NR 547 Differential Dx Midterm
questions with correct answers
Differential bDx b- bquestions bwith banswersDiagnostic breasoning bis bthe bprocess bof
bquestioning bone's bthinking bto bdetermine bif ball bpossible bavenues bhave bbeen
bexplored band bif bthe bconclusions bthat bare bdrawn bare bbased bon bevidence. bThis bis
ba bcritical bstep bfor bproviders bwho bare btrying bto buncover ba bcause, bor bdiagnosis, bfor
btheir bclients' bsigns band bsymptoms. bThe bprovider's binitial bhypothesis bis bknown bas
bthe bdifferential bdiagnosis. bThe bdifferential bdiagnosis, bor bdifferential, bis ba bworking
blist bof bpotential bproblems bthat bcan bbe bassociated bwith bthe binitial bor bchief
bcomplaint. bEstablishing ba bdifferential bdiagnosis bis ba bcritical bstep bin bproviding bsafe,
bquality bcare. bThis bevolving bprocess bof bclinical breasoning band bdecision bmaking
binvolves bexamining bthe bclient's bpresentation, bclinical bdata, band bwhen bappropriate,
bscreening band bdiagnostic btest bresults bto bdistinguish bone bdisease bfrom banother
band barrive bat bthe bcorrect bdiagnosis. bThe bDiagnostic band bStatistical bManual bof
bMental bDisorders b(DSM-5-TR)provides bguidance bfor bidentifying bpsychiatric
bdiagnosest
History bof bPresent bIllness b- bquestions bwith banswersHow blong bhave byou bbeen
bfeeling bthis bway?
Did bsomething bhappen bin byour blife bthat bmay bhave btriggered bthese bemotions?
How bis bthis bcurrent bsituation bimpacting byour blife?
The bPsychiatric bHistory b- bquestions bwith banswersHave byou bever bbeen bhospitalized
bfor bany bmental bhealth bissues?
Have byou bever bhad bcounseling bor bpsychotherapy?
Have byou bever btaken bmedications bfor byour bmental bhealth bin bthe bpast?
Are byou bcurrently bon bany bmedications bfor bmental bhealth bor bsleep?
Medical bHistory/Screening bfor bGeneral bMedical bConditions b- bquestions bwith
banswersDo byou bhave ba bprimary bcare bprovider?
Do byou bhave bany bmedical billnesses?
Are byou bcurrently btaking bany bmedications bor bherbal bsupplements?
Do byou bhave bany ballergies bto bmedications?
Have byou bever bbeen bhospitalized bfor bany breason?
Have byou bever bhad bsurgery?
Family bPsychiatric bHistory b- bquestions bwith banswersHas bany brelative bof byours bever
bbeen bhospitalized bfor ba bmental bhealth bissue?
,Has bany bblood brelative bof byours bever bbeen bdiagnosed bwith ba bmental bhealth
bissue?
Has bany bblood brelative bof byours bhad ba bhistory bof bseizures bor
bdementia/Alzheimer's?
Social band bDevelopmental bHistory b- bquestions bwith banswersTell bme ba blittle bbit
babout byour bchildhood band bhow byou bgrew bup.
How bwas byour bexperience bin bschool bwhen byou bwere byounger? bDid byou benjoy
bschool?
How bdo byou bsupport byourself bwith byour bfinances?
Do byou bhave ba bgood bsupport bsystem? bAre byou bcurrently bin ba brelationship?
bWhere bdo byou blive? bWho bdo byou blive bwith?
What bdo byou bdo bin byour bfree btime? bWhat bactivities bdo byou benjoy?
Which bof bthe bfollowing bshould bbe bincluded bwhen bproviding bclient beducation babout
bmedication bregimens? bSelect ball bthat bapply. b- bquestions bwith banswersA)Explain
bhow bthe bmedication btargets bthe bsymptoms, bspecific bbenefits, band bexpected btime
bcourse. b(Correct banswer)
B)Identify bpotential bside beffects, bduration bof bside beffects, band badverse beffects.
b(Correct banswer)
C)Explain bthe binstructions, bdosing, band bspecial brequirements. b(Correct banswer)
D)Use bteach-back bmethods bto bensure bclient bunderstanding. b(Correct banswer)
Apply bthe bAsk bSuicide-Screening bQuestions b(ASQ) bSuicide bRisk bScreening bTool
b(Links bto ban bexternal bsite.) bto bthe bscenario bbelow.
