NR 547 Differential Dx Midterm 100%
Correct!!
Differential Dx - ANSWERDiagnostic 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
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
History of Present Illness - ANSWERHow long have you been feeling this way?
Did something happen in your life that may have triggered these emotions?
How is this current situation impacting your life?
The Psychiatric History - ANSWERHave 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 - ANSWERDo you have a primary care
provider?
Do you have any medical illnesses?
Are you currently taking any medications or herbal supplements?
Do you have any allergies to medications?
Have you ever been hospitalized for any reason?
Have you ever had surgery?
Family Psychiatric History - ANSWERHas 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?
Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
Social and Developmental History - ANSWERTell 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?
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?
Which of the following should be included when providing client education about medication
regimens? Select all that apply. - ANSWERA)Explain how the medication targets the symptoms,
specific benefits, and expected time course. (Correct answer)
B)Identify potential side effects, duration of side effects, and adverse effects. (Correct answer)
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 Questions (ASQ) Suicide Risk Screening Tool (Links to an external
site.) to the scenario below.
A 52-year-old client presents to the emergency department following a car accident. The emergency
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 - ANSWERB)Provide a brief suicide safety assessment.
Rationale: While the client's responses do not indicate a need for a stat full safety and mental health
evaluation, the client requires a brief suicide safety assessment to determine whether a full mental
health evaluation in necessary. It is also important to notify the client's physician or the clinician
responsible for the client's care.
Complete Blood Count - ANSWERThe 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 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
Hemoglobin
Hematocrit
Reticulocytes - ANSWERRed blood cells: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
Normal Range of?
White blood cells (total):
Neutrophils:
Eosinophils:
Basophils:
Lymphocytes:
Monocytes:
Platelets: - ANSWERWhite blood cells (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Comprehensive Metabolic Panel (CMP) - ANSWERThe 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, 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 Levels
Electrolytes
Sodium (Na+):
, Postassium (K+):
Chloride (Cl-):
Bicarbonate (HCO3-): - ANSWERNormal CMP Levels
Electrolytes
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): 22-28 mEq/L
Normal CMP levels
Misc.
Calcium, serum (Ca 2+)
Glucose, serum Fasting:
2-h postprandial:
Cholesterol, serum:
Total Protein
Albumin - ANSWERCalcium, serum (Ca 2+) 8.4-10.2 mg/dl
Glucose, serum Fasting: 70-110 mg/dl;
2-h postprandial: <120mg/dl
Cholesterol, serum: REC<200 mg/dl
Total Protein 6.0-7.8 g/dl
Albumin 3.5-5.5 g/dl
Kidney Tests
Creatinine, serum
Urea nitrogen, serum (BUN) - ANSWERCreatinine, serum 0.6-1.2mg/dl
Urea nitrogen, serum (BUN) 7-18mg/dl
Liver Tests
Alanine aminotransferase (ALT), serum:
Aspartate aminotransferase (AST),
Bilirubin, serum (adult) Total//Direct:
Phosphatase (alkaline), serum: - ANSWERLiver Tests
Alanine aminotransferase (ALT), serum: 8-20 U/L
