NR547 MIDTERM EXAM QUESTIONS AND COMPLETE
VERIFIED ANSWERS RATED 100% GUARANTEED PASS
Differential Diagnosis and Initial Hypothesis
1. Provider's Initial Hypothesis
o A working list of potential problems that can be associated with the
initial or chief complaint.
o Reference: Diagnostic and Statistical Manual of Mental Disorders
(DSM-5-TR)
Psychiatric Assessment: History Taking
1. History of Present Illness
o How long have you been feeling this way?
o Did something happen in your life that may have triggered these
emotions?
o How is this current situation impacting your life?
2. The Psychiatric History
o Have you ever been hospitalized for any mental health issues?
o Have you ever had counseling or psychotherapy?
o Have you ever taken medications for your mental health in the past?
o Are you currently on any medications for mental health or sleep?
3. Medical History/Screening for General Medical Conditions
o Do you have a primary care provider?
o Do you have any medical illnesses?
o Are you currently taking any medications or herbal supplements?
o Do you have any allergies to medications?
, o Have you ever been hospitalized for any reason?
o Have you ever had surgery?
4. Family Psychiatric History
o Has any relative of yours ever been hospitalized for a mental health
issue?
o Has any blood relative of yours ever been diagnosed with a mental
health issue?
o Has any blood relative of yours had a history of seizures or
dementia/Alzheimer's?
5. Social and Developmental History
o Tell me a little bit about your childhood and how you grew up.
o How was your experience in school when you were younger? Did you
enjoy school?
o How do you support yourself with your finances?
o Do you have a good support system? Are you currently in a
relationship? Where do you live? Who do you live with?
o 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.
Reference: NIMH - Assessment Tools
Case Example
,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, the most appropriate response is:
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 is
necessary. It is also important to notify the client's physician or the clinician
responsible for the client's care.
Reference: Suicide Prevention Resource Center
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
1. Complete Blood Count (CBC)
o Measures RBCs, WBCs, hemoglobin, hematocrit, and platelets.
, o Includes a differential of the WBCs.
o 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.
Example: Rule out anemia as a cause for depressive symptoms
and fatigue.
Example: Rule out infection as a cause of acute mental status
changes.
Normal Ranges for CBC Components:
RBCs: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
WBCs (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
Reference:
Mayo Clinic - Complete Blood Count
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP)
VERIFIED ANSWERS RATED 100% GUARANTEED PASS
Differential Diagnosis and Initial Hypothesis
1. Provider's Initial Hypothesis
o A working list of potential problems that can be associated with the
initial or chief complaint.
o Reference: Diagnostic and Statistical Manual of Mental Disorders
(DSM-5-TR)
Psychiatric Assessment: History Taking
1. History of Present Illness
o How long have you been feeling this way?
o Did something happen in your life that may have triggered these
emotions?
o How is this current situation impacting your life?
2. The Psychiatric History
o Have you ever been hospitalized for any mental health issues?
o Have you ever had counseling or psychotherapy?
o Have you ever taken medications for your mental health in the past?
o Are you currently on any medications for mental health or sleep?
3. Medical History/Screening for General Medical Conditions
o Do you have a primary care provider?
o Do you have any medical illnesses?
o Are you currently taking any medications or herbal supplements?
o Do you have any allergies to medications?
, o Have you ever been hospitalized for any reason?
o Have you ever had surgery?
4. Family Psychiatric History
o Has any relative of yours ever been hospitalized for a mental health
issue?
o Has any blood relative of yours ever been diagnosed with a mental
health issue?
o Has any blood relative of yours had a history of seizures or
dementia/Alzheimer's?
5. Social and Developmental History
o Tell me a little bit about your childhood and how you grew up.
o How was your experience in school when you were younger? Did you
enjoy school?
o How do you support yourself with your finances?
o Do you have a good support system? Are you currently in a
relationship? Where do you live? Who do you live with?
o 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.
Reference: NIMH - Assessment Tools
Case Example
,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, the most appropriate response is:
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 is
necessary. It is also important to notify the client's physician or the clinician
responsible for the client's care.
Reference: Suicide Prevention Resource Center
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
1. Complete Blood Count (CBC)
o Measures RBCs, WBCs, hemoglobin, hematocrit, and platelets.
, o Includes a differential of the WBCs.
o 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.
Example: Rule out anemia as a cause for depressive symptoms
and fatigue.
Example: Rule out infection as a cause of acute mental status
changes.
Normal Ranges for CBC Components:
RBCs: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
WBCs (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
Reference:
Mayo Clinic - Complete Blood Count
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP)