A b52-year-old bclient bpresents bto bthe bemergency bdepartment bfollowing ba bcar
baccident. bThe bemergency bdepartment b(ED) bphysician bis bconcerned bthat bthe bclient
bmay bhave bintentionally bcrashed bher bcar band brequests ba bstat bPMHNP bconsult. bIn
bspeaking bwith bthe bPMHNP, bthe bclient bdescribes bpersistent bfeelings bof bsadness
band bhopelessness. bShe bstates bthat bshe boften bwonders bif bher bhusband bwould bbe
bhappier bif bshe bwasn't baround banymore bsince bshe's bnever bhappy band bsometimes
bthinks babout bwhat bit bwould bbe blike bto bjust btake ba bhandful bof bsleeping bpills band
bgo bto bsleep bforever. bThe bclient breports ba bprevious bsuicide battempt bwhen bshe
bwas b16 bbut bdenies bthat bshe bis bconsidering bkilling bherself bright bnow.
Based bon bthe bclient's bASQ bscore, bwhat bis bthe bmost bappropriate bresponse?
A) bNo baction bis bnecessary bas bthe bclient bis bnot b- bquestions bwith banswersB)Provide
ba bbrief bsuicide bsafety bassessment. b
Rationale: bWhile bthe bclient's bresponses bdo bnot bindicate ba bneed bfor ba bstat bfull
bsafety band bmental bhealth bevaluation, bthe bclient brequires ba bbrief bsuicide bsafety
bassessment bto bdetermine bwhether ba bfull bmental bhealth bevaluation bin bnecessary. bIt
bis balso bimportant bto bnotify bthe bclient's bphysician bor bthe bclinician bresponsible bfor
bthe bclient's bcare.
Complete bBlood bCount b- bquestions bwith banswersThe bCBC bis ba bserum bdiagnostic
btest bthat bmeasures bred bblood bcells, bwhite bblood bcells, bhemoglobin, bhematocrit,
,band bplatelets. bThe bCBC bincludes ba bdifferential bof bthe bwhite bblood bcells. bA bCBC
bis boften bincluded bas bpart bof broutine bhealth bscreening bor bto bobtain binformation
brelated bto bspecific bconditions. bIn bmental bhealth, bthe bCBC bis bused bto brule bout
bmedical bconditions bthat bmay bpresent bwith bsymptoms bthat bcan bbe battributed bto
bboth bmedical band bpsychiatric bdiagnoses. bFor bexample, bthe bCBC bcan bhelp brule
bout banemia bas ba bcause bfor bdepressive bsymptoms band bfatigue bor brule bout
binfection bas ba bcause bof bacute bmental bstatus bchanges. bThe bCBC bis balso bused bto
bmonitor bcertain btreatment bregimens. bFor bexample, bsome bmedications, bsuch bas
bclozapine, brequire broutine banalysis bof babsolute bneutrophil bcount band bplatelet
blevels.
Normal bRange bof: b
Red bblood bcells
Hemoglobin
Hematocrit
Reticulocytes b- bquestions bwith banswersRed bblood bcells: b4.5-6.0 bmillion/microliter
Hemoglobin: b12-18 bgrams/100 bmL
Hematocrit: b38%-48%
Reticulocytes: b0%-1.5%
Normal bRange bof? b
White bblood bcells b(total): b
Neutrophils: b
Eosinophils: b
Basophils: b
Lymphocytes: b
Monocytes: b
Platelets: b- bquestions bwith banswersWhite bblood bcells b(total): b5000-10,000/microliter
Neutrophils: b55%-70%
Eosinophils: b1%-3%
Basophils: b0.5%-1%
Lymphocytes: b20%-35%
Monocytes: b3%-8%
Platelets: b150,000-300,000/microliter
Comprehensive bMetabolic bPanel b(CMP) b- bquestions bwith banswersThe bCMP bis
banother bcommon bblood btest bused bto bdetermine bgeneral bhealth bstatus. bThe bCMP
bincludes bseveral btests bthat bprovide binformation babout bfluid band belectrolyte bbalance
bas bwell bas bthe bstatus bof bthe bbody's bmetabolism, bliver bfunction, band bkidney
bfunction. bIn bpsychiatric bcare, bthe bCMP bmay bbe bused bto brule bout bmedical
bconditions bthat bcould bcause bsymptoms bsuch bas bchanges bin bmood bor bcognition.
bThe bCMP bis balso bused bto bmonitor bthe beffects bof bmedications, bsuch bas
bantipsychotics, bon bliver bfunction band bglucose blevels.
