NR 547 Differential Dx Midterm EXAM LATEST 2024 GRA
b b b b b b b b
DED A+ QUESTION AND ANSWER (CHAMBERLAIN UNIVE
b b b b b b
RSITY)
differentialbdiagnosisb-bANSWER:bThebprovider'sbinitialbhypothesis
-
abworkingblistbofbpotentialbproblemsbthatbcanbbebassociatedbwithbthebinitialborbchiefbco
mplaint
-DiagnosticbandbStatisticalbManualbofbMentalbDisordersb(DSM-5-TR)
•bprovidesbguidancebforbidentifyingbpsychiatricbdiagnoses
Psychiatricbassessment:bHistorybtakingb-bANSWER:b-HistorybofbPresentbIllness
-Howblongbhavebyoubbeenbfeelingbthisbway?
-Didbsomethingbhappenbinbyourblifebthatbmaybhavebtriggeredbthesebemotions?
-Howbisbthisbcurrentbsituationbimpactingbyourblife?
ThebPsychiatricbHistory
-Havebyoubeverbbeenbhospitalizedbforbanybmentalbhealthbissues?
-Havebyoubeverbhadbcounselingborbpsychotherapy?
-Havebyoubeverbtakenbmedicationsbforbyourbmentalbhealthbinbthebpast?
-Arebyoubcurrentlybonbanybmedicationsbforbmentalbhealthborbsleep?
MedicalbHistory/ScreeningbforbGeneralbMedicalbConditions
-Dobyoubhavebabprimarybcarebprovider?
-Dobyoubhavebanybmedicalbillnesses?
-Arebyoubcurrentlybtakingbanybmedicationsborbherbalbsupplements?
-Dobyoubhavebanyballergiesbtobmedications?
-Havebyoubeverbbeenbhospitalizedbforbanybreason?
-Havebyoubeverbhadbsurgery?
FamilybPsychiatricbHistory
-Hasbanybrelativebofbyoursbeverbbeenbhospitalizedbforbabmentalbhealthbissue?
-Hasbanybbloodbrelativebofbyoursbeverbbeenbdiagnosedbwithbabmentalbhealthbissue?
-Hasbanybbloodbrelativebofbyoursbhadbabhistorybofbseizuresborbdementia/Alzheimer's?
SocialbandbDevelopmentalbHistory
-Tellbmebablittlebbitbaboutbyourbchildhoodbandbhowbyoubgrewbup.
-Howbwasbyourbexperiencebinbschoolbwhenbyoubwerebyounger?bDidbyoubenjoybschool?
-Howbdobyoubsupportbyourselfbwithbyourbfinances?
-
Dobyoubhavebabgoodbsupportbsystem?bArebyoubcurrentlybinbabrelationship?bWherebdoby
oublive?bWhobdobyoublivebwith?
-Whatbdobyoubdobinbyourbfreebtime?bWhatbactivitiesbdobyoubenjoy?
ScreeningbandbPsychiatricbRatingbScalesb-bANSWER:bEvidence-
basedbscreeningbtoolsbandbpsychiatricbratingbscales
,-
canbhelpbthebproviderbidentifybsymptomsbandbassessbtheirbseveritybandbcanbassistbwithb
thebevaluationbofbresponsebtobtreatment
Ab52-year-
oldbclientbpresentsbtobthebemergencybdepartmentbfollowingbabcarbaccident.bThebemerg
encybdepartmentb(ED)bphysicianbisbconcernedbthatbthebclientbmaybhavebintentionallybc
rashedbherbcarbandbrequestsbabstatbPMHNPbconsult.bInbspeakingbwithbthebPMHNP,btheb
clientbdescribesbpersistentbfeelingsbofbsadnessbandbhopelessness.bShebstatesbthatbsheb
oftenbwondersbifbherbhusbandbwouldbbebhappierbifbshebwasn'tbaroundbanymorebsincebs
he'sbneverbhappybandbsometimesbthinksbaboutbwhatbitbwouldbbeblikebtobjustbtakebabhan
dfulbofbsleepingbpillsbandbgobtobsleepbforever.bThebclientbreportsbabpreviousbsuicidebatte
mptbwhenbshebwasb16bbutbdeniesbthatbshebisbconsideringbkillingbherselfbrightbnow.
Basedbonbthebclient'sbASQbscore,bwhatbisbthebmostbappropriatebresponse?
Nobactionbisbnecessarybasbthebclientbisbnotbcurrentlybconsideringbsuicide.
Providebabbriefbsuicidebsafetybassessment.b
Alertbthebclient'sbprimarybcarebphysician.
