NR 547 Differential Dx Midterm
b b b b
Exam questions with correct answers
b b b b b
Diagnosticbreasoningbisbthebprocessbofbquestioningbone'sbthinkingbtobdeterminebifballbpossi
blebavenuesbhavebbeenbexploredbandbifbthebconclusionsbthatbarebdrawnbarebbasedbonbevid
ence.bThisbisbabcriticalbstepbforbprovidersbwhobarebtryingbtobuncoverbabcause,borbdiagnosis,bf
orbtheirbclients'bsignsbandbsymptoms.bThebprovider'sbinitialbhypothesisbisbknownbasbthebdiffe
rentialbdiagnosis.bThebdifferentialbdiagnosis,borbdifferential,bisbabworkingblistbofbpotentialbpro
blemsbthatbcanbbebassociatedbwithbthebinitialborbchiefbcomplaint.bEstablishingbabdifferentialb
diagnosisbisbabcriticalbstepbinbprovidingbsafe,bqualitybcare.bThisbevolvingbprocessbofbclinicalb
reasoningbandbdecisionbmakingbinvolvesbexaminingbthebclient'sbpresentation,bclinicalbdata,
bandbwhenbappropriate,bscreeningbandbdiagnosticbtestbresultsbtobdistinguishbonebdiseasebfr
ombanotherbandbarrivebatbthebcorrectbdiagnosis.bThebDiagnosticbandbStatisticalbManualbofb
MentalbDib-bDifferentialbDx
Howblongbhavebyoubbeenbfeelingbthisbway?
Didbsomethingbhappenbinbyourblifebthatbmaybhavebtriggeredbthesebemotions?
Howbisbthisbcurrentbsituationbimpactingbyourblife?b-bHistorybofbPresentbIllness
Havebyoubeverbbeenbhospitalizedbforbanybmentalbhealthbissues?
Havebyoubeverbhadbcounselingborbpsychotherapy?
Havebyoubeverbtakenbmedicationsbforbyourbmentalbhealthbinbthebpast?
Arebyoubcurrentlybonbanybmedicationsbforbmentalbhealthborbsleep?b-
bThebPsychiatricbHistory
Dobyoubhavebabprimarybcarebprovider?
Dobyoubhavebanybmedicalbillnesses?
Arebyoubcurrentlybtakingbanybmedicationsborbherbalbsupplements?
Dobyoubhavebanyballergiesbtobmedications?
Havebyoubeverbbeenbhospitalizedbforbanybreason?
Havebyoubeverbhadbsurgery?b-bMedicalbHistory/ScreeningbforbGeneralbMedicalbConditions
Hasbanybrelativebofbyoursbeverbbeenbhospitalizedbforbabmentalbhealthbissue?
Hasbanybbloodbrelativebofbyoursbeverbbeenbdiagnosedbwithbabmentalbhealthbissue?
Hasbanybbloodbrelativebofbyoursbhadbabhistorybofbseizuresborbdementia/Alzheimer's?b-
bFamilybPsychiatricbHistory
,Tellbmebablittlebbitbaboutbyourbchildhoodbandbhowbyoubgrewbup.
Howbwasbyourbexperiencebinbschoolbwhenbyoubwerebyounger?bDidbyoubenjoybschool?
Howbdobyoubsupportbyourselfbwithbyourbfinances?
Dobyoubhavebabgoodbsupportbsystem?bArebyoubcurrentlybinbabrelationship?bWherebdobyoubli
ve?bWhobdobyoublivebwith?
Whatbdobyoubdobinbyourbfreebtime?bWhatbactivitiesbdobyoubenjoy?b-
bSocialbandbDevelopmentalbHistory
A)Explainbhowbthebmedicationbtargetsbthebsymptoms,bspecificbbenefits,bandbexpectedbtime
bcourse.b(Correctbanswer)
B)Identifybpotentialbsidebeffects,bdurationbofbsidebeffects,bandbadversebeffects.b(Correctban
swer)
C)Explainbthebinstructions,bdosing,bandbspecialbrequirements.b(Correctbanswer)
D)Usebteach-backbmethodsbtobensurebclientbunderstanding.b(Correctbanswer)b-
bWhichbofbthebfollowingbshouldbbebincludedbwhenbprovidingbclientbeducationbaboutbmedicat
ionbregimens?bSelectballbthatbapply.