Normal bCMP bLevels
Electrolytes
, Sodium b(Na+): b
Postassium b(K+): b
Chloride b(Cl-): b
Bicarbonate b(HCO3-): b- bquestions bwith banswersNormal bCMP bLevels
Electrolytes
Sodium b(Na+): b136-145 bmEq/L
Postassium b(K+): b3.5-5.0 bmEq/L
Chloride b(Cl-): b95-105 bmEq/L
Bicarbonate b(HCO3-): b22-28 bmEq/L
Normal bCMP blevels
Misc. b
Calcium, bserum b(Ca b2+) b
Glucose, bserum bFasting: b
2-h bpostprandial: b
Cholesterol, bserum:
Total bProtein
Albumin b- bquestions bwith banswersCalcium, bserum b(Ca b2+) b8.4-10.2 bmg/dl
Glucose, bserum bFasting: b70-110 bmg/dl;
b2-h bpostprandial: b<120mg/dl
Cholesterol, bserum: bREC<200 bmg/dl
Total bProtein b6.0-7.8 bg/dl
Albumin b3.5-5.5 bg/dl
Kidney bTests
Creatinine, bserum b
Urea bnitrogen, bserum b(BUN) b- bquestions bwith banswersCreatinine, bserum b0.6-
1.2mg/dl
Urea bnitrogen, bserum b(BUN) b7-18mg/dl
Liver bTests
Alanine baminotransferase b(ALT), bserum: b
Aspartate baminotransferase b(AST), b
Bilirubin, bserum b(adult) bTotal//Direct: b
Phosphatase b(alkaline), bserum: b- bquestions bwith banswersLiver bTests
Alanine baminotransferase b(ALT), bserum: b8-20 bU/L
Aspartate baminotransferase b(AST), bserum: b8-20 bU/L
Bilirubin, bserum b(adult) bTotal//Direct: b0.1-1.0 bmg/dl b// b0.0-0.3 bmg/dl
Phosphatase b(alkaline), bserum: b20-70 bU/L
Normal bTFT blevels
TSH: b
T3:
T4: b- bquestions bwith banswersNormal bTFT blevels
TSH: b0.4-4.5 bmIU/L
T3: b100-200 bng/dL
questions with correct answers
Differential bDx b- bquestions bwith banswersDiagnostic breasoning bis bthe bprocess bof
bquestioning bone's bthinking bto bdetermine bif ball bpossible bavenues bhave bbeen
bexplored band bif bthe bconclusions bthat bare bdrawn bare bbased bon bevidence. bThis bis
ba bcritical bstep bfor bproviders bwho bare btrying bto buncover ba bcause, bor bdiagnosis, bfor
btheir bclients' bsigns band bsymptoms. bThe bprovider's binitial bhypothesis bis bknown bas
bthe bdifferential bdiagnosis. bThe bdifferential bdiagnosis, bor bdifferential, bis ba bworking
blist bof bpotential bproblems bthat bcan bbe bassociated bwith bthe binitial bor bchief
bcomplaint. bEstablishing ba bdifferential bdiagnosis bis ba bcritical bstep bin bproviding bsafe,
bquality bcare. bThis bevolving bprocess bof bclinical breasoning band bdecision bmaking
binvolves bexamining bthe bclient's bpresentation, bclinical bdata, band bwhen bappropriate,
bscreening band bdiagnostic btest bresults bto bdistinguish bone bdisease bfrom banother
band barrive bat bthe bcorrect bdiagnosis. bThe bDiagnostic band bStatistical bManual bof
bMental bDisorders b(DSM-5-TR)provides bguidance bfor bidentifying bpsychiatric
bdiagnosest
History bof bPresent bIllness b- bquestions bwith banswersHow blong bhave byou bbeen
bfeeling bthis bway?
Did bsomething bhappen bin byour blife bthat bmay bhave btriggered bthese bemotions?
How bis bthis bcurrent bsituation bimpacting byour blife?
The bPsychiatric bHistory b- bquestions bwith banswersHave byou bever bbeen bhospitalized
bfor bany bmental bhealth bissues?
Have byou bever bhad bcounseling bor bpsychotherapy?
Have byou bever btaken bmedications bfor byour bmental bhealth bin bthe bpast?
Are byou bcurrently bon bany bmedications bfor bmental bhealth bor bsleep?
Medical bHistory/Screening bfor bGeneral bMedical bConditions b- bquestions bwith
banswersDo byou bhave ba bprimary bcare bprovider?