ProvidebabSTb-bANSWER:bProvidebabbriefbsuicidebsafetybassessment.b
Rationale:bWhilebthebclient'sbresponsesbdobnotbindicatebabneedbforbabstatbfullbsafetyban
dbmentalbhealthbevaluation,bthebclientbrequiresbabbriefbsuicidebsafetybassessmentbtobde
terminebwhetherbabfullbmentalbhealthbevaluationbinbnecessary.bItbisbalsobimportantbtobn
otifybthebclient'sbphysicianborbthebclinicianbresponsiblebforbthebclient'sbcare.
DiagnosticbTestingbwhenbdiagnosingbmentalbhealthbdisordersb-bANSWER:b-
Diagnosticbtestsbandblabsbarebmostbusedbtobruleboutbphysicalbconditionsbthatbmaybcaus
ebpsychiatricbsymptomsbandbtobevaluatebthebeffectsbofbtreatment
BasicbLaboratorybInterpretationb-bANSWER:bCompletebBloodbCount
ComprehensivebMetabolicbPanelb(CMP)
ThyroidbFunctionbTests
VitaminbB12bLevel
VitaminbDbLevel
ToxicologybScreen
Urinalysisb(UA)
BasicbLaboratorybInterpretation:bCompletebBloodbCountb-bANSWER:b-
measuresbRBCs,bWBCs,bhemoglobin,bhematocrit,bandbplatelets
-includesbabdifferentialbofbthebWBCs
-
Inbmentalbhealth,bthebCBCbisbusedbtobruleboutbmedicalbconditionsbthatbmaybpresentbwit
hbsymptomsbthatbcanbbebattributedbtobbothbmedicalbandbpsychiatricbdiagnoses
•bEx:bruleboutbanemiabasbabcausebforbdepressivebsymptomsbandbfatigue
•bEx:bruleboutbinfectionbasbabcausebofbacutebmentalbstatusbchanges
RBCs:b4.5-6.0bmillion/microliter
,Hemoglobin:b12-18bgrams/100bmL
Hematocrit:b38%-48%
Reticulocytes:b0%-1.5%
WBCsb(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
BasicbLaboratorybInterpretation:bComprehensivebMetabolicbPanelb(CMP)b-
bANSWER:bcommonbbloodbtestbusedbtobdeterminebgeneralbhealthbstatus
-
fluidbandbelectrolytebbalance,bstatusbofbthebbody'sbmetabolism,bliverbfunction,bandbkid
neybfunction
-
usedbtobmonitorbthebeffectsbofbmedications,bsuchbasbantipsychotics,bonbliverbfunctionba
ndbglucoseblevels
-ruleboutbmedicalbconditionsbthatbcouldbcausebsymptoms
•bEx:bchangesbinbmoodborbcognition
Sodiumb(Na+):b136-145bmEq/L
Postassiumb(K+):b3.5-5.0bmEq/L
Chlorideb(Cl-):b95-105bmEq/L
Bicarbonateb(HCO3-):b22-28bmEq/L
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/dl
-KidneybTests
•bCreatinine,bserumb0.6-1.2mg/dl
•bUreabnitrogen,bserumb(BUN)b7-18mg/dl
-LiverbTests
•bAlaninebaminotransferaseb(ALT),bserum:b8-20bU/L
•bAspartatebaminotransferaseb(AST),bserum:b8-20bU/L
•bBilirubin,bserumb(adult)bTotal//Direct:b0.1-1.0bmg/dlb//b0.0-0.3bmg/dl
•bPhosphataseb(alkaline),bserum:b20-70bU/L
BasicbLaboratorybInterpretation:bThyroidbFunctionbTestsb(TFTs)b-
bANSWER:busedbtobruleboutbthyroidbdisordersbasbabcausebforbsymptoms
•bsymptomsbrelatedbtobthyroidbdisordersbincludebanxiety,brestlessness,bdepression,bm
oodbswings,bsleepingbdifficulties,bdifficultiesbwithbconcentration,bshort-
termbmemoryblapses,bandblackbofbmentalbalertness
NormalbTFTblevels
, TSH:b0.4-4.5bmIU/L
T3:b100-200bng/dL
T4:b5-11bug/dL
BasicbLaboratorybInterpretation:bVitaminbB12bLevelb-
bANSWER:bDeficiencybofbvitaminbB12bcanbaffectbmoodbandbotherbbrainbfunctions
-
psychiatricbsymptomsbassociatedbwithbB12bdeficiencybincludebdepression,bmania,bpsyc
