4/12/25, 8:12 NR 547 Differential Dx Midterm |
PM
NR 547 DIFFERENTIAL DX MIDTERM EXAM
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED
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Terms in this set (187)
Diagnostic reasoning is the process of questioning one's thinking to determine if
all possible avenues have been explored and if the conclusions that are drawn
are based on evidence. This is a critical step for providers who are trying to
uncover a cause, or diagnosis, for their clients' signs and symptoms. The
provider's initial hypothesis is known as the differential diagnosis. The differential
diagnosis, or differential, is a working list of potential problems that can be
Differential Dx associated with the initial or chief complaint. Establishing a differential diagnosis
is a critical step in providing safe, quality care. This evolving process of clinical
reasoning and decision making involves examining the client's presentation,
clinical data, and when appropriate, screening and diagnostic test results to
distinguish one disease from another and arrive at the correct diagnosis. The
Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)provides
guidance for identifying psychiatric diagnosest
How long have you been feeling this way?
History of Present Illness Did something happen in your life that may have triggered these emotions?
How is this current situation impacting your life?
Have you ever been hospitalized for any mental health issues?
Have you ever had counseling or psychotherapy?
The Psychiatric History
Have you ever taken medications for your mental health in the past?
Are you currently on any medications for mental health or sleep?
Do you have a primary care provider?
Do you have any medical illnesses?
Medical History/Screening for General Are you currently taking any medications or herbal supplements?
Medical Conditions Do you have any allergies to medications?
Have you ever been hospitalized for any reason?
Have you ever had surgery?
Has any relative of yours ever been hospitalized for a mental health issue?
Has any blood relative of yours ever been diagnosed with a mental health issue?
Family Psychiatric History
Has any blood relative of yours had a history of seizures or
dementia/Alzheimer's?
Tell me a little bit about your childhood and how you grew up.
How was your experience in school when you were younger? Did you enjoy
school?
Social and Developmental History How do you support yourself with your finances?
Do you have a good support system? Are you currently in a relationship? Where
do you live? Who do you live with?
What do you do in your free time? What activities do you enjoy?
1/16
,4/12/25, 8:12 NR 547 Differential Dx Midterm |
PM
A) Explain how the medication targets the symptoms, specific benefits,
Which of the following should be and expected time course. (Correct answer)
included when providing client education B) Identify potential side effects, duration of side effects, and adverse
about medication regimens? Select all effects. (Correct answer)
that apply. C) Explain the instructions, dosing, and special requirements. (Correct answer)
D) Use teach-back methods to ensure client understanding. (Correct answer)
Apply the Ask Suicide-Screening B)Provide a brief suicide safety assessment.
Questions (ASQ) Suicide Risk Screening
Tool (Links to an external site.) to the Rationale: While the client's responses do not indicate a need for a stat full safety
scenario below. and mental health evaluation, the client requires a brief suicide safety
A 52-year-old client presents to the assessment to determine whether a full mental health evaluation in necessary. It
emergency department following a is also important to notify the client's physician or the clinician responsible for
car accident. The emergency the client's care.
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?
A) No action is necessary as the client
is not currently considering suicide.
B) Provide a brief
suicide safety assessment.
C) Alert the client's primary care
physician.
D) Provide a STAT safety and
full mental health evaluation.
The CBC is a serum diagnostic test that measures red blood cells, white blood
cells, hemoglobin, hematocrit, and platelets. The CBC includes a differential of the
white blood cells. A CBC is often included as part of routine health screening
or to obtain information related to specific conditions. In mental health, the CBC is
used to rule out medical conditions that may present with symptoms that can be
Complete Blood Count attributed to both medical and psychiatric diagnoses. For example, the CBC
can help rule out anemia as a cause for depressive symptoms and fatigue or rule
out infection as a cause of acute mental status changes. The CBC is also used
to monitor certain treatment regimens. For example, some medications, such as
clozapine, require routine analysis of absolute neutrophil count and platelet
levels.
Normal Range of: Red blood cells: 4.5-6.0 million/microliter
Red blood cells Hemoglobin: 12-18 grams/100 mL
Hemoglobin Hematocrit: 38%-48%
Hematocrit Reticulocytes: 0%-1.5%
Reticulocytes
2/16
, 4/12/25, 8:12 NR 547 Differential Dx Midterm |
PM
Normal Range of? White blood cells (total): 5000-10,000/microliter
White blood cells (total): Neutrophils: 55%-70%
Neutrophils: Eosinophils: 1%-3%
Eosinophils: Basophils: 0.5%-1%
Basophils: Lymphocytes: 20%-35%
Lymphocytes: Monocytes: 3%-8%
Monocytes: Platelets: 150,000-300,000/microliter
Platelets:
The CMP is another common blood test used to determine general health status.