B)Providebabbriefbsuicidebsafetybassessment.b
Rationale:bWhilebthebclient'sbresponsesbdobnotbindicatebabneedbforbabstatbfullbsafetybandbme
ntalbhealthbevaluation,bthebclientbrequiresbabbriefbsuicidebsafetybassessmentbtobdetermineb
whetherbabfullbmentalbhealthbevaluationbinbnecessary.bItbisbalsobimportantbtobnotifybthebclient
'sbphysicianborbthebclinicianbresponsiblebforbthebclient'sbcare.b-bApplybthebAskbSuicide-
ScreeningbQuestionsb(ASQ)bSuicidebRiskbScreeningbToolb(Linksbtobanbexternalbsite.)btobth
ebscenariobbelow.
Ab52-year-
oldbclientbpresentsbtobthebemergencybdepartmentbfollowingbabcarbaccident.bThebemergenc
ybdepartmentb(ED)bphysicianbisbconcernedbthatbthebclientbmaybhavebintentionallybcrashedb
herbcarbandbrequestsbabstatbPMHNPbconsult.bInbspeakingbwithbthebPMHNP,bthebclientbdesc
ribesbpersistentbfeelingsbofbsadnessbandbhopelessness.bShebstatesbthatbsheboftenbwonder
sbifbherbhusbandbwouldbbebhappierbifbshebwasn'tbaroundbanymorebsincebshe'sbneverbhappyb
andbsometimesbthinksbaboutbwhatbitbwouldbbeblikebtobjustbtakebabhandfulbofbsleepingbpillsban
dbgobtobsleepbforever.bThebclientbreportsbabpreviousbsuicidebattemptbwhenbshebwasb16bbutb
deniesbthatbshebisbconsideringbkillingbherselfbrightbnow.
Basedbonbthebclient'sbASQbscore,bwhatbisbthebmostbappropriatebresponse?
A)bNobactionbisbnecessarybasbthebclientbisbnot
ThebCBCbisbabserumbdiagnosticbtestbthatbmeasuresbredbbloodbcells,bwhitebbloodbcells,bhem
oglobin,bhematocrit,bandbplatelets.bThebCBCbincludesbabdifferentialbofbthebwhitebbloodbcells
.b
,AbCBCbisboftenbincludedbasbpartbofbroutinebhealthbscreeningborbtobobtainbinformationbrelate
dbtobspecificbconditions.bInbmentalbhealth,bthebCBCbisbusedbtobruleboutbmedicalbconditionsbt
hatbmaybpresentbwithbsymptomsbthatbcanbbebattributedbtobbothbmedicalbandbpsychiatricbdia
gnoses.bForbexample,bthebCBCbcanbhelpbruleboutbanemiabasbabcausebforbdepressivebsympt
omsbandbfatigueborbruleboutbinfectionbasbabcausebofbacutebmentalbstatusbchanges.bThebCB
Cbisbalsobusedbtobmonitorbcertainbtreatmentbregimens.bForbexample,bsomebmedications,bsu
chbasbclozapine,brequirebroutinebanalysisbofbabsolutebneutrophilbcountbandbplateletblevels.b-
bCompletebBloodbCount
Redbbloodbcells:b4.5-6.0bmillion/microliter
Hemoglobin:b12-18bgrams/100bmL
Hematocrit:b38%-48%
Reticulocytes:b0%-1.5%b-bNormalbRangebof:b
Redbbloodbcells
Hemoglobin
Hematocrit
Reticulocytes
Whitebbloodbcellsb(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/microliterb-bNormalbRangebof?b
Whitebbloodbcellsb(total):b
Neutrophils:b
Eosinophils:b
Basophils:b
Lymphocytes:b
Monocytes:b
Platelets:
ThebCMPbisbanotherbcommonbbloodbtestbusedbtobdeterminebgeneralbhealthbstatus.bThebCM
Pbincludesbseveralbtestsbthatbprovidebinformationbaboutbfluidbandbelectrolytebbalancebasbwe
llbasbthebstatusbofbthebbody'sbmetabolism,bliverbfunction,bandbkidneybfunction.bInbpsychiatric
