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Final Exam: NR 547/ NR547 (New 2025/ 2026 Update) Differential Diagnosis in Psychiatric-Me, Exams of Nursing

Indiana University Purdue University (IUPUI)Nursing

Final Exam: NR 547/ NR547 (New 2025/ 2026 Update) Differential Diagnosis in Psychiatric-Mental Health Review| Questions & Answers| Grade A| 100% Correct

Typology: Exams

2024/2025

Available from 06/23/2025

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FINAL EXAM: NR 547/ NR547 (NEW 2025/ 2026

UPDATE) DIFFERENTIAL DIAGNOSIS IN

PSYCHIATRIC-MENTAL HEALTH REVIEW|

QUESTIONS & ANSWERS| GRADE A| 100%

CORRECT

Differential diagnosis – ANSWER-The provider's

initial hypothesis

-a working list of potential problems that can be

associated with the initial or chief complaint

-Diagnostic and Statistical Manual of Mental Disorders

(DSM-5-TR)

• provides guidance for identifying psychiatric

diagnoses

Psychiatric assessment: History taking - ANSWER-

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?

Partial preview of the text

Download Final Exam: NR 547/ NR547 (New 2025/ 2026 Update) Differential Diagnosis in Psychiatric-Me and more Exams Nursing in PDF only on Docsity!

FINAL EXAM: NR 547/ NR547 (NEW 2025/ 202 6

UPDATE) DIFFERENTIAL DIAGNOSIS IN

PSYCHIATRIC-MENTAL HEALTH REVIEW|

QUESTIONS & ANSWERS| GRADE A| 100%

CORRECT

Differential diagnosis – ANSWER-The provider's initial hypothesis

a working list of potential problems that can be associated with the initial or chief complaint
Diagnostic and Statistical Manual of Mental Disorders (DSM- 5 - TR)
provides guidance for identifying psychiatric diagnoses Psychiatric assessment: History taking - ANSWER- 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?

Provide a ST – ANSWER-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. Diagnostic Testing when diagnosing mental health disorders - ANSWER-Diagnostic tests and labs are most used to rule out physical conditions that may cause psychiatric symptoms and to evaluate the effects of treatment Basic Laboratory Interpretation – ANSWER-Complete Blood Count Comprehensive Metabolic Panel (CMP) Thyroid Function Tests Vitamin B12 Level Vitamin D Level Toxicology Screen Urinalysis (UA) Basic Laboratory Interpretation: Complete Blood Count

ANSWER-measures RBCs, WBCs, haemoglobin, haematocrit, and platelets
includes a differential of the WBCs

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
Ex: rule out anaemia as a cause for depressive symptoms and fatigue
Ex: rule out infection as a cause of acute mental status changes RBCs: 4.5-6.0 million/microliter Haemoglobin: 12-18 grams/100 mL Haematocrit: 38%-48% Reticulocytes: 0%-1.5% WBCs (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 Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP) – ANSWER-common blood test used to determine general health status
fluid and electrolyte balance, status of the body's metabolism, liver function, and kidney function
used to monitor the effects of medications, such as antipsychotics, on liver function and glucose levels
rule out medical conditions that could cause symptoms
Ex: changes in mood or cognition

T3: 100-200 ng/dL T4: 5-11 ug/dL Basic Laboratory Interpretation: Vitamin B12 Level – ANSWER-Deficiency of vitamin B12 can affect mood and other brain functions

psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms, and cognitive impairment normal: 190 - 950 picograms/mL
200-300/mL indicates a borderline level with a possible need for additional testing Basic Laboratory Interpretation: Vitamin D Level – ANSWER-affects functions such as neurotransmission, neuroprotection, & neuroimmunomodulation
high prevalence of vitamin D deficiency in clients with psychiatric disorders such as schizophrenia, depression, seasonal affective disorder, and cognitive impairment
Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain development 25 - hydroxy vitamin D blood test: normal 20-50 ng/mL, less than 12 ng/mL indicates a deficiency Basic Laboratory Interpretation: Toxicology Screen - ANSWER-rule out substance use as a cause for symptoms