Do byou bhave bany bmedical billnesses?
Are byou bcurrently btaking bany bmedications bor bherbal bsupplements?
Do byou bhave bany ballergies bto bmedications?
Have byou bever bbeen bhospitalized bfor bany breason?
Have byou bever bhad bsurgery?
Family bPsychiatric bHistory b- bquestions bwith banswersHas bany brelative bof byours bever
bbeen bhospitalized bfor ba bmental bhealth bissue?
,Has bany bblood brelative bof byours bever bbeen bdiagnosed bwith ba bmental bhealth
bissue?
Has bany bblood brelative bof byours bhad ba bhistory bof bseizures bor
bdementia/Alzheimer's?
Social band bDevelopmental bHistory b- bquestions bwith banswersTell bme ba blittle bbit
babout byour bchildhood band bhow byou bgrew bup.
How bwas byour bexperience bin bschool bwhen byou bwere byounger? bDid byou benjoy
bschool?
How bdo byou bsupport byourself bwith byour bfinances?
Do byou bhave ba bgood bsupport bsystem? bAre byou bcurrently bin ba brelationship?
bWhere bdo byou blive? bWho bdo byou blive bwith?
What bdo byou bdo bin byour bfree btime? bWhat bactivities bdo byou benjoy?
Which bof bthe bfollowing bshould bbe bincluded bwhen bproviding bclient beducation babout
bmedication bregimens? bSelect ball bthat bapply. b- bquestions bwith banswersA)Explain
bhow bthe bmedication btargets bthe bsymptoms, bspecific bbenefits, band bexpected btime
bcourse. b(Correct banswer)
B)Identify bpotential bside beffects, bduration bof bside beffects, band badverse beffects.
b(Correct banswer)
C)Explain bthe binstructions, bdosing, band bspecial brequirements. b(Correct banswer)
D)Use bteach-back bmethods bto bensure bclient bunderstanding. b(Correct banswer)
Apply bthe bAsk bSuicide-Screening bQuestions b(ASQ) bSuicide bRisk bScreening bTool
b(Links bto ban bexternal bsite.) bto bthe bscenario bbelow.
A b52-year-old bclient bpresents bto bthe bemergency bdepartment bfollowing ba bcar
baccident. bThe bemergency bdepartment b(ED) bphysician bis bconcerned bthat bthe bclient
bmay bhave bintentionally bcrashed bher bcar band brequests ba bstat bPMHNP bconsult. bIn
bspeaking bwith bthe bPMHNP, bthe bclient bdescribes bpersistent bfeelings bof bsadness
band bhopelessness. bShe bstates bthat bshe boften bwonders bif bher bhusband bwould bbe
bhappier bif bshe bwasn't baround banymore bsince bshe's bnever bhappy band bsometimes
bthinks babout bwhat bit bwould bbe blike bto bjust btake ba bhandful bof bsleeping bpills band
bgo bto bsleep bforever. bThe bclient breports ba bprevious bsuicide battempt bwhen bshe
bwas b16 bbut bdenies bthat bshe bis bconsidering bkilling bherself bright bnow.
Based bon bthe bclient's bASQ bscore, bwhat bis bthe bmost bappropriate bresponse?
A) bNo baction bis bnecessary bas bthe bclient bis bnot b- bquestions bwith banswersB)Provide
ba bbrief bsuicide bsafety bassessment. b
Rationale: bWhile bthe bclient's bresponses bdo bnot bindicate ba bneed bfor ba bstat bfull
bsafety band bmental bhealth bevaluation, bthe bclient brequires ba bbrief bsuicide bsafety
bassessment bto bdetermine bwhether ba bfull bmental bhealth bevaluation bin bnecessary. bIt
bis balso bimportant bto bnotify bthe bclient's bphysician bor bthe bclinician bresponsible bfor
bthe bclient's bcare.
