NR-547 MIDTERM QUESTIONS AND
ANSWERS
Name44the44644of44a44differential44diagnosis44-44answer--
1.)44RULE44OUT44Malingering44or44Factitous44disorder
2.)Ruling44out44substance44etiology
3.)44ruling44out44a44medical44etiology
4.)44Determining44the44specific44primary44disorder
5.)44Differentiating44adjustment44disorder44from44the44residual44"other44specified"44and44
"unspecified"44conditions
6.)44Establishing44the44boundary44with44no44mental44disorder
Remember44with44step445,44the44PMHNP44can44use44"other44specified"44in44the44diagno
sis44when44they44want44to44indicate44the44specific44reason44for44a44diagnosis.
They44use44"unspecified"44if:
the44information44doesnt44conform44to44DSM5
there44is44insufficient44info44to44make44a44specific44diagnosis
there44is44more44info44the44be44revealed44with44time44OR44they44want44to44help44the44pa
tient44avoid44stigmas44-44answer--
The44PMHNP44wants44to44rule44out44anemia44as44a44cause44for44a44patients44fatigue44a
nd44lack44of44motivation.44What44lab44should44she44order?44-44answer--
a44CBC44with44iron44studies
hg-12-18
hematocrit:4438-48%
What44is44normal44creat/BUN44level?44-44answer--BUN:447-18
creat:440.6-1.2
A44patient44presents44with44brain44fog,44lack44of44focus,44insomnia44&44mood44swing,44la
ck44of44mental44alertness.44What44lab44should44the44PMHNP44order?44-44answer--
THYROID44FUNCTION44TEST
TSH:440.4-4.5
, T3:44100-200
T4:445-11
The44patient44has44a44b1244level44of4412644picograms/
mL.44what44symptoms44may44the44patient44experience?44-44answer--normal44B12:44190-
95044picograms/mL
but44borderline44is44200-30044&44will44need44additional44testing.
depression,44mania,44psychotic44symptoms,44cognitive44impairment
Name44the44normal44vitamin44D44levels:44-44answer--20-5044ng/ML
Tell44me44about44the44HAM-A44-44answer--
This44is44the44Hamilton44Anxiety44Scale,44creates44to44assess44somatic/
cognitive44anxiety44symptoms.44MAINLY44TO44ASSESS44ANXIETY.44It44does44not44hel
p44to44assess44the44worry44aspect44usually44found44with44GAD.
less44than4417-44mild
18-23-44mod
25-3044mod-severe
_____44shows44there44is44an44INCREASE44activation44of44the44amygdala44which44is44an
44increase44in44the44fear44response.44There44is44a44decreased44activation44of44the44pre-
frontal44cortex44which44results44in44lessened44reasoning.44-44answer--
Generalized44Anxiety44Disorder
Explain44GAD44-44answer--
This44is44characterized44when44a44person44WORRY44about44ORDINARY,44everyday44sit
uations.44These44patients44have44a44hard44time44getting44over44the44what44ifs44and44hyp
erfixate.44Due44to44this44they44are44unable44to44get44more44of44their44pressing44tasks44d
one
What44is44the44DSM44criteria44for44GAD?44-44answer--
WORRY44about44everyday44tasks,44sleep44disturbance,44restlessness,44fatigue44and44i
mmanent44fear,44muscle44tension44or44difficulty44concentrating44has44to44be44persistent4
4for44six44months44or44GREATER
Name44the44first44line44treatment44for44GAD.44-44answer--SSRIs
What44are44some44s/e44of44SSRIS?44-44answer--
hyponatremia,44weight44loss,44weight44gain,44anxiety44in44the44initial44stages.
