NR-547 MIDTERM EXAMS LATEST UPDATE
Name the 6 of a differential diagnosis
1.) RULE OUT Malingering or Factitous disorder
2.)Ruling out substance etiology
3.) ruling out a medical etiology
4.) Determining the specific primary disorder
5.) Differentiating adjustment disorder from the residual "other specified" and
"unspecified" conditions
6.) Establishing the boundary with no mental disorder
Remember with step 5, the PMHNP can use "other specified" in the diagnosis
when they want to indicate the specific reason for a diagnosis.
They use "unspecified" if:
the information doesnt conform to DSM5
there is insufficient info to make a specific diagnosis
there is more info the be revealed with time OR they want to help the patient
avoid stigmas
The PMHNP wants to rule out anemia as a cause for a patients fatigue and lack of
motivation. What lab should she order?
a CBC with iron studies
hg-12-18
hematocrit: 38-48%
What is normal creat/BUN level?
BUN: 7-18
creat: 0.6-1.2
A patient presents with brain fog, lack of focus, insomnia & mood swing, lack of
mental alertness. What lab should the PMHNP order?
THYROID FUNCTION TEST
TSH: 0.4-4.5
T3: 100-200
T4: 5-11
The patient has a b12 level of 126 picograms/mL. what symptoms may the patient
experience?
normal B12: 190-950 picograms/mL
but borderline is 200-300 & will need additional testing.
depression, mania, psychotic symptoms, cognitive impairment
Name the normal vitamin D levels:
20-50 ng/ML
Tell me about the HAM-A
This is the Hamilton Anxiety Scale, creates to assess somatic/cognitive anxiety
symptoms. MAINLY TO ASSESS ANXIETY. It does not help to assess the worry aspect
usually found with GAD.
less than 17- mild
, 18-23- mod
25-30 mod-severe
_____ shows there is an INCREASE activation of the amygdala which is an
increase in the fear response. There is a decreased activation of the pre-frontal
cortex which results in lessened reasoning.
Generalized Anxiety Disorder
Explain GAD
This is characterized when a person WORRY about ORDINARY, everyday situations.
These patients have a hard time getting over the what ifs and hyperfixate. Due to this
they are unable to get more of their pressing tasks done
What is the DSM criteria for GAD?
WORRY about everyday tasks, sleep disturbance, restlessness, fatigue and immanent
fear, muscle tension or difficulty concentrating has to be persistent for six months or
GREATER
Name the first line treatment for GAD.
SSRIs
What are some s/e of SSRIS?
hyponatremia, weight loss, weight gain, anxiety in the initial stages.
What is another adjunct treatment or PRN medication used as a treatment for
GAD?
Buspirone- This is an anxiolytic with decreased adverse effects & drug interactions. It
can take about 2-4 weeks to work and it is pretty weak however effective when used as
an adjunct.
What is the GAD-7 screening tool?
This is a rapid screening for the presence of clinically significant anxiety disorders such
as: GAD, Panic disorders, PTSD, & social phobias.
5-9- mild
10-14- moderate
over 15- severe & active treatment is warranted
Name the DSM for panic disorder
Panic disorder is a MARKED PERSISTENT reoccurimg panic attacks associated with
worry or concern of a negative outcome. These attacks are usually UNPROVOKED &
can happen in familiar places like home or school. The panic attacks can peak from 10-
20 minutes but some can last for hours.
1 month of worry after 1 panic attack
1 plus panic attack plus 4 of the somatic symptoms
Avoidant behavior/anticipatory anxiety for one month
What are some s/s that patients may complain of when having a panic attack or if
they are diagnosed with panic disorder?
Palpitations, feeling of choking, smothering sensation, nausea, abd stress,
derealization, dizziness, paresthesia, trembling
What is the first line treatment for Panic disorder?
SSRI plus CBT therapy
Tell me about agoraphobia
Name the 6 of a differential diagnosis
1.) RULE OUT Malingering or Factitous disorder
2.)Ruling out substance etiology
3.) ruling out a medical etiology
4.) Determining the specific primary disorder
5.) Differentiating adjustment disorder from the residual "other specified" and
"unspecified" conditions
6.) Establishing the boundary with no mental disorder
Remember with step 5, the PMHNP can use "other specified" in the diagnosis
when they want to indicate the specific reason for a diagnosis.
They use "unspecified" if:
the information doesnt conform to DSM5
there is insufficient info to make a specific diagnosis
there is more info the be revealed with time OR they want to help the patient
avoid stigmas
The PMHNP wants to rule out anemia as a cause for a patients fatigue and lack of
motivation. What lab should she order?
a CBC with iron studies
hg-12-18
hematocrit: 38-48%
What is normal creat/BUN level?
BUN: 7-18
creat: 0.6-1.2
A patient presents with brain fog, lack of focus, insomnia & mood swing, lack of
mental alertness. What lab should the PMHNP order?
THYROID FUNCTION TEST
TSH: 0.4-4.5
T3: 100-200
T4: 5-11
The patient has a b12 level of 126 picograms/mL. what symptoms may the patient
experience?
normal B12: 190-950 picograms/mL
but borderline is 200-300 & will need additional testing.
depression, mania, psychotic symptoms, cognitive impairment
Name the normal vitamin D levels:
20-50 ng/ML
Tell me about the HAM-A
This is the Hamilton Anxiety Scale, creates to assess somatic/cognitive anxiety
symptoms. MAINLY TO ASSESS ANXIETY. It does not help to assess the worry aspect
usually found with GAD.
less than 17- mild
, 18-23- mod
25-30 mod-severe
_____ shows there is an INCREASE activation of the amygdala which is an
increase in the fear response. There is a decreased activation of the pre-frontal
cortex which results in lessened reasoning.
Generalized Anxiety Disorder
Explain GAD
This is characterized when a person WORRY about ORDINARY, everyday situations.
These patients have a hard time getting over the what ifs and hyperfixate. Due to this
they are unable to get more of their pressing tasks done
What is the DSM criteria for GAD?
WORRY about everyday tasks, sleep disturbance, restlessness, fatigue and immanent
fear, muscle tension or difficulty concentrating has to be persistent for six months or
GREATER
Name the first line treatment for GAD.
SSRIs
What are some s/e of SSRIS?
hyponatremia, weight loss, weight gain, anxiety in the initial stages.
What is another adjunct treatment or PRN medication used as a treatment for
GAD?
Buspirone- This is an anxiolytic with decreased adverse effects & drug interactions. It
can take about 2-4 weeks to work and it is pretty weak however effective when used as
an adjunct.
What is the GAD-7 screening tool?
This is a rapid screening for the presence of clinically significant anxiety disorders such
as: GAD, Panic disorders, PTSD, & social phobias.
5-9- mild
10-14- moderate
over 15- severe & active treatment is warranted
Name the DSM for panic disorder
Panic disorder is a MARKED PERSISTENT reoccurimg panic attacks associated with
worry or concern of a negative outcome. These attacks are usually UNPROVOKED &
can happen in familiar places like home or school. The panic attacks can peak from 10-
20 minutes but some can last for hours.
1 month of worry after 1 panic attack
1 plus panic attack plus 4 of the somatic symptoms
Avoidant behavior/anticipatory anxiety for one month
What are some s/s that patients may complain of when having a panic attack or if
they are diagnosed with panic disorder?
Palpitations, feeling of choking, smothering sensation, nausea, abd stress,
derealization, dizziness, paresthesia, trembling
What is the first line treatment for Panic disorder?
SSRI plus CBT therapy
Tell me about agoraphobia