bcare,bthebCMPbmaybbebusedbtobruleboutbmedicalbconditionsbthatbcouldbcausebsymptomsbsu
chbasbchangesbinbmoodborbcognition.bThebCMPbisbalsobusedbtobmonitorbthebeffectsbofbmedic
ations,bsuchbasbantipsychotics,bonbliverbfunctionbandbglucoseblevels.b-
bComprehensivebMetabolicbPanelb(CMP)
, NormalbCMPbLevels
Electrolytes
Sodiumb(Na+):b136-145bmEq/L
Postassiumb(K+):b3.5-5.0bmEq/L
Chlorideb(Cl-):b95-105bmEq/L
Bicarbonateb(HCO3-):b22-28bmEq/Lb-bNormalbCMPbLevels
Electrolytes
Sodiumb(Na+):b
Postassiumb(K+):b
Chlorideb(Cl-):b
Bicarbonateb(HCO3-):
Calcium,bserumb(Cab2+)b8.4-10.2bmg/dl
Glucose,bserumbFasting:b70-110bmg/dl;
b2-hbpostprandial:b<120mg/dl
Cholesterol,bserum:bREC<200bmg/dl
TotalbProteinb6.0-7.8bg/dl
Albuminb3.5-5.5bg/dlb-bNormalbCMPblevels
Misc.b
Calcium,bserumb(Cab2+)b
Glucose,bserumbFasting:b
2-hbpostprandial:b
Cholesterol,bserum:
TotalbProtein
Albumin
Creatinine,bserumb0.6-1.2mg/dl
Ureabnitrogen,bserumb(BUN)b7-18mg/dlb-bKidneybTests
Creatinine,bserumb
Ureabnitrogen,bserumb(BUN)
LiverbTests
Alaninebaminotransferaseb(ALT),bserum:b8-20bU/L
Aspartatebaminotransferaseb(AST),bserum:b8-20bU/L
Bilirubin,bserumb(adult)bTotal//Direct:b0.1-1.0bmg/dlb//b0.0-0.3bmg/dl
Phosphataseb(alkaline),bserum:b20-70bU/Lb-bLiverbTests
Alaninebaminotransferaseb(ALT),bserum:b
Aspartatebaminotransferaseb(AST),b
Bilirubin,bserumb(adult)bTotal//Direct:b
b b b b
Exam questions with correct answers
b b b b b
Diagnosticbreasoningbisbthebprocessbofbquestioningbone'sbthinkingbtobdeterminebifballbpossi
blebavenuesbhavebbeenbexploredbandbifbthebconclusionsbthatbarebdrawnbarebbasedbonbevid
ence.bThisbisbabcriticalbstepbforbprovidersbwhobarebtryingbtobuncoverbabcause,borbdiagnosis,bf
orbtheirbclients'bsignsbandbsymptoms.bThebprovider'sbinitialbhypothesisbisbknownbasbthebdiffe
rentialbdiagnosis.bThebdifferentialbdiagnosis,borbdifferential,bisbabworkingblistbofbpotentialbpro
blemsbthatbcanbbebassociatedbwithbthebinitialborbchiefbcomplaint.bEstablishingbabdifferentialb
diagnosisbisbabcriticalbstepbinbprovidingbsafe,bqualitybcare.bThisbevolvingbprocessbofbclinicalb
reasoningbandbdecisionbmakingbinvolvesbexaminingbthebclient'sbpresentation,bclinicalbdata,
bandbwhenbappropriate,bscreeningbandbdiagnosticbtestbresultsbtobdistinguishbonebdiseasebfr
ombanotherbandbarrivebatbthebcorrectbdiagnosis.bThebDiagnosticbandbStatisticalbManualbofb
MentalbDib-bDifferentialbDx
Howblongbhavebyoubbeenbfeelingbthisbway?
Didbsomethingbhappenbinbyourblifebthatbmaybhavebtriggeredbthesebemotions?
Howbisbthisbcurrentbsituationbimpactingbyourblife?b-bHistorybofbPresentbIllness
Havebyoubeverbbeenbhospitalizedbforbanybmentalbhealthbissues?
Havebyoubeverbhadbcounselingborbpsychotherapy?
Havebyoubeverbtakenbmedicationsbforbyourbmentalbhealthbinbthebpast?
Arebyoubcurrentlybonbanybmedicationsbforbmentalbhealthborbsleep?b-
bThebPsychiatricbHistory
Dobyoubhavebabprimarybcarebprovider?