What44is44another44adjunct44treatment44or44PRN44medication44used44as44a44treatment44f
or44GAD?44-44answer--Buspirone-
44This44is44an44anxiolytic44with44decreased44adverse44effects44&44drug44interactions.44It4
4can44take44about442-
ANSWERS
Name44the44644of44a44differential44diagnosis44-44answer--
1.)44RULE44OUT44Malingering44or44Factitous44disorder
2.)Ruling44out44substance44etiology
3.)44ruling44out44a44medical44etiology
4.)44Determining44the44specific44primary44disorder
5.)44Differentiating44adjustment44disorder44from44the44residual44"other44specified"44and44
"unspecified"44conditions
6.)44Establishing44the44boundary44with44no44mental44disorder
Remember44with44step445,44the44PMHNP44can44use44"other44specified"44in44the44diagno
sis44when44they44want44to44indicate44the44specific44reason44for44a44diagnosis.
They44use44"unspecified"44if:
the44information44doesnt44conform44to44DSM5
there44is44insufficient44info44to44make44a44specific44diagnosis
there44is44more44info44the44be44revealed44with44time44OR44they44want44to44help44the44pa
tient44avoid44stigmas44-44answer--
The44PMHNP44wants44to44rule44out44anemia44as44a44cause44for44a44patients44fatigue44a
nd44lack44of44motivation.44What44lab44should44she44order?44-44answer--
a44CBC44with44iron44studies
hg-12-18
hematocrit:4438-48%
What44is44normal44creat/BUN44level?44-44answer--BUN:447-18
creat:440.6-1.2
A44patient44presents44with44brain44fog,44lack44of44focus,44insomnia44&44mood44swing,44la
ck44of44mental44alertness.44What44lab44should44the44PMHNP44order?44-44answer--
THYROID44FUNCTION44TEST
TSH:440.4-4.5
, T3:44100-200
T4:445-11
The44patient44has44a44b1244level44of4412644picograms/
mL.44what44symptoms44may44the44patient44experience?44-44answer--normal44B12:44190-
95044picograms/mL
but44borderline44is44200-30044&44will44need44additional44testing.
depression,44mania,44psychotic44symptoms,44cognitive44impairment
Name44the44normal44vitamin44D44levels:44-44answer--20-5044ng/ML
Tell44me44about44the44HAM-A44-44answer--
This44is44the44Hamilton44Anxiety44Scale,44creates44to44assess44somatic/
cognitive44anxiety44symptoms.44MAINLY44TO44ASSESS44ANXIETY.44It44does44not44hel
p44to44assess44the44worry44aspect44usually44found44with44GAD.
less44than4417-44mild
18-23-44mod
25-3044mod-severe
_____44shows44there44is44an44INCREASE44activation44of44the44amygdala44which44is44an
44increase44in44the44fear44response.44There44is44a44decreased44activation44of44the44pre-
frontal44cortex44which44results44in44lessened44reasoning.44-44answer--
Generalized44Anxiety44Disorder
Explain44GAD44-44answer--
This44is44characterized44when44a44person44WORRY44about44ORDINARY,44everyday44sit
uations.44These44patients44have44a44hard44time44getting44over44the44what44ifs44and44hyp
erfixate.44Due44to44this44they44are44unable44to44get44more44of44their44pressing44tasks44d
one
What44is44the44DSM44criteria44for44GAD?44-44answer--
WORRY44about44everyday44tasks,44sleep44disturbance,44restlessness,44fatigue44and44i
mmanent44fear,44muscle44tension44or44difficulty44concentrating44has44to44be44persistent4
4for44six44months44or44GREATER
Name44the44first44line44treatment44for44GAD.44-44answer--SSRIs
What44are44some44s/e44of44SSRIS?44-44answer--
hyponatremia,44weight44loss,44weight44gain,44anxiety44in44the44initial44stages.
What44is44another44adjunct44treatment44or44PRN44medication44used44as44a44treatment44f
or44GAD?44-44answer--Buspirone-
44This44is44an44anxiolytic44with44decreased44adverse44effects44&44drug44interactions.44It4
4can44take44about442-