hoticbsymptoms,bandbcognitivebimpairment
normal:b190-950bpicograms/mL
•b200-300/mLbindicatesbabborderlineblevelbwithbabpossiblebneedbforbadditionalbtesting
BasicbLaboratorybInterpretation:bVitaminbDbLevelb-
bANSWER:baffectsbfunctionsbsuchbasbneurotransmission,bneuroprotection,b&bneuroim
munomodulation
-
highbprevalencebofbvitaminbDbdeficiencybinbclientsbwithbpsychiatricbdisordersbsuchbasbsc
hizophrenia,bdepression,bseasonalbaffectivebdisorder,bandbcognitivebimpairment
-
SymptomsbofbvitaminbDbdeficiencybincludebdepression,birritability,banxiety,bpsychosis,b
andbpoorbbrainbdevelopment
25-hydroxybvitaminbDbbloodbtest:bnormalb20-
50bng/mL,blessbthanb12bng/mLbindicatesbabdeficiency
BasicbLaboratorybInterpretation:bToxicologybScreenb-bANSWER:b-
ruleboutbsubstancebusebasbabcausebforbsymptoms
-usedbbeforebstartingbtherapybinvolvingbcontrolledbsubstances
-usedbtobmonitorbmedicationbadherence
-usedbinbthebdiagnosisbofbsubstancebusebdisorder
BasicbLaboratorybInterpretation:bUrinalysisb(UA)b-
bANSWER:bUrinarybtractbinfectionsbarebassociatedbwithbabvarietybofbneuropsychiatricbsy
mptoms
-acutebmentalbstatusbchanges
•bUAbmaybbebusedbtobruleboutbabUTIbasbthebcause.
TreatborbRefer:
Tonibisbab58-year-oldbwhobpresentsbwithbfatigue.bHerbTSHbisb6.3bmIU/L.b-
bANSWER:bRefer
Rationale:bAbTSHblevelb>4.0bisbindicativebofbhypothyroidism,bwhichbisbassociatedbwithbf
atigue.bAbreferralbforbtreatmentbofbhypothyroidismbisbrequired.bClientbcanbbebreevalua
tedbforbfatiguebifbsymptomsbpersistbafterbhypothyroidbtreatmentbhasbbeenbinitiated,bTS
Hblevelsbarebwithinbnormalblimits.
b b b b b b b b
DED A+ QUESTION AND ANSWER (CHAMBERLAIN UNIVE
b b b b b b
RSITY)
differentialbdiagnosisb-bANSWER:bThebprovider'sbinitialbhypothesis
-
abworkingblistbofbpotentialbproblemsbthatbcanbbebassociatedbwithbthebinitialborbchiefbco
mplaint
-DiagnosticbandbStatisticalbManualbofbMentalbDisordersb(DSM-5-TR)
•bprovidesbguidancebforbidentifyingbpsychiatricbdiagnoses
Psychiatricbassessment:bHistorybtakingb-bANSWER:b-HistorybofbPresentbIllness
-Howblongbhavebyoubbeenbfeelingbthisbway?
-Didbsomethingbhappenbinbyourblifebthatbmaybhavebtriggeredbthesebemotions?
-Howbisbthisbcurrentbsituationbimpactingbyourblife?
ThebPsychiatricbHistory
-Havebyoubeverbbeenbhospitalizedbforbanybmentalbhealthbissues?
-Havebyoubeverbhadbcounselingborbpsychotherapy?
-Havebyoubeverbtakenbmedicationsbforbyourbmentalbhealthbinbthebpast?
-Arebyoubcurrentlybonbanybmedicationsbforbmentalbhealthborbsleep?
MedicalbHistory/ScreeningbforbGeneralbMedicalbConditions
-Dobyoubhavebabprimarybcarebprovider?
-Dobyoubhavebanybmedicalbillnesses?
-Arebyoubcurrentlybtakingbanybmedicationsborbherbalbsupplements?
-Dobyoubhavebanyballergiesbtobmedications?
-Havebyoubeverbbeenbhospitalizedbforbanybreason?
-Havebyoubeverbhadbsurgery?
FamilybPsychiatricbHistory
-Hasbanybrelativebofbyoursbeverbbeenbhospitalizedbforbabmentalbhealthbissue?
-Hasbanybbloodbrelativebofbyoursbeverbbeenbdiagnosedbwithbabmentalbhealthbissue?
-Hasbanybbloodbrelativebofbyoursbhadbabhistorybofbseizuresborbdementia/Alzheimer's?