Dobyoubhavebanybmedicalbillnesses?
Arebyoubcurrentlybtakingbanybmedicationsborbherbalbsupplements?
Dobyoubhavebanyballergiesbtobmedications?
Havebyoubeverbbeenbhospitalizedbforbanybreason?
Havebyoubeverbhadbsurgery?b-bMedicalbHistory/ScreeningbforbGeneralbMedicalbConditions
Hasbanybrelativebofbyoursbeverbbeenbhospitalizedbforbabmentalbhealthbissue?
Hasbanybbloodbrelativebofbyoursbeverbbeenbdiagnosedbwithbabmentalbhealthbissue?
Hasbanybbloodbrelativebofbyoursbhadbabhistorybofbseizuresborbdementia/Alzheimer's?b-
bFamilybPsychiatricbHistory
,Tellbmebablittlebbitbaboutbyourbchildhoodbandbhowbyoubgrewbup.
Howbwasbyourbexperiencebinbschoolbwhenbyoubwerebyounger?bDidbyoubenjoybschool?
Howbdobyoubsupportbyourselfbwithbyourbfinances?
Dobyoubhavebabgoodbsupportbsystem?bArebyoubcurrentlybinbabrelationship?bWherebdobyoubli
ve?bWhobdobyoublivebwith?
Whatbdobyoubdobinbyourbfreebtime?bWhatbactivitiesbdobyoubenjoy?b-
bSocialbandbDevelopmentalbHistory
A)Explainbhowbthebmedicationbtargetsbthebsymptoms,bspecificbbenefits,bandbexpectedbtime
bcourse.b(Correctbanswer)
B)Identifybpotentialbsidebeffects,bdurationbofbsidebeffects,bandbadversebeffects.b(Correctban
swer)
C)Explainbthebinstructions,bdosing,bandbspecialbrequirements.b(Correctbanswer)
D)Usebteach-backbmethodsbtobensurebclientbunderstanding.b(Correctbanswer)b-
bWhichbofbthebfollowingbshouldbbebincludedbwhenbprovidingbclientbeducationbaboutbmedicat
ionbregimens?bSelectballbthatbapply.
B)Providebabbriefbsuicidebsafetybassessment.b
Rationale:bWhilebthebclient'sbresponsesbdobnotbindicatebabneedbforbabstatbfullbsafetybandbme
ntalbhealthbevaluation,bthebclientbrequiresbabbriefbsuicidebsafetybassessmentbtobdetermineb
whetherbabfullbmentalbhealthbevaluationbinbnecessary.bItbisbalsobimportantbtobnotifybthebclient
'sbphysicianborbthebclinicianbresponsiblebforbthebclient'sbcare.b-bApplybthebAskbSuicide-
ScreeningbQuestionsb(ASQ)bSuicidebRiskbScreeningbToolb(Linksbtobanbexternalbsite.)btobth
ebscenariobbelow.
Ab52-year-
oldbclientbpresentsbtobthebemergencybdepartmentbfollowingbabcarbaccident.bThebemergenc
ybdepartmentb(ED)bphysicianbisbconcernedbthatbthebclientbmaybhavebintentionallybcrashedb
herbcarbandbrequestsbabstatbPMHNPbconsult.bInbspeakingbwithbthebPMHNP,bthebclientbdesc
ribesbpersistentbfeelingsbofbsadnessbandbhopelessness.bShebstatesbthatbsheboftenbwonder
sbifbherbhusbandbwouldbbebhappierbifbshebwasn'tbaroundbanymorebsincebshe'sbneverbhappyb
andbsometimesbthinksbaboutbwhatbitbwouldbbeblikebtobjustbtakebabhandfulbofbsleepingbpillsban
dbgobtobsleepbforever.bThebclientbreportsbabpreviousbsuicidebattemptbwhenbshebwasb16bbutb
deniesbthatbshebisbconsideringbkillingbherselfbrightbnow.
Basedbonbthebclient'sbASQbscore,bwhatbisbthebmostbappropriatebresponse?
