NR547 MIDTERM EXAM QUESTIONS
AND ANSWERS
Differential44diagnosis44-44answer--The44provider's44initial44hypothesis
-
a44working44list44of44potential44problems44that44can44be44associated44with44the44initial44o
r44chief44complaint
-Diagnostic44and44Statistical44Manual44of44Mental44Disorders44(DSM-5-TR)
•44provides44guidance44for44identifying44psychiatric44diagnoses
Psychiatric44assessment:44History44taking44-44answer---History44of44Present44Illness
-How44long44have44you44been44feeling44this44way?
-Did44something44happen44in44your44life44that44may44have44triggered44these44emotions?
-How44is44this44current44situation44impacting44your44life?
The44Psychiatric44History
-Have44you44ever44been44hospitalized44for44any44mental44health44issues?
-Have44you44ever44had44counseling44or44psychotherapy?
-Have44you44ever44taken44medications44for44your44mental44health44in44the44past?
-Are44you44currently44on44any44medications44for44mental44health44or44sleep?
Medical44History/Screening44for44General44Medical44Conditions
-Do44you44have44a44primary44care44provider?
-Do44you44have44any44medical44illnesses?
-Are44you44currently44taking44any44medications44or44herbal44supplements?
-Do44you44have44any44allergies44to44medications?
-Have44you44ever44been44hospitalized44for44any44reason?
-Have44you44ever44had44surgery?
Family44Psychiatric44History
-Has44any44relative44of44yours44ever44been44hospitalized44for44a44mental44health44issue?
-
Has44any44blood44relative44of44yours44ever44been44diagnosed44with44a44mental44health44
issue?
,-
Has44any44blood44relative44of44yours44had44a44history44of44seizures44or44dementia/Alzhei
mer's?
Social44and44Developmental44History
-Tell44me44a44little44bit44about44your44childhood44and44how44you44grew44up.
-
How44was44your44experience44in44school44when44you44were44younger?44Did44you44enjo
y44school?
-How44do44you44support44yourself44with44your44finances?
-
Do44you44have44a44good44support44system?44Are44you44currently44in44a44relationship?44
Where44do44you44live?44Who44do44you44live44with?
-What44do44you44do44in44your44free44time?44What44activities44do44you44enjoy?
Screening44and44Psychiatric44Rating44Scales44-44answer--Evidence-
based44screening44tools44and44psychiatric44rating44scales
-
can44help44the44provider44identify44symptoms44and44assess44their44severity44and44can44
assist44with44the44evaluation44of44response44to44treatment
A4452-year-
old44client44presents44to44the44emergency44department44following44a44car44accident.44Th
e44emergency44department44(ED)44physician44is44concerned44that44the44client44may44ha
ve44intentionally44crashed44her44car44and44requests44a44stat44PMHNP44consult.44In44spe
aking44with44the44PMHNP,44the44client44describes44persistent44feelings44of44sadness44a
nd44hopelessness.44She44states44that44she44often44wonders44if44her44husband44would44
be44happier44if44she44wasn't44around44anymore44since44she's44never44happy44and44som
etimes44thinks44about44what44it44would44be44like44to44just44take44a44handful44of44sleeping
44pills44and44go44to44sleep44forever.44The44client44reports44a44previous44suicide44attempt
44when44she44was441644but44denies44that44she44is44considering44killing44herself44right44n
ow.
Based44on44the44client's44ASQ44score,44what44is44the44most44appropriate44response?
No44action44is44necessary44as44the44client44is44not44currently44considering44suicide.
Provide44a44brief44suicide44safety44assessment.44
Alert44the44client's44primary44care44physician.
Provide44a44ST44-44answer--Provide44a44brief44suicide44safety44assessment.44
Rationale:44While44the44client's44responses44do44not44indicate44a44need44for44a44stat44ful
l44safety44and44mental44health44evaluation,44the44client44requires44a44brief44suicide44safe
ty44assessment44to44determine44whether44a44full44mental44health44evaluation44in44neces
sary.44It44is44also44important44to44notify44the44client's44physician44or44the44clinician44resp
onsible44for44the44client's44care.