SocialbandbDevelopmentalbHistory
-Tellbmebablittlebbitbaboutbyourbchildhoodbandbhowbyoubgrewbup.
-Howbwasbyourbexperiencebinbschoolbwhenbyoubwerebyounger?bDidbyoubenjoybschool?
-Howbdobyoubsupportbyourselfbwithbyourbfinances?
-
Dobyoubhavebabgoodbsupportbsystem?bArebyoubcurrentlybinbabrelationship?bWherebdoby
oublive?bWhobdobyoublivebwith?
-Whatbdobyoubdobinbyourbfreebtime?bWhatbactivitiesbdobyoubenjoy?
ScreeningbandbPsychiatricbRatingbScalesb-bANSWER:bEvidence-
basedbscreeningbtoolsbandbpsychiatricbratingbscales
,-
canbhelpbthebproviderbidentifybsymptomsbandbassessbtheirbseveritybandbcanbassistbwithb
thebevaluationbofbresponsebtobtreatment
Ab52-year-
oldbclientbpresentsbtobthebemergencybdepartmentbfollowingbabcarbaccident.bThebemerg
encybdepartmentb(ED)bphysicianbisbconcernedbthatbthebclientbmaybhavebintentionallybc
rashedbherbcarbandbrequestsbabstatbPMHNPbconsult.bInbspeakingbwithbthebPMHNP,btheb
clientbdescribesbpersistentbfeelingsbofbsadnessbandbhopelessness.bShebstatesbthatbsheb
oftenbwondersbifbherbhusbandbwouldbbebhappierbifbshebwasn'tbaroundbanymorebsincebs
he'sbneverbhappybandbsometimesbthinksbaboutbwhatbitbwouldbbeblikebtobjustbtakebabhan
dfulbofbsleepingbpillsbandbgobtobsleepbforever.bThebclientbreportsbabpreviousbsuicidebatte
mptbwhenbshebwasb16bbutbdeniesbthatbshebisbconsideringbkillingbherselfbrightbnow.
Basedbonbthebclient'sbASQbscore,bwhatbisbthebmostbappropriatebresponse?
Nobactionbisbnecessarybasbthebclientbisbnotbcurrentlybconsideringbsuicide.
Providebabbriefbsuicidebsafetybassessment.b
Alertbthebclient'sbprimarybcarebphysician.
ProvidebabSTb-bANSWER:bProvidebabbriefbsuicidebsafetybassessment.b
Rationale:bWhilebthebclient'sbresponsesbdobnotbindicatebabneedbforbabstatbfullbsafetyban
dbmentalbhealthbevaluation,bthebclientbrequiresbabbriefbsuicidebsafetybassessmentbtobde
terminebwhetherbabfullbmentalbhealthbevaluationbinbnecessary.bItbisbalsobimportantbtobn
otifybthebclient'sbphysicianborbthebclinicianbresponsiblebforbthebclient'sbcare.
DiagnosticbTestingbwhenbdiagnosingbmentalbhealthbdisordersb-bANSWER:b-
Diagnosticbtestsbandblabsbarebmostbusedbtobruleboutbphysicalbconditionsbthatbmaybcaus
ebpsychiatricbsymptomsbandbtobevaluatebthebeffectsbofbtreatment
BasicbLaboratorybInterpretationb-bANSWER:bCompletebBloodbCount
ComprehensivebMetabolicbPanelb(CMP)
ThyroidbFunctionbTests
VitaminbB12bLevel
VitaminbDbLevel
ToxicologybScreen
Urinalysisb(UA)
BasicbLaboratorybInterpretation:bCompletebBloodbCountb-bANSWER:b-
measuresbRBCs,bWBCs,bhemoglobin,bhematocrit,bandbplatelets
-includesbabdifferentialbofbthebWBCs
-
Inbmentalbhealth,bthebCBCbisbusedbtobruleboutbmedicalbconditionsbthatbmaybpresentbwit
hbsymptomsbthatbcanbbebattributedbtobbothbmedicalbandbpsychiatricbdiagnoses
•bEx:bruleboutbanemiabasbabcausebforbdepressivebsymptomsbandbfatigue
•bEx:bruleboutbinfectionbasbabcausebofbacutebmentalbstatusbchanges
RBCs:b4.5-6.0bmillion/microliter
,Hemoglobin:b12-18bgrams/100bmL
Hematocrit:b38%-48%
Reticulocytes:b0%-1.5%
WBCsb(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
BasicbLaboratorybInterpretation:bComprehensivebMetabolicbPanelb(CMP)b-