A)bNobactionbisbnecessarybasbthebclientbisbnot
ThebCBCbisbabserumbdiagnosticbtestbthatbmeasuresbredbbloodbcells,bwhitebbloodbcells,bhem
oglobin,bhematocrit,bandbplatelets.bThebCBCbincludesbabdifferentialbofbthebwhitebbloodbcells
.b
,AbCBCbisboftenbincludedbasbpartbofbroutinebhealthbscreeningborbtobobtainbinformationbrelate
dbtobspecificbconditions.bInbmentalbhealth,bthebCBCbisbusedbtobruleboutbmedicalbconditionsbt
hatbmaybpresentbwithbsymptomsbthatbcanbbebattributedbtobbothbmedicalbandbpsychiatricbdia
gnoses.bForbexample,bthebCBCbcanbhelpbruleboutbanemiabasbabcausebforbdepressivebsympt
omsbandbfatigueborbruleboutbinfectionbasbabcausebofbacutebmentalbstatusbchanges.bThebCB
Cbisbalsobusedbtobmonitorbcertainbtreatmentbregimens.bForbexample,bsomebmedications,bsu
chbasbclozapine,brequirebroutinebanalysisbofbabsolutebneutrophilbcountbandbplateletblevels.b-
bCompletebBloodbCount
Redbbloodbcells:b4.5-6.0bmillion/microliter
Hemoglobin:b12-18bgrams/100bmL
Hematocrit:b38%-48%
Reticulocytes:b0%-1.5%b-bNormalbRangebof:b
Redbbloodbcells
Hemoglobin
Hematocrit
Reticulocytes
Whitebbloodbcellsb(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/microliterb-bNormalbRangebof?b
Whitebbloodbcellsb(total):b
Neutrophils:b
Eosinophils:b
Basophils:b
Lymphocytes:b
Monocytes:b
Platelets:
ThebCMPbisbanotherbcommonbbloodbtestbusedbtobdeterminebgeneralbhealthbstatus.bThebCM
Pbincludesbseveralbtestsbthatbprovidebinformationbaboutbfluidbandbelectrolytebbalancebasbwe
llbasbthebstatusbofbthebbody'sbmetabolism,bliverbfunction,bandbkidneybfunction.bInbpsychiatric
bcare,bthebCMPbmaybbebusedbtobruleboutbmedicalbconditionsbthatbcouldbcausebsymptomsbsu
chbasbchangesbinbmoodborbcognition.bThebCMPbisbalsobusedbtobmonitorbthebeffectsbofbmedic
ations,bsuchbasbantipsychotics,bonbliverbfunctionbandbglucoseblevels.b-
bComprehensivebMetabolicbPanelb(CMP)
, NormalbCMPbLevels
Electrolytes
Sodiumb(Na+):b136-145bmEq/L
Postassiumb(K+):b3.5-5.0bmEq/L
Chlorideb(Cl-):b95-105bmEq/L
Bicarbonateb(HCO3-):b22-28bmEq/Lb-bNormalbCMPbLevels
Electrolytes
Sodiumb(Na+):b
Postassiumb(K+):b
Chlorideb(Cl-):b
Bicarbonateb(HCO3-):
Calcium,bserumb(Cab2+)b8.4-10.2bmg/dl
Glucose,bserumbFasting:b70-110bmg/dl;
b2-hbpostprandial:b<120mg/dl
Cholesterol,bserum:bREC<200bmg/dl
TotalbProteinb6.0-7.8bg/dl
Albuminb3.5-5.5bg/dlb-bNormalbCMPblevels
Misc.b
Calcium,bserumb(Cab2+)b
Glucose,bserumbFasting:b
2-hbpostprandial:b
Cholesterol,bserum:
TotalbProtein
Albumin
Creatinine,bserumb0.6-1.2mg/dl
Ureabnitrogen,bserumb(BUN)b7-18mg/dlb-bKidneybTests
Creatinine,bserumb
Ureabnitrogen,bserumb(BUN)
LiverbTests
Alaninebaminotransferaseb(ALT),bserum:b8-20bU/L
Aspartatebaminotransferaseb(AST),bserum:b8-20bU/L
Bilirubin,bserumb(adult)bTotal//Direct:b0.1-1.0bmg/dlb//b0.0-0.3bmg/dl
Phosphataseb(alkaline),bserum:b20-70bU/Lb-bLiverbTests
Alaninebaminotransferaseb(ALT),bserum:b
Aspartatebaminotransferaseb(AST),b
Bilirubin,bserumb(adult)bTotal//Direct:b