The CMP includes several tests that provide information about fluid and
electrolyte balance as well as the status of the body's metabolism, liver function,
Comprehensive Metabolic Panel (CMP) and kidney function. In psychiatric care, the CMP may be used to rule out medical
conditions that could cause symptoms such as changes in mood or cognition. The
CMP is also used to monitor the effects of medications, such as antipsychotics, on
liver function and glucose levels.
Normal CMP Normal CMP
Levels Electrolytes Levels Electrolytes
Sodium (Na+): Sodium (Na+): 136-145 mEq/L
Postassium (K+): Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): Bicarbonate (HCO3-): 22-28 mEq/L
Normal CMP levels Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Misc. Glucose, serum Fasting: 70-110 mg/dl;
Calcium, serum (Ca 2+) 2-h postprandial: <120mg/dl
Glucose, serum Fasting: Cholesterol, serum: REC<200 mg/dl
2-h postprandial: Total Protein 6.0-7.8 g/dl
Cholesterol, serum: Albumin 3.5-5.5 g/dl
Total Protein
Albumin
Kidney Tests Creatinine, serum 0.6-1.2mg/dl
Creatinine, serum Urea nitrogen, serum (BUN) 7-18mg/dl
Urea nitrogen, serum (BUN)
Liver Tests Liver Tests
Alanine aminotransferase (ALT), serum: Alanine aminotransferase (ALT), serum: 8-20 U/L
Aspartate aminotransferase (AST), Aspartate aminotransferase (AST), serum: 8-20 U/L
Bilirubin, serum (adult) Total//Direct: Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl Phosphatase
Phosphatase (alkaline), serum: (alkaline), serum: 20-70 U/L
Normal TFT Normal TFT levels
levels TSH: TSH: 0.4-4.5 mIU/L
T3: T3: 100-200 ng/dL
T4: T4: 5-11 ug/dL
Providers may choose to check vitamin B12 levels. Deficiency of vitamin B12 can
affect mood and other brain functions. Common psychiatric symptoms associated
with B12 deficiency include depression, mania, psychotic symptoms, and
Vitamin B12 Level cognitive impairment (
A normal vitamin B12 level is between 190-950 picograms/mL. Between 200-
300/mL indicates a borderline level with a possible need for additional testing.
3/16
PM
NR 547 DIFFERENTIAL DX MIDTERM EXAM
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED
4.6 (5 reviews)
Save
Terms in this set (187)
Diagnostic reasoning is the process of questioning one's thinking to determine if
all possible avenues have been explored and if the conclusions that are drawn
are based on evidence. This is a critical step for providers who are trying to
uncover a cause, or diagnosis, for their clients' signs and symptoms. The
provider's initial hypothesis is known as the differential diagnosis. The differential
diagnosis, or differential, is a working list of potential problems that can be
Differential Dx associated with the initial or chief complaint. Establishing a differential diagnosis
is a critical step in providing safe, quality care. This evolving process of clinical
reasoning and decision making involves examining the client's presentation,
clinical data, and when appropriate, screening and diagnostic test results to
distinguish one disease from another and arrive at the correct diagnosis. The
Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)provides
guidance for identifying psychiatric diagnosest
How long have you been feeling this way?
History of Present Illness Did something happen in your life that may have triggered these emotions?
How is this current situation impacting your life?
Have you ever been hospitalized for any mental health issues?
Have you ever had counseling or psychotherapy?
The Psychiatric History
Have you ever taken medications for your mental health in the past?
Are you currently on any medications for mental health or sleep?
Do you have a primary care provider?
Do you have any medical illnesses?
Medical History/Screening for General Are you currently taking any medications or herbal supplements?
Medical Conditions Do you have any allergies to medications?
Have you ever been hospitalized for any reason?
Have you ever had surgery?
Has any relative of yours ever been hospitalized for a mental health issue?
Has any blood relative of yours ever been diagnosed with a mental health issue?
Family Psychiatric History
Has any blood relative of yours had a history of seizures or
dementia/Alzheimer's?
Tell me a little bit about your childhood and how you grew up.
How was your experience in school when you were younger? Did you enjoy
school?
Social and Developmental History How do you support yourself with your finances?
Do you have a good support system? Are you currently in a relationship? Where
do you live? Who do you live with?
What do you do in your free time? What activities do you enjoy?