used before starting therapy involving controlled substances
used to monitor medication adherence
used in the diagnosis of substance use disorder Basic Laboratory Interpretation: Urinalysis (UA) – ANSWER-Urinary tract infections are associated with a variety of neuropsychiatric symptoms
acute mental status changes
UA may be used to rule out a UTI as the cause. Treat or Refer: Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L. – ANSWER- Refer Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with fatigue. A referral for treatment of hypothyroidism is required. Client can be re-evaluated for fatigue if symptoms persist after hypothyroid treatment has been initiated, TSH levels are within normal limits. Treat or Refer: Leo is a 4 9 - year-old who presents with fatigue. His haemoglobin is 15 g/dL and haematocrit is 42%. – ANSWER-Begin treatment Rationale: The haemoglobin and haematocrit are within normal limits. This client's complaint of fatigue is not

hyperthyroid treatment has been initiated and T3 levels are within normal limits. Treat or Refer: Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is 900 picograms/mL. – ANSWER- Begin treatment Rationale: The B12 level is within normal limits. Treatment for symptoms of psychosis should be initiated. Treat or Refer: Ted is a 64-year-old who presents with confusion. His serum creatinine is 7.0 mg/dL and BUN is 32. – ANSWER-Refer Rationale: Elevated serum creatinine and BUN indicate a problem with kidney function, which could contribute to confusion. Symptom-Directed Treatment – ANSWER- Psychiatric medication is generally prescribed in a transdiagnostic manner in which symptoms rather than diagnoses guide clinical practice Social Determinants of Health (SDOH) – ANSWER-the conditions in which individuals are "born, grow, live, work, and age" that contribute to the development of

both physical and psychiatric pathology over the course of one's life" SDOH: social and structural factors that impact mental health - ANSWER• Discrimination, racism, social exclusion

Adverse early life experiences
Poor education
Unemployment, underemployment, job insecurity
Poverty
Neighbourhood deprivation
Food insecurity
Poor housing quality and housing instability Legal and Ethical Considerations – ANSWER- Protecting the privacy and confidentiality of client records is a legal obligation and may help reassure the client The SNAPPS Method – ANSWER-Summarize the history and findings Narrow the differential dx to 2-3 possibilities analyse the differential by comparing & contrasting the possibilities Probe the preceptor by asking questions about alternative approaches or uncertainties

Developmental and social history Review of systems Mental status examination Physical examination Formulation DSM-5 diagnoses Treatment plan Psychiatric Review of Systems - ANSWERMood

Depression: Sadness, tearfulness, sleep, appetite, energy, concentration, sexual function, guilt, psychomotor agitation or slowing, interest. A common pneumonic used to remember the symptoms of major depression is SIGECAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor agitation or slowing, Suicidality).
Mania: Impulsivity, grandiosity, recklessness, excessive energy, decreased need for sleep, increased spending beyond means, talkativeness, racing thoughts, hypersexuality.
Mixed/Other: Irritability, liability. Anxiety
Generalized anxiety symptoms: Where, when, who, how long, how frequent.
Panic disorder symptoms: How long until peak, somatic symptoms including racing heart, sweating, shortness of breath, trouble swallowing, sense of doom, fear of recurrence, agoraphobia.

Obsessive-compulsive symptoms: Checking, cleaning, organizing, rituals, hang-ups, obsessive thinking, counting, rational vs. irrational beliefs.
Posttraumatic stress disorder: Nightmares, flashbacks, startle response, avoidance.
Social anxiety symptoms
Simple phobias, for example, heights, planes, spiders, etc. Psychosis
Hallucinations: Auditory, visual, olfactory, tactile.
Paranoia.
Delusions: TV, radio, thought broadcasting, mind control, referential thinking.
Patient's perception: Spiritual or cultural context of symptoms, reality testing. Other
Attention-deficit/hyperactivity disorder symptoms.
Eating disorder symptoms: Binging, purging, excessive exercising process of DSM-5 differential diagnosis - ANSWER1) ruling out Malingering and Factitious Disorder

ruling out a substance etiology
ruling out an etiological medical condition
determining the specific primary disorder(s)
differentiating Adjustment Disorder from the residual Other Specified and Unspecified conditions
establishing the boundary with no mental disorder