,Diagnostic44Testing44when44diagnosing44mental44health44disorders44-44answer---
Diagnostic44tests44and44labs44are44most44used44to44rule44out44physical44conditions44that
44may44cause44psychiatric44symptoms44and44to44evaluate44the44effects44of44treatment
Basic44Laboratory44Interpretation44-44answer--Complete44Blood44Count
Comprehensive44Metabolic44Panel44(CMP)
Thyroid44Function44Tests
Vitamin44B1244Level
Vitamin44D44Level
Toxicology44Screen
Urinalysis44(UA)
Basic44Laboratory44Interpretation:44Complete44Blood44Count44-44answer---
measures44RBCs,44WBCs,44hemoglobin,44hematocrit,44and44platelets
-includes44a44differential44of44the44WBCs
-
In44mental44health,44the44CBC44is44used44to44rule44out44medical44conditions44that44may4
4present44with44symptoms44that44can44be44attributed44to44both44medical44and44psychiatri
c44diagnoses
•44Ex:44rule44out44anemia44as44a44cause44for44depressive44symptoms44and44fatigue
•44Ex:44rule44out44infection44as44a44cause44of44acute44mental44status44changes
RBCs:444.5-6.044million/microliter
Hemoglobin:4412-1844grams/10044mL
Hematocrit:4438%-48%
Reticulocytes:440%-1.5%
WBCs44(total):445000-10,000/microliter
Neutrophils:4455%-70%
Eosinophils:441%-3%
Basophils:440.5%-1%
Lymphocytes:4420%-35%
Monocytes:443%-8%
Platelets:44150,000-300,000/microliter
Basic44Laboratory44Interpretation:44Comprehensive44Metabolic44Panel44(CMP)44-
44answer--common44blood44test44used44to44determine44general44health44status
-
fluid44and44electrolyte44balance,44status44of44the44body's44metabolism,44liver44function,44
and44kidney44function
-
used44to44monitor44the44effects44of44medications,44such44as44antipsychotics,44on44liver44f
unction44and44glucose44levels
-rule44out44medical44conditions44that44could44cause44symptoms
•44Ex:44changes44in44mood44or44cognition
Sodium44(Na+):44136-14544mEq/L
, Postassium44(K+):443.5-5.044mEq/L
Chloride44(Cl-):4495-10544mEq/L
Bicarbonate44(HCO3-):4422-2844mEq/L
Calcium,44serum44(Ca442+)448.4-10.244mg/dl
Glucose,44serum44Fasting:4470-11044mg/dl;442-h44postprandial:44<120mg/dl
Cholesterol,44serum:44REC<20044mg/dl
Total44Protein446.0-7.844g/dl
Albumin443.5-5.544g/dl
-Kidney44Tests
•44Creatinine,44serum440.6-1.2mg/dl
•44Urea44nitrogen,44serum44(BUN)447-18mg/dl
-Liver44Tests
•44Alanine44aminotransferase44(ALT),44serum:448-2044U/L
•44Aspartate44aminotransferase44(AST),44serum:448-2044U/L
•44Bilirubin,44serum44(adult)44Total//Direct:440.1-1.044mg/dl44//440.0-0.344mg/dl
•44Phosphatase44(alkaline),44serum:4420-7044U/L
Basic44Laboratory44Interpretation:44Thyroid44Function44Tests44(TFTs)44-44answer--
used44to44rule44out44thyroid44disorders44as44a44cause44for44symptoms
•44symptoms44related44to44thyroid44disorders44include44anxiety,44restlessness,44depressi
on,44mood44swings,44sleeping44difficulties,44difficulties44with44concentration,44short-
term44memory44lapses,44and44lack44of44mental44alertness
Normal44TFT44levels
TSH:440.4-4.544mIU/L
T3:44100-20044ng/dL
T4:445-1144ug/dL
Basic44Laboratory44Interpretation:44Vitamin44B1244Level44-44answer--
Deficiency44of44vitamin44B1244can44affect44mood44and44other44brain44functions
-
psychiatric44symptoms44associated44with44B1244deficiency44include44depression,44mani
a,44psychotic44symptoms,44and44cognitive44impairment
normal:44190-95044picograms/mL
•44200-
300/mL44indicates44a44borderline44level44with44a44possible44need44for44additional44testin
g
Basic44Laboratory44Interpretation:44Vitamin44D44Level44-44answer--
affects44functions44such44as44neurotransmission,44neuroprotection,44&44neuroimmunom
odulation
-
high44prevalence44of44vitamin44D44deficiency44in44clients44with44psychiatric44disorders44s
uch44as44schizophrenia,44depression,44seasonal44affective44disorder,44and44cognitive44i
mpairment
AND ANSWERS
Differential44diagnosis44-44answer--The44provider's44initial44hypothesis
-
a44working44list44of44potential44problems44that44can44be44associated44with44the44initial44o
r44chief44complaint
-Diagnostic44and44Statistical44Manual44of44Mental44Disorders44(DSM-5-TR)
•44provides44guidance44for44identifying44psychiatric44diagnoses
Psychiatric44assessment:44History44taking44-44answer---History44of44Present44Illness
-How44long44have44you44been44feeling44this44way?
