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NR 547 Differential Dx Midterm Exam Questions and Answers
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NR 547 Differential Dx Midterm ExamQuestions and Answers
Differential Dx - -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 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 - -How 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 - -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 - -Do 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 - -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?
Has any blood relative of yours had a history of seizures or
dementia/Alzheimer's?
, -Social and Developmental History - -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?
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. - -A)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 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. - -B)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 - -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 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 - -Red 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: - -White 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) - -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, 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-): - -Normal 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 - -Calcium, 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) - -Creatinine, 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: - -Liver Tests
Alanine aminotransferase (ALT), serum: 8-20 U/L
Aspartate aminotransferase (AST), serum: 8-20 U/L
Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
Phosphatase (alkaline), serum: 20-70 U/L
-Normal TFT levels
TSH:
T3:
T4: - -Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
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