Drug therapy for at least 1 year first line medication treatment: Social anxiety disorder - ANSWER-Sertraline
Paroxetine
Drug therapy takes 4 weeks to see effects first line medication treatment: Post-traumatic stress disorder - ANSWER-Paroxetine
Sertraline Anxiety is often comorbid with _________________ as well as medical conditions such as ____________, ___________, and ___________ - ANSWERmajor depression, COPD, asthma, diabetes Generalized anxiety disorder (anxiety) - ANSWERneurological condition
characterized by persistent, uncontrollable worrying that causes emotional distress
show symptoms on most days, for a period of at least six months
common symptoms of anxiety include restlessness, irritability, muscle tension, fatigue, and sleep disturbances
GAD is twice as common in women as in men Patients with anxiety disorders often show increased activity in the ______________ and _______________
ANSWERamygdala and prefrontal cortex

Positron emission tomography (PET) scans have shown reduced ___________________ in patients with anxiety

ANSWERserotonin binding Risk factors for developing anxiety: - ANSWER- genetic predisposition (family history of anxiety)
being female
recent life stressors
chronic physical illness
lack of support during childhood Anxiety Disorders - ANSWERGeneralized Anxiety Disorder (GAD) Social Anxiety Disorder Panic Phobias Agoraphobia Adjustment Disorder with Anxiety GAD often presents with physical symptoms, including:
ANSWERrestlessness or edginess fatigue difficulty concentrating irritability muscle tension sleep disturbance Functional neuroimaging studies of GAD show: - ANSWERincreased activation of the amygdala and

derealization, or a feeling of "spacing out," may occur
Causes likely include a combination of genetic and environmental factors
past year: 7% of adults and 9% of adolescents
DSM- 5 - TR defines social anxiety disorder as an individual's fear of acting in a way that might cause judgment by others
anxiety is persistent, lasting greater than six months Usually, social anxiety disorder causes distress and anxiety in specific social situations such as: - ANSWER-making small talk with others
meeting new people
performing in front of others (called performance anxiety) Panic attack - ANSWERbrief episode of acute anxiety during which an individual develops an intense fear of negative outcomes accompanied by a feeling of imminent danger
can be unpredictable
feelings are often accompanied by physiological symptoms
symptoms typically peak within ten to twenty minutes, some may last for hours Symptoms of Panic Attacks: - ANSWER-Palpitations, pounding heart, or accelerated heart rate
Trembling or shaking
Paresthesias (numbness or tingling sensations)

Sensation of shortness of breath or smothering
Derealization (feelings of unreality) or depersonalization (feeling detached from oneself)
Feeling of choking
Feeling of chest pain or discomfort
Nausea or abdominal stress
Feeling dizzy, unsteady, light-headed or faint
Chills or heat sensations Panic disorder - ANSWERoccurs when a person experiences repeated panic attacks
Anxiety about future attacks may lead to behavioral changes
avoid situations that might trigger attacks Fabrizia is a 27-year-old graphic designer who presents to the clinic two months after an emergency department visit for complaints of chest pain, palpitations, nausea, and dizziness. Her electrocardiogram (ECG) and cardiac enzyme panels showed no abnormalities. She states that the symptoms began while she was watching a movie with her boyfriend and lasted about 15 minutes. She has never experienced anything like this in the past, but since the episode, she has worried occasionally about the symptoms recurring, as her father died of a heart attack at age 45. Based on the DSM- 5 - TR, does Fabrizia meet diagnostic criteria for panic disorder? - ANSWERNo

Final Exam: NR 547/ NR547 (New 2025/ 2026 Update) Differential Diagnosis in Psychiatric-Me, Exams of Nursing

Related documents

Partial preview of the text

Download Final Exam: NR 547/ NR547 (New 2025/ 2026 Update) Differential Diagnosis in Psychiatric-Me and more Exams Nursing in PDF only on Docsity!

FINAL EXAM: NR 547/ NR547 (NEW 2025/ 202 6

UPDATE) DIFFERENTIAL DIAGNOSIS IN

PSYCHIATRIC-MENTAL HEALTH REVIEW|

QUESTIONS & ANSWERS| GRADE A| 100%

CORRECT