-Did44something44happen44in44your44life44that44may44have44triggered44these44emotions?
-How44is44this44current44situation44impacting44your44life?
The44Psychiatric44History
-Have44you44ever44been44hospitalized44for44any44mental44health44issues?
-Have44you44ever44had44counseling44or44psychotherapy?
-Have44you44ever44taken44medications44for44your44mental44health44in44the44past?
-Are44you44currently44on44any44medications44for44mental44health44or44sleep?
Medical44History/Screening44for44General44Medical44Conditions
-Do44you44have44a44primary44care44provider?
-Do44you44have44any44medical44illnesses?
-Are44you44currently44taking44any44medications44or44herbal44supplements?
-Do44you44have44any44allergies44to44medications?
-Have44you44ever44been44hospitalized44for44any44reason?
-Have44you44ever44had44surgery?
Family44Psychiatric44History
-Has44any44relative44of44yours44ever44been44hospitalized44for44a44mental44health44issue?
-
Has44any44blood44relative44of44yours44ever44been44diagnosed44with44a44mental44health44
issue?
,-
Has44any44blood44relative44of44yours44had44a44history44of44seizures44or44dementia/Alzhei
mer's?
Social44and44Developmental44History
-Tell44me44a44little44bit44about44your44childhood44and44how44you44grew44up.
-
How44was44your44experience44in44school44when44you44were44younger?44Did44you44enjo
y44school?
-How44do44you44support44yourself44with44your44finances?
-
Do44you44have44a44good44support44system?44Are44you44currently44in44a44relationship?44
Where44do44you44live?44Who44do44you44live44with?
-What44do44you44do44in44your44free44time?44What44activities44do44you44enjoy?
Screening44and44Psychiatric44Rating44Scales44-44answer--Evidence-
based44screening44tools44and44psychiatric44rating44scales
-
can44help44the44provider44identify44symptoms44and44assess44their44severity44and44can44
assist44with44the44evaluation44of44response44to44treatment
A4452-year-
old44client44presents44to44the44emergency44department44following44a44car44accident.44Th
e44emergency44department44(ED)44physician44is44concerned44that44the44client44may44ha
ve44intentionally44crashed44her44car44and44requests44a44stat44PMHNP44consult.44In44spe
aking44with44the44PMHNP,44the44client44describes44persistent44feelings44of44sadness44a
nd44hopelessness.44She44states44that44she44often44wonders44if44her44husband44would44
be44happier44if44she44wasn't44around44anymore44since44she's44never44happy44and44som
etimes44thinks44about44what44it44would44be44like44to44just44take44a44handful44of44sleeping
44pills44and44go44to44sleep44forever.44The44client44reports44a44previous44suicide44attempt
44when44she44was441644but44denies44that44she44is44considering44killing44herself44right44n
ow.
Based44on44the44client's44ASQ44score,44what44is44the44most44appropriate44response?
No44action44is44necessary44as44the44client44is44not44currently44considering44suicide.
Provide44a44brief44suicide44safety44assessment.44
Alert44the44client's44primary44care44physician.
Provide44a44ST44-44answer--Provide44a44brief44suicide44safety44assessment.44
Rationale:44While44the44client's44responses44do44not44indicate44a44need44for44a44stat44ful
l44safety44and44mental44health44evaluation,44the44client44requires44a44brief44suicide44safe
ty44assessment44to44determine44whether44a44full44mental44health44evaluation44in44neces
sary.44It44is44also44important44to44notify44the44client's44physician44or44the44clinician44resp
onsible44for44the44client's44care.