1/16
,4/12/25, 8:12 NR 547 Differential Dx Midterm |
PM
A) Explain how the medication targets the symptoms, specific benefits,
Which of the following should be and expected time course. (Correct answer)
included when providing client education B) Identify potential side effects, duration of side effects, and adverse
about medication regimens? Select all effects. (Correct answer)
that apply. C) Explain the instructions, dosing, and special requirements. (Correct answer)
D) Use teach-back methods to ensure client understanding. (Correct answer)
Apply the Ask Suicide-Screening B)Provide a brief suicide safety assessment.
Questions (ASQ) Suicide Risk Screening
Tool (Links to an external site.) to the Rationale: While the client's responses do not indicate a need for a stat full safety
scenario below. and mental health evaluation, the client requires a brief suicide safety
A 52-year-old client presents to the assessment to determine whether a full mental health evaluation in necessary. It
emergency department following a is also important to notify the client's physician or the clinician responsible for
car accident. The emergency the client's care.
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?
A) No action is necessary as the client
is not currently considering suicide.
B) Provide a brief
suicide safety assessment.
C) Alert the client's primary care
physician.
D) Provide a STAT safety and
full mental health evaluation.
The CBC is a serum diagnostic test that measures red blood cells, white blood
cells, hemoglobin, hematocrit, and platelets. The CBC includes a differential of the
white blood cells. A CBC is often included as part of routine health screening
or to obtain information related to specific conditions. In mental health, the CBC is
used to rule out medical conditions that may present with symptoms that can be
Complete Blood Count attributed to both medical and psychiatric diagnoses. For example, the CBC
can help rule out anemia as a cause for depressive symptoms and fatigue or rule
out infection as a cause of acute mental status changes. The CBC is also used
to monitor certain treatment regimens. For example, some medications, such as
clozapine, require routine analysis of absolute neutrophil count and platelet
levels.
Normal Range of: Red blood cells: 4.5-6.0 million/microliter
Red blood cells Hemoglobin: 12-18 grams/100 mL
Hemoglobin Hematocrit: 38%-48%
Hematocrit Reticulocytes: 0%-1.5%
Reticulocytes
2/16
, 4/12/25, 8:12 NR 547 Differential Dx Midterm |
PM
Normal Range of? White blood cells (total): 5000-10,000/microliter
White blood cells (total): Neutrophils: 55%-70%
Neutrophils: Eosinophils: 1%-3%
Eosinophils: Basophils: 0.5%-1%
Basophils: Lymphocytes: 20%-35%
Lymphocytes: Monocytes: 3%-8%
Monocytes: Platelets: 150,000-300,000/microliter
Platelets:
The CMP is another common blood test used to determine general health status.
The CMP includes several tests that provide information about fluid and
electrolyte balance as well as the status of the body's metabolism, liver function,
Comprehensive Metabolic Panel (CMP) and kidney function. In psychiatric care, the CMP may be used to rule out medical
conditions that could cause symptoms such as changes in mood or cognition. The
CMP is also used to monitor the effects of medications, such as antipsychotics, on
liver function and glucose levels.
Normal CMP Normal CMP
Levels Electrolytes Levels Electrolytes
Sodium (Na+): Sodium (Na+): 136-145 mEq/L
Postassium (K+): Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): Bicarbonate (HCO3-): 22-28 mEq/L
Normal CMP levels Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Misc. Glucose, serum Fasting: 70-110 mg/dl;
Calcium, serum (Ca 2+) 2-h postprandial: <120mg/dl
Glucose, serum Fasting: Cholesterol, serum: REC<200 mg/dl
2-h postprandial: Total Protein 6.0-7.8 g/dl
Cholesterol, serum: Albumin 3.5-5.5 g/dl
Total Protein
Albumin
Kidney Tests Creatinine, serum 0.6-1.2mg/dl
Creatinine, serum Urea nitrogen, serum (BUN) 7-18mg/dl
Urea nitrogen, serum (BUN)
Liver Tests Liver Tests
Alanine aminotransferase (ALT), serum: Alanine aminotransferase (ALT), serum: 8-20 U/L
Aspartate aminotransferase (AST), Aspartate aminotransferase (AST), serum: 8-20 U/L
Bilirubin, serum (adult) Total//Direct: Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl Phosphatase
Phosphatase (alkaline), serum: (alkaline), serum: 20-70 U/L
Normal TFT Normal TFT levels
levels TSH: TSH: 0.4-4.5 mIU/L
T3: T3: 100-200 ng/dL
T4: T4: 5-11 ug/dL
Providers may choose to check vitamin B12 levels. Deficiency of vitamin B12 can
affect mood and other brain functions. Common psychiatric symptoms associated
with B12 deficiency include depression, mania, psychotic symptoms, and
Vitamin B12 Level cognitive impairment (
A normal vitamin B12 level is between 190-950 picograms/mL. Between 200-
300/mL indicates a borderline level with a possible need for additional testing.
3/16
