NEW NR 547 DIFFERENTIAL DX MIDTERM EXAM
WITH RATIONALES AND Q&A TESTED AND
APPROVED!!!
Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL and
hematocrit is 42%.
A) Begin Treatment
B) Refer -- ANSWER--A) Begin treatment.
Rationale: The hemoglobin and hematocrit are within normal limits. This
client's complaint of fatigue is not due to anemia. Begin treatment based on a
complete evaluation.
Terri is a 79-year old who presents with confusion. She has positive urine
leukocyte esterase.
A) Begin treatment
B) Refer -- ANSWER--B)Refer
Rationale: A positive Urine Leukocyte Esterase indicates the presence of a
urinary tract infection (UTI) , which may cause confusion. Refer this client for
treatment of the UTI.
Julio is a 66-year-old who presents with depression. His vitamin D level 11
ng/mL.
A) Begin Treatment
Page 1 of 60
,B) Refer -- ANSWER--B) Refer
Rationale: Vitamin D deficiency is associated with depressive symptoms. The
PMHNP may refer or treat vitamin D deficiency depending on the level of
comfort of the provider.
Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL.
A) Begin Treatment
B) Refer -- ANSWER--B) Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels.
Hyperthyroidism is associated with anxiety symptoms. Client can be
reevaluated for anxiety once hyperthyroid treatment has been initiated and T3
levels are within normal limits.
Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is 900
picograms/mL.
A) Begin Treatment
B) Refer -- ANSWER--A) Begin treatment
Rationale: The B12 level is within normal limits. Treatment for symptoms of
psychosis should be initiated.
Ted is a 64-year-old who presents with confusion. His serum creatinine is 7.0
mg/dL and
BUN is 32
Page 2 of 60
,A) Begin Treatment
B) Refer -- ANSWER--B) Refer
Rationale: Elevated serum creatinine and BUN indicate a problem with kidney
function, which could contribute to confusion.
Social Determinants of Health (SDOH) -- ANSWER--1: Discrimination,
racism, social exclusion
2: Adverse early life experiences
3: Poor education
4: Unemployment, underemployment, job insecurity
5: Poverty
6: Neighborhood deprivation
7: Food insecurity
8: Poor housing quality and housing instability
Holistic Care: Culture, Values, and Health Beliefs -- ANSWER--Holistic
approaches to mental health care consider all aspects of the individual, not just
the symptoms and diagnosis. A holistic approach not only addresses psychiatric
and medical considerations, it recognizes that social, spiritual, lifestyle, and
behavioral elements also impact mental health. Psychiatric symptoms may be
secondary to environmental factors or life events. Clients' culture, values, and
health beliefs may affect how mental health diagnoses are manifest or described
and may impact treatment choices. Healing and rehabilitation are most likely to
Page 3 of 60
, occur when providers address client needs holistically and involve clients in
treatment planning.
A commonly used method is the "SNAPPS" method, which follows a
mnemonic consisting of six steps. This method is often used for client
presentations to preceptors. The six steps includ -- ANSWER--1.Summarize the
history and findings
2.Narrow the differential diagnosis to two or three possibilities
3.Analyze the differential by comparing and contrasting the possibilities
4.Probe the preceptor by asking questions about alternative approaches or
uncertainties
5.Plan the management of the client's health issues
6.Select an issue from the case for self-directed learning
The Psychiatric History -- ANSWER--Have you ever been hospitalized for any
mental health issues?
Have you ever had counseling or psychotherapy?
Have you ever taken medications for your mental health in the past?
Are you currently on any medications for mental health or sleep?
Medical History/Screening for General Medical Conditions -- ANSWER--Do
you have a primary care provider?
Do you have any medical illnesses?
Page 4 of 60
WITH RATIONALES AND Q&A TESTED AND
APPROVED!!!
Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL and
hematocrit is 42%.
A) Begin Treatment
B) Refer -- ANSWER--A) Begin treatment.
Rationale: The hemoglobin and hematocrit are within normal limits. This
client's complaint of fatigue is not due to anemia. Begin treatment based on a
complete evaluation.
Terri is a 79-year old who presents with confusion. She has positive urine
leukocyte esterase.
A) Begin treatment
B) Refer -- ANSWER--B)Refer
Rationale: A positive Urine Leukocyte Esterase indicates the presence of a
urinary tract infection (UTI) , which may cause confusion. Refer this client for
treatment of the UTI.
Julio is a 66-year-old who presents with depression. His vitamin D level 11
ng/mL.
A) Begin Treatment
Page 1 of 60
,B) Refer -- ANSWER--B) Refer
Rationale: Vitamin D deficiency is associated with depressive symptoms. The
PMHNP may refer or treat vitamin D deficiency depending on the level of
comfort of the provider.
Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL.
A) Begin Treatment
B) Refer -- ANSWER--B) Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels.
Hyperthyroidism is associated with anxiety symptoms. Client can be
reevaluated for anxiety once hyperthyroid treatment has been initiated and T3
levels are within normal limits.
Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is 900
picograms/mL.
A) Begin Treatment
B) Refer -- ANSWER--A) Begin treatment
Rationale: The B12 level is within normal limits. Treatment for symptoms of
psychosis should be initiated.
Ted is a 64-year-old who presents with confusion. His serum creatinine is 7.0
mg/dL and
BUN is 32
Page 2 of 60
,A) Begin Treatment
B) Refer -- ANSWER--B) Refer
Rationale: Elevated serum creatinine and BUN indicate a problem with kidney
function, which could contribute to confusion.
Social Determinants of Health (SDOH) -- ANSWER--1: Discrimination,
racism, social exclusion
2: Adverse early life experiences
3: Poor education
4: Unemployment, underemployment, job insecurity
5: Poverty
6: Neighborhood deprivation
7: Food insecurity
8: Poor housing quality and housing instability
Holistic Care: Culture, Values, and Health Beliefs -- ANSWER--Holistic
approaches to mental health care consider all aspects of the individual, not just
the symptoms and diagnosis. A holistic approach not only addresses psychiatric
and medical considerations, it recognizes that social, spiritual, lifestyle, and
behavioral elements also impact mental health. Psychiatric symptoms may be
secondary to environmental factors or life events. Clients' culture, values, and
health beliefs may affect how mental health diagnoses are manifest or described
and may impact treatment choices. Healing and rehabilitation are most likely to
Page 3 of 60
, occur when providers address client needs holistically and involve clients in
treatment planning.
A commonly used method is the "SNAPPS" method, which follows a
mnemonic consisting of six steps. This method is often used for client
presentations to preceptors. The six steps includ -- ANSWER--1.Summarize the
history and findings
2.Narrow the differential diagnosis to two or three possibilities
3.Analyze the differential by comparing and contrasting the possibilities
4.Probe the preceptor by asking questions about alternative approaches or
uncertainties
5.Plan the management of the client's health issues
6.Select an issue from the case for self-directed learning
The Psychiatric History -- ANSWER--Have you ever been hospitalized for any
mental health issues?
Have you ever had counseling or psychotherapy?
Have you ever taken medications for your mental health in the past?
Are you currently on any medications for mental health or sleep?
Medical History/Screening for General Medical Conditions -- ANSWER--Do
you have a primary care provider?
Do you have any medical illnesses?
Page 4 of 60