,Diagnostic44Testing44when44diagnosing44mental44health44disorders44-44answer---
Diagnostic44tests44and44labs44are44most44used44to44rule44out44physical44conditions44that
44may44cause44psychiatric44symptoms44and44to44evaluate44the44effects44of44treatment
Basic44Laboratory44Interpretation44-44answer--Complete44Blood44Count
Comprehensive44Metabolic44Panel44(CMP)
Thyroid44Function44Tests
Vitamin44B1244Level
Vitamin44D44Level
Toxicology44Screen
Urinalysis44(UA)
Basic44Laboratory44Interpretation:44Complete44Blood44Count44-44answer---
measures44RBCs,44WBCs,44hemoglobin,44hematocrit,44and44platelets
-includes44a44differential44of44the44WBCs
-
In44mental44health,44the44CBC44is44used44to44rule44out44medical44conditions44that44may4
4present44with44symptoms44that44can44be44attributed44to44both44medical44and44psychiatri
c44diagnoses
•44Ex:44rule44out44anemia44as44a44cause44for44depressive44symptoms44and44fatigue
•44Ex:44rule44out44infection44as44a44cause44of44acute44mental44status44changes
RBCs:444.5-6.044million/microliter
Hemoglobin:4412-1844grams/10044mL
Hematocrit:4438%-48%
Reticulocytes:440%-1.5%
WBCs44(total):445000-10,000/microliter
Neutrophils:4455%-70%
Eosinophils:441%-3%
Basophils:440.5%-1%
Lymphocytes:4420%-35%
Monocytes:443%-8%
Platelets:44150,000-300,000/microliter
Basic44Laboratory44Interpretation:44Comprehensive44Metabolic44Panel44(CMP)44-
44answer--common44blood44test44used44to44determine44general44health44status
-
fluid44and44electrolyte44balance,44status44of44the44body's44metabolism,44liver44function,44
and44kidney44function
-
used44to44monitor44the44effects44of44medications,44such44as44antipsychotics,44on44liver44f
unction44and44glucose44levels
-rule44out44medical44conditions44that44could44cause44symptoms
•44Ex:44changes44in44mood44or44cognition
Sodium44(Na+):44136-14544mEq/L
, Postassium44(K+):443.5-5.044mEq/L
Chloride44(Cl-):4495-10544mEq/L
Bicarbonate44(HCO3-):4422-2844mEq/L
Calcium,44serum44(Ca442+)448.4-10.244mg/dl
Glucose,44serum44Fasting:4470-11044mg/dl;442-h44postprandial:44<120mg/dl
Cholesterol,44serum:44REC<20044mg/dl
Total44Protein446.0-7.844g/dl
Albumin443.5-5.544g/dl
-Kidney44Tests
•44Creatinine,44serum440.6-1.2mg/dl
•44Urea44nitrogen,44serum44(BUN)447-18mg/dl
-Liver44Tests
•44Alanine44aminotransferase44(ALT),44serum:448-2044U/L
•44Aspartate44aminotransferase44(AST),44serum:448-2044U/L
•44Bilirubin,44serum44(adult)44Total//Direct:440.1-1.044mg/dl44//440.0-0.344mg/dl
•44Phosphatase44(alkaline),44serum:4420-7044U/L
Basic44Laboratory44Interpretation:44Thyroid44Function44Tests44(TFTs)44-44answer--
used44to44rule44out44thyroid44disorders44as44a44cause44for44symptoms
•44symptoms44related44to44thyroid44disorders44include44anxiety,44restlessness,44depressi
on,44mood44swings,44sleeping44difficulties,44difficulties44with44concentration,44short-
term44memory44lapses,44and44lack44of44mental44alertness
Normal44TFT44levels
TSH:440.4-4.544mIU/L
T3:44100-20044ng/dL
T4:445-1144ug/dL
Basic44Laboratory44Interpretation:44Vitamin44B1244Level44-44answer--
Deficiency44of44vitamin44B1244can44affect44mood44and44other44brain44functions
-
psychiatric44symptoms44associated44with44B1244deficiency44include44depression,44mani
a,44psychotic44symptoms,44and44cognitive44impairment
normal:44190-95044picograms/mL
•44200-
300/mL44indicates44a44borderline44level44with44a44possible44need44for44additional44testin
g
Basic44Laboratory44Interpretation:44Vitamin44D44Level44-44answer--
affects44functions44such44as44neurotransmission,44neuroprotection,44&44neuroimmunom
odulation
-
high44prevalence44of44vitamin44D44deficiency44in44clients44with44psychiatric44disorders44s
uch44as44schizophrenia,44depression,44seasonal44affective44disorder,44and44cognitive44i
mpairment
