Download NR 547 DIFFERENTIAL DX MIDTERM EXAM 2025-2026|WITH 187 QS AND AS|A+PASS and more Exams Nursing in PDF only on Docsity!
NR 547 DIFFERENTIAL DX MIDTERM EXAM 2025-
2026|WITH 187 QS AND AS|A+PASS
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?
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 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
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
Normal TFT levels TSH: 0.4-4.5 mIU/L T3: 100-200 ng/dL T4: 5-11 ug/dL Vitamin B12 Level Providers may choose to check vitamin B12 levels. Deficiency of vitamin B12 can affect mood and other brain functions. Common psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms, and cognitive impairment ( A normal vitamin B12 level is between 190-950 picograms/mL. Between 200-300/mL indicates a borderline level with a possible need for additional testing. Vitamin D Level Vitamin D affects functions such as neurotransmission, neuroprotection, and neuroimmunomodulation. Studies have indicated a high prevalence of vitamin D deficiency in clients with psychiatric disorders such as schizophrenia, depression, seasonal affective disorder, and cognitive impairment (Cuomo et al., 2019).
Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain development. A vitamin D level can be measured via the 25-hydroxy vitamin D blood test. A normal level is between 20-50 ng/mL. A level less than 12 ng/mL indicates a deficiency. Toxicology Screen When diagnosing psychiatric conditions, providers may use toxicology screenings to rule out substance use as a cause for symptoms. Toxicology screenings are also used before starting therapy involving controlled substances, to monitor medication adherence, and in the diagnosis of substance use disorder. Urinalysis (UA) Urinary tract infections are associated with a variety of neuropsychiatric symptoms (Lee et al., 2019). When clients present with acute mental status changes, a urinalysis may be used to rule out a urinary tract infection as the cause. Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L.
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 B) Refer 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 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 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 A) Begin Treatment B) Refer B) Refer Rationale: Elevated serum creatinine and BUN indicate a problem with kidney function, which could contribute to confusion. Social Determinants of Health (SDOH) 1: Discrimination, racism, social exclusion 2: Adverse early life experiences
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 What is the most common mental illness in the US? And what percentage does it affect adult and children? Anxiety disorders are the most common mental illness in the United States. Anxiety impacts approximately 18% of the adult population and 25% of children ages 13-17 each year (Anxiety & Depression Association of America [ADAA], n.d.). People who experience anxiety have a higher incidence of work and school absenteeism and higher use of medical resources, such as emergency department and provider visits than the general population First line of Tx for Generalized anxiety disorder? SSRIs SNRIs
Buspirone Drug Therapy at least 12 months First line of Tx for Panic Disorder? Paroxetine Sertraline Fluoxetine Drug therapy 6-9 months First line of Tx for Obsessive compulsive disorder Fluoxetine Fluvoxamine Sertraline Paroxetine Clomipramine (TCA) Drug therapy for at least 1 year First line of Tx for Social anxiety disorder Sertraline
- Fears
- Insomnia
- Intellectual
- Depressed mood
- somatic (muscular)
- Somatic (sensory)
- cardiovascular symptoms
- Respiratory symptoms
- gastrointestinal symptoms
- Genitourinary symptoms
- Autonomic symptoms
- Behavior at interview Anxiety is usually comorbid with? Depression, COPD, asthma, and diabetes Pt's with GAD show persistent, uncontrollable worrying that causes emotional distress and show symptoms on most days for a period of how long? 6 months
Pt's with anxiety often show increase activity in where? Amygdala and prefrontal cortex Positron emission tomography (PET) scans show reduced what in pt's with anxiety? Reduced serotonin binding What are risk factors for developing anxiety?
- family Hx
- being female
- recent life stressors
- chronic physical illness
- lack of support during childhood Increased brain activity in prefrontal cortex is a sign of? Anxiety