bANSWER:bcommonbbloodbtestbusedbtobdeterminebgeneralbhealthbstatus
-
fluidbandbelectrolytebbalance,bstatusbofbthebbody'sbmetabolism,bliverbfunction,bandbkid
neybfunction
-
usedbtobmonitorbthebeffectsbofbmedications,bsuchbasbantipsychotics,bonbliverbfunctionba
ndbglucoseblevels
-ruleboutbmedicalbconditionsbthatbcouldbcausebsymptoms
•bEx:bchangesbinbmoodborbcognition
Sodiumb(Na+):b136-145bmEq/L
Postassiumb(K+):b3.5-5.0bmEq/L
Chlorideb(Cl-):b95-105bmEq/L
Bicarbonateb(HCO3-):b22-28bmEq/L
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/dl
-KidneybTests
•bCreatinine,bserumb0.6-1.2mg/dl
•bUreabnitrogen,bserumb(BUN)b7-18mg/dl
-LiverbTests
•bAlaninebaminotransferaseb(ALT),bserum:b8-20bU/L
•bAspartatebaminotransferaseb(AST),bserum:b8-20bU/L
•bBilirubin,bserumb(adult)bTotal//Direct:b0.1-1.0bmg/dlb//b0.0-0.3bmg/dl
•bPhosphataseb(alkaline),bserum:b20-70bU/L
BasicbLaboratorybInterpretation:bThyroidbFunctionbTestsb(TFTs)b-
bANSWER:busedbtobruleboutbthyroidbdisordersbasbabcausebforbsymptoms
•bsymptomsbrelatedbtobthyroidbdisordersbincludebanxiety,brestlessness,bdepression,bm
oodbswings,bsleepingbdifficulties,bdifficultiesbwithbconcentration,bshort-
termbmemoryblapses,bandblackbofbmentalbalertness
NormalbTFTblevels
, TSH:b0.4-4.5bmIU/L
T3:b100-200bng/dL
T4:b5-11bug/dL
BasicbLaboratorybInterpretation:bVitaminbB12bLevelb-
bANSWER:bDeficiencybofbvitaminbB12bcanbaffectbmoodbandbotherbbrainbfunctions
-
psychiatricbsymptomsbassociatedbwithbB12bdeficiencybincludebdepression,bmania,bpsyc
hoticbsymptoms,bandbcognitivebimpairment
normal:b190-950bpicograms/mL
•b200-300/mLbindicatesbabborderlineblevelbwithbabpossiblebneedbforbadditionalbtesting
BasicbLaboratorybInterpretation:bVitaminbDbLevelb-
bANSWER:baffectsbfunctionsbsuchbasbneurotransmission,bneuroprotection,b&bneuroim
munomodulation
-
highbprevalencebofbvitaminbDbdeficiencybinbclientsbwithbpsychiatricbdisordersbsuchbasbsc
hizophrenia,bdepression,bseasonalbaffectivebdisorder,bandbcognitivebimpairment
-
SymptomsbofbvitaminbDbdeficiencybincludebdepression,birritability,banxiety,bpsychosis,b
andbpoorbbrainbdevelopment
25-hydroxybvitaminbDbbloodbtest:bnormalb20-
50bng/mL,blessbthanb12bng/mLbindicatesbabdeficiency
BasicbLaboratorybInterpretation:bToxicologybScreenb-bANSWER:b-
ruleboutbsubstancebusebasbabcausebforbsymptoms
-usedbbeforebstartingbtherapybinvolvingbcontrolledbsubstances
-usedbtobmonitorbmedicationbadherence
-usedbinbthebdiagnosisbofbsubstancebusebdisorder
BasicbLaboratorybInterpretation:bUrinalysisb(UA)b-
bANSWER:bUrinarybtractbinfectionsbarebassociatedbwithbabvarietybofbneuropsychiatricbsy
mptoms
-acutebmentalbstatusbchanges
•bUAbmaybbebusedbtobruleboutbabUTIbasbthebcause.
TreatborbRefer:
Tonibisbab58-year-oldbwhobpresentsbwithbfatigue.bHerbTSHbisb6.3bmIU/L.b-
bANSWER:bRefer
Rationale:bAbTSHblevelb>4.0bisbindicativebofbhypothyroidism,bwhichbisbassociatedbwithbf
atigue.bAbreferralbforbtreatmentbofbhypothyroidismbisbrequired.bClientbcanbbebreevalua
tedbforbfatiguebifbsymptomsbpersistbafterbhypothyroidbtreatmentbhasbbeenbinitiated,bTS
Hblevelsbarebwithinbnormalblimits.
