NR 547 MIDTERM EXAM 2024 QUESTIONS AND
ANSWERS (VERIFIED) 100% CORRECT
SOLUTIONS WITH RATIONALE| A + GRADE
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 - ANSWER---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 - ANSWER----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 - ANSWER---Complete Blood Count
Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
Toxicology Screen
Urinalysis (UA)
, NR 547 MIDTERM EXAM 2024 QUESTIONS AND
ANSWERS (VERIFIED) 100% CORRECT
SOLUTIONS WITH RATIONALE| A + GRADE
Basic Laboratory Interpretation: Complete Blood Count - ANSWER----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
• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes
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%
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP) - ANSWER---common blood test
used to determine general health status
-fluid and electrolyte balance, status of the body's metabolism, liver function, and kidney function
-used to monitor the effects of medications, such as antipsychotics, on liver function and glucose levels
-rule out medical conditions that could cause symptoms
• Ex: changes in mood or cognition
, NR 547 MIDTERM EXAM 2024 QUESTIONS AND
ANSWERS (VERIFIED) 100% CORRECT
SOLUTIONS WITH RATIONALE| A + GRADE
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): 22-28 mEq/L
Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Glucose, serum Fasting: 70-110 mg/dl; 2-h postprandial: <120mg/dl
Cholesterol, serum: REC<200 mg/dl
Total Protein 6.0-7.8 g/dl
Albumin 3.5-5.5 g/dl
-Kidney Tests
• Creatinine, serum 0.6-1.2mg/dl
• Urea nitrogen, serum (BUN) 7-18mg/dl
-Liver Tests
• Alanine aminotransferase (ALT), serum: 8-20 U/L
• Aspartate aminotransferase (AST), serum: 8-20 U/L
• Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
• Phosphatase (alkaline), serum: 20-70 U/L
Basic Laboratory Interpretation: Thyroid Function Tests (TFTs) - ANSWER---used to rule out thyroid
disorders as a cause for symptoms
• symptoms related to thyroid disorders include anxiety, restlessness, depression, mood swings,
sleeping difficulties, difficulties with concentration, short-term memory lapses, and lack of mental
alertness
Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
, NR 547 MIDTERM EXAM 2024 QUESTIONS AND
ANSWERS (VERIFIED) 100% CORRECT
SOLUTIONS WITH RATIONALE| A + GRADE
Basic Laboratory Interpretation: Vitamin B12 Level - ANSWER---Deficiency of vitamin B12 can affect
mood and other brain functions
-psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms,
and cognitive impairment
normal: 190-950 picograms/mL
• 200-300/mL indicates a borderline level with a possible need for additional testing
Basic Laboratory Interpretation: Vitamin D Level - ANSWER---affects functions such as
neurotransmission, neuroprotection, & neuroimmunomodulation
-high prevalence of vitamin D deficiency in clients with psychiatric disorders such as schizophrenia,
depression, seasonal affective disorder, and cognitive impairment
-Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain
development
25-hydroxy vitamin D blood test: normal 20-50 ng/mL, less than 12 ng/mL indicates a deficiency
Basic Laboratory Interpretation: Toxicology Screen - ANSWER----rule out substance use as a cause for
symptoms
-used before starting therapy involving controlled substances
-used to monitor medication adherence
-used in the diagnosis of substance use disorder
Basic Laboratory Interpretation: Urinalysis (UA) - ANSWER---Urinary tract infections are associated with
a variety of neuropsychiatric symptoms
-acute mental status changes
• UA may be used to rule out a UTI as the cause.
ANSWERS (VERIFIED) 100% CORRECT
SOLUTIONS WITH RATIONALE| A + GRADE
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 - ANSWER---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 - ANSWER----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 - ANSWER---Complete Blood Count
Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
Toxicology Screen
Urinalysis (UA)
, NR 547 MIDTERM EXAM 2024 QUESTIONS AND
ANSWERS (VERIFIED) 100% CORRECT
SOLUTIONS WITH RATIONALE| A + GRADE
Basic Laboratory Interpretation: Complete Blood Count - ANSWER----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
• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes
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%
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP) - ANSWER---common blood test
used to determine general health status
-fluid and electrolyte balance, status of the body's metabolism, liver function, and kidney function
-used to monitor the effects of medications, such as antipsychotics, on liver function and glucose levels
-rule out medical conditions that could cause symptoms
• Ex: changes in mood or cognition
, NR 547 MIDTERM EXAM 2024 QUESTIONS AND
ANSWERS (VERIFIED) 100% CORRECT
SOLUTIONS WITH RATIONALE| A + GRADE
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): 22-28 mEq/L
Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Glucose, serum Fasting: 70-110 mg/dl; 2-h postprandial: <120mg/dl
Cholesterol, serum: REC<200 mg/dl
Total Protein 6.0-7.8 g/dl
Albumin 3.5-5.5 g/dl
-Kidney Tests
• Creatinine, serum 0.6-1.2mg/dl
• Urea nitrogen, serum (BUN) 7-18mg/dl
-Liver Tests
• Alanine aminotransferase (ALT), serum: 8-20 U/L
• Aspartate aminotransferase (AST), serum: 8-20 U/L
• Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
• Phosphatase (alkaline), serum: 20-70 U/L
Basic Laboratory Interpretation: Thyroid Function Tests (TFTs) - ANSWER---used to rule out thyroid
disorders as a cause for symptoms
• symptoms related to thyroid disorders include anxiety, restlessness, depression, mood swings,
sleeping difficulties, difficulties with concentration, short-term memory lapses, and lack of mental
alertness
Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
, NR 547 MIDTERM EXAM 2024 QUESTIONS AND
ANSWERS (VERIFIED) 100% CORRECT
SOLUTIONS WITH RATIONALE| A + GRADE
Basic Laboratory Interpretation: Vitamin B12 Level - ANSWER---Deficiency of vitamin B12 can affect
mood and other brain functions
-psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms,
and cognitive impairment
normal: 190-950 picograms/mL
• 200-300/mL indicates a borderline level with a possible need for additional testing
Basic Laboratory Interpretation: Vitamin D Level - ANSWER---affects functions such as
neurotransmission, neuroprotection, & neuroimmunomodulation
-high prevalence of vitamin D deficiency in clients with psychiatric disorders such as schizophrenia,
depression, seasonal affective disorder, and cognitive impairment
-Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain
development
25-hydroxy vitamin D blood test: normal 20-50 ng/mL, less than 12 ng/mL indicates a deficiency
Basic Laboratory Interpretation: Toxicology Screen - ANSWER----rule out substance use as a cause for
symptoms
-used before starting therapy involving controlled substances
-used to monitor medication adherence
-used in the diagnosis of substance use disorder
Basic Laboratory Interpretation: Urinalysis (UA) - ANSWER---Urinary tract infections are associated with
a variety of neuropsychiatric symptoms
-acute mental status changes
• UA may be used to rule out a UTI as the cause.