Complete bBlood bCount b- bquestions bwith banswersThe bCBC bis ba bserum bdiagnostic
btest bthat bmeasures bred bblood bcells, bwhite bblood bcells, bhemoglobin, bhematocrit,
,band bplatelets. bThe bCBC bincludes ba bdifferential bof bthe bwhite bblood bcells. bA bCBC
bis boften bincluded bas bpart bof broutine bhealth bscreening bor bto bobtain binformation
brelated bto bspecific bconditions. bIn bmental bhealth, bthe bCBC bis bused bto brule bout
bmedical bconditions bthat bmay bpresent bwith bsymptoms bthat bcan bbe battributed bto
bboth bmedical band bpsychiatric bdiagnoses. bFor bexample, bthe bCBC bcan bhelp brule
bout banemia bas ba bcause bfor bdepressive bsymptoms band bfatigue bor brule bout
binfection bas ba bcause bof bacute bmental bstatus bchanges. bThe bCBC bis balso bused bto
bmonitor bcertain btreatment bregimens. bFor bexample, bsome bmedications, bsuch bas
bclozapine, brequire broutine banalysis bof babsolute bneutrophil bcount band bplatelet
blevels.
Normal bRange bof: b
Red bblood bcells
Hemoglobin
Hematocrit
Reticulocytes b- bquestions bwith banswersRed bblood bcells: b4.5-6.0 bmillion/microliter
Hemoglobin: b12-18 bgrams/100 bmL
Hematocrit: b38%-48%
Reticulocytes: b0%-1.5%
Normal bRange bof? b
White bblood bcells b(total): b
Neutrophils: b
Eosinophils: b
Basophils: b
Lymphocytes: b
Monocytes: b
Platelets: b- bquestions bwith banswersWhite bblood bcells b(total): b5000-10,000/microliter
Neutrophils: b55%-70%
Eosinophils: b1%-3%
Basophils: b0.5%-1%
Lymphocytes: b20%-35%
Monocytes: b3%-8%
Platelets: b150,000-300,000/microliter
Comprehensive bMetabolic bPanel b(CMP) b- bquestions bwith banswersThe bCMP bis
banother bcommon bblood btest bused bto bdetermine bgeneral bhealth bstatus. bThe bCMP
bincludes bseveral btests bthat bprovide binformation babout bfluid band belectrolyte bbalance
bas bwell bas bthe bstatus bof bthe bbody's bmetabolism, bliver bfunction, band bkidney
bfunction. bIn bpsychiatric bcare, bthe bCMP bmay bbe bused bto brule bout bmedical
bconditions bthat bcould bcause bsymptoms bsuch bas bchanges bin bmood bor bcognition.
bThe bCMP bis balso bused bto bmonitor bthe beffects bof bmedications, bsuch bas
bantipsychotics, bon bliver bfunction band bglucose blevels.
Normal bCMP bLevels
Electrolytes
, Sodium b(Na+): b
Postassium b(K+): b
Chloride b(Cl-): b
Bicarbonate b(HCO3-): b- bquestions bwith banswersNormal bCMP bLevels
Electrolytes
Sodium b(Na+): b136-145 bmEq/L
Postassium b(K+): b3.5-5.0 bmEq/L
Chloride b(Cl-): b95-105 bmEq/L
Bicarbonate b(HCO3-): b22-28 bmEq/L
Normal bCMP blevels
Misc. b
Calcium, bserum b(Ca b2+) b
Glucose, bserum bFasting: b
2-h bpostprandial: b
Cholesterol, bserum:
Total bProtein
Albumin b- bquestions bwith banswersCalcium, bserum b(Ca b2+) b8.4-10.2 bmg/dl
Glucose, bserum bFasting: b70-110 bmg/dl;
b2-h bpostprandial: b<120mg/dl
Cholesterol, bserum: bREC<200 bmg/dl
Total bProtein b6.0-7.8 bg/dl
Albumin b3.5-5.5 bg/dl
Kidney bTests
Creatinine, bserum b
Urea bnitrogen, bserum b(BUN) b- bquestions bwith banswersCreatinine, bserum b0.6-
1.2mg/dl
Urea bnitrogen, bserum b(BUN) b7-18mg/dl
Liver bTests
Alanine baminotransferase b(ALT), bserum: b
Aspartate baminotransferase b(AST), b
Bilirubin, bserum b(adult) bTotal//Direct: b
Phosphatase b(alkaline), bserum: b- bquestions bwith banswersLiver bTests
Alanine baminotransferase b(ALT), bserum: b8-20 bU/L
Aspartate baminotransferase b(AST), bserum: b8-20 bU/L
Bilirubin, bserum b(adult) bTotal//Direct: b0.1-1.0 bmg/dl b// b0.0-0.3 bmg/dl
Phosphatase b(alkaline), bserum: b20-70 bU/L
Normal bTFT blevels
TSH: b
T3:
T4: b- bquestions bwith banswersNormal bTFT blevels
TSH: b0.4-4.5 bmIU/L
T3: b100-200 bng/dL
