Pmhnp Question with complete solution 2023

Pmhnp Question with complete solution 2023Reflexes expected at 1 month Moro until 4 months, Palmer until 4 months, Plantar util 8 months, Babinski (2 years is disease) Signs of fetal alcohol syndrome small head, shoey palpebral fissure, inner epicanthal folds. Do IEP and early intervention specialist Rhett Syndrome a rare disorder found virtually exclusively in girls, is a neurodevelopmental disorder in which the child usually develops normally unitl about 6 to 18 months of age at which characteristics of the syndrome emerge; characteristics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated head growth, and disinterest in play activities EPS types Tardive dyskinesia happen after years (eps is a precursor). Acute dystonia (hours), Parkinsons (weeks), Akathisia (days) Where do EPS originate nigrostiatal tract. How does tegretol interact with cipro cipro and erythromycin are inhibitors. Cause increased level of Tegretol. Black box warning Tegretol side effects Aplastic anemia, agranulocytosis, steven johnsons, hyponatremia. Watch with cipro and erythro nuchal rigidity stiffness in cervical neck area, meningitis ACE inhibitors -pril, CHF signs of serotonin syndrome -shivering -anxiety -diaphoresis -hyperthermia Shits and Shivers diarrhea, shivering, hyperreflexia/myoclonis, increased temperature, vital sign instability, encephalopathy, restlessness, sweating Serotonin Discontinuation Syndrome syndrome caused by abrupt withdrawal of an antidepressant drug, resulting in sensory disturbances, sleeping disturbances, disequilibrium, flu-like symptoms, dizzy, vertigo, paresthesia (brain zaps), nausea/vomiting, and gastrointestinal effects NMS neuroleptic malignant syndrome Severe fever Changing LOC Autonomic instability Rigidity Sweating and drooling FEVERS- fever, encephalopathy, vitals instability, elevated white blood cell count/cpk, rigidity Levels of Prevention Primary: prevent/promotion, classes, safety initiatives, education, classes, modifying environment Secondary: screen-early detection, crisis hotlines, disaster Tertiary: treat- to prevent further deterioration, rehab, restoration, day treatment, social skills Risk factors for serotonin syndrome more than 1 SSRI, st johns wart, tramadol, demerol, ultram, maperidone, 5HT Grade 2/5 hoarse systolic heart murmur aortic stenosis Woman with GAD advise on medication stop benzos because can cause floppy baby syndrome and cleft palate, cotinue buspar What to give to agitated pt in seclusion IM Geodon Labs for macrocytic anemia Folic acid, vitamin B12, ESR/CRP, HGB, MCV (liver) When to assess a patient in restraints for face/face 1 hour then 8 hours therapeutic communication open ended, 'tell me' Reluctant/silent patient open ended questions Patients husband shows up but not the patient both people need to be present, reschedule Abnormal Trendelenburg Test Hip disease, refer child out, assessed during head to toe Hamilton Depression Scale i. Severe 19- 23 (monitor for SI) ii. Moderate 14 - 18 iii. Mild 8 -13 0-7 normal GAD-7 scale More than 15 severe HAM-A Hamilton Anxiety Scale, most commonly used 14 domains, 14=mild, 18-24= moderate, 25-30=severe Anxiety 25/15 severe Scope of practice comes from the state, board of nursing/american nurse association Elderly patient with dementia how do you know id can give consent Able to repeat back risks and benefits elements= nature/pupose of tx, risks/benefits of tx, risks/benefits not doing tx, alternatives, diagnosis/prognosis Patient moving states, what do you do with medication? send enough medication is standard of practice just culture refers to an organization's commitment to accountability and a focus supporting universal safety in health care. Find out the error ad where went wrong 2 classes of medications that should not be used together? Ace inhibitors and ARBs together Keeping chronically mentally ill in the community? ACT model Law that makes sure people with mental health issues get the same financial treatment? Parity Laws Brother sexually abusing sister make sure that he is not left alone with her and call CPS, mandatory reporter, arrange crisis therapy Kleinfelter's Syndrome male with more than one X chromosome (XXY), little to no sperm, fertility treatment clozaril wbc+anc If less than 950 discontinue the medication and get a repeat level, 1000 is the cutoff 1.5-2 cbc biweekly 1-1.5 hold, cbc q dayx 3 weeks less than 1- Stop medication 12.5initial, target 300-900mg/d once or bid schizophenrenia/pscyhosis agranulocytosis, seizures, myocarditis (inflammed heart muscle -chest pain,diff breath) wg, increase lipids/glucose REMS pharmacy need clozaril registry to dispense to start: WBC must be >_3500 and ANC >_2000 WBC + ANC weekly q6months, then every 2w q6months, then monthly Labs for rheumatoid arthritis . ESR erythrocyte sedimentation rate elevation. Synovial fluid analysis. X ray of joints. Rheumatoid factor titer, CRP, Hgb PTSD nightmares prazosin