agonists, Orexin Antagonists); Sexual Dysfunction (Female Interest/Arousal
Disorder, Genito-Pelvic Pain, Orgasmic Disorder, Male Hypoactive Sexual Desire Disorder, Erectile
Disorder, Delayed/Premature Ejaculation).
Source: NR547 Midterm Exam 2025/2026, DSM-5-TR, APA Practice Guidelines.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
52-year-old client after car accident, ED physician suspects intentional crash. Client describes
persistent sadness, hopelessness, wonders if husband would be happier if she wasn't around,
thinks about taking sleeping pills. Reports previous suicide attempt at 16 but denies current
suicidal ideation. Based on ASQ score, most appropriate response?
Correct Answer: Provide a brief suicide safety assessment.
1. ASQ (Ask Suicide-Screening Questions) positive requires brief suicide safety assessment to
determine level of risk and need for full mental health evaluation.
2. Even with denial of current intent, history of attempt and passive ideation warrant further assessment.
Notify clinician responsible for client's care.
Toni, 58-year-old with fatigue. TSH is 6.3 mIU/L. Treat or refer?
Correct Answer: Refer (hypothyroidism – TSH >4.0).
1. Normal TSH 0.4-4.5 mIU/L. TSH 6.3 indicates hypothyroidism, which causes fatigue. Refer for
treatment. Reevaluate fatigue after TSH normalized.
Terri, 79-year-old with confusion. Positive urine leukocyte esterase. Treat or refer?
Correct Answer: Refer (UTI causes confusion in elderly).
1. Positive leukocyte esterase indicates UTI, which often presents with acute mental status changes
(delirium) in older adults. Refer for UTI treatment.
, Harold, 32-year-old, fatigue, difficulty concentrating, difficulty falling asleep, constant worry
about finances/work/relationship for 8 months, impacting relationship. Does he meet GAD
criteria?
Correct Answer: Yes
1. GAD criteria: excessive worry more days than not ≥6 months, ≥3 symptoms (fatigue, difficulty
concentrating, sleep disturbance), clinically significant distress/impairment.
Fabrizia, 27-year-old, ED visit for chest pain, palpitations, nausea, dizziness during movie
lasting 15 minutes. ECG/cardiac enzymes normal. One episode, worried about recurrence. Does
she meet panic disorder criteria?
Correct Answer: No
1. Panic disorder requires recurrent unexpected panic attacks plus ≥1 month of persistent concern about
additional attacks or change in behavior. She had one attack; concern about recurrence not persistent.
Ella, 17-year-old, afraid of basement due to spiders, will take punishment over facing spiders,
fear since childhood. Most appropriate ICD-10-CM code?
Correct Answer: F40.218 Specific phobia – animal
1. Specific phobia (animal type) – persistent fear of a specific object (spiders) causing avoidance and
impairment.
Sigourney, 47-year-old, anxious using subway, attending concerts/movies, going to bodega.
Fears being trapped in emergency. Changed behaviors (walking, grocery delivery). Does she
meet agoraphobia criteria?
Correct Answer: Yes
1. Agoraphobia criteria: marked fear/anxiety in ≥2 of 5 situations (public transportation, open spaces,
enclosed spaces, crowds, outside home alone), avoidance, impairment.
Callie, 18-year-old college student, anxiety about law school admission, assumed she won't be
accepted, decided not to apply. Diagnosis?
Correct Answer: Generalized anxiety disorder
1. Persistent anxiety with restlessness, irritability, unrealistic thoughts (predetermined she is not good
enough without evidence).
Jeremy, 44-year-old, anxiety before announcing layoffs, physical symptoms (heart pounding,
nausea, dizziness) during meeting, unable to answer question. Diagnosis?
Correct Answer: Panic attack
1. Panic attack – discrete episode of intense fear with ≥4 physical symptoms (palpitations, nausea,
dizziness, derealization).
Sari, 34-year-old, anxious about meeting fiancé's teens, concerned they won't accept her
because she is not their mother, avoided meeting. Diagnosis?
Correct Answer: Social anxiety disorder
1. Social anxiety disorder – fear of being judged negatively by others, avoidance of social situations
(meeting teens).
