Pmhnp exam with complete solution

Pmhnp exam with complete solution 1. Reflexes expected at 1 month: Moro until 4 months, Palmer until 4 months, Plantar util 8 months, Babinski (2 years is disease) 2. Signs of fetal alcohol syndrome: small head, shoey palpebral fissure, inner epicanthal folds. Do IEP and early intervention specialist 3. Rhett Syndrome: a rare disorder found virtually exclusively in girls, is a neu- rodevelopmental disorder in which the child usually develops normally unitl about 6 to 18 months of age at which characteristics of the syndrome emerge; character- istics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated head growth, and disinterest in play activities 4. EPS types: Tardive dyskinesia happen after years (eps is a precursor). Acute dystonia (hours), Parkinsons (weeks), Akathisia (days) 5. Where do EPS originate: nigrostiatal tract. 6. How does tegretol interact with cipro: cipro and erythromycin are inhibitors. Cause increased level of Tegretol. Black box warning 7. Tegretol side effects: Aplastic anemia, agranulocytosis, steven johnsons, hy- ponatremia. Watch with cipro and erythro 8. nuchal rigidity: stiffness in cervical neck area, meningitis 9. ACE inhibitors: -pril, CHF 10. signs of serotonin syndrome: -shivering -anxiety -diaphoresis -hyperthermia Shits and Shivers diarrhea, shivering, hyperreflexia/myoclonis, increased temperature, vital sign in- stability, encephalopathy, restlessness, sweating 11. Serotonin Discontinuation Syndrome: syndrome caused by abrupt with- drawal of an antidepressant drug, resulting in sensory disturbances, sleeping disturbances, disequilibrium, flu-like symptoms, dizzy, vertigo, paresthesia (brain zaps), nausea/vomiting, and gastrointestinal effects 12. NMS: neuroleptic malignant syndrome *S*evere fever *C*hanging LOC *A*utonomic instability *R*igidity *S*weating and drooling FEVERS- fever, encephalopathy, vitals instability, elevated white blood cell count/cpk, rigidity 13. 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 14. Risk factors for serotonin syndrome: more than 1 SSRI, st johns wart, tramadol, demerol, ultram, maperidone, 5HT 15. Grade 2/5 hoarse systolic heart murmur: aortic stenosis 16. Woman with GAD advise on medication: stop benzos because can cause floppy baby syndrome and cleft palate, cotinue buspar 17. What to give to agitated pt in seclusion: IM Geodon 18. Labs for macrocytic anemia: Folic acid, vitamin B12, ESR/CRP, HGB, MCV (liver) 19. When to assess a patient in restraints for face/face: 1 hour then 8 hours 20. therapeutic communication: open ended, 'tell me' 21. Reluctant/silent patient: open ended questions 22. Patients husband shows up but not the patient: both people need to be present, reschedule 23. Abnormal Trendelenburg Test: Hip disease, refer child out, assessed during head to toe 24. Hamilton Depression Scale: i. Severe 19- 23 (monitor for SI) ii. Moderate 14 - 18 iii. Mild 8 -13 0-7 normal 25. GAD-7 scale: More than 15 severe 26. HAM-A: Hamilton Anxiety Scale, most commonly used 14 domains, 14=mild, 18-24= moderate, 25-30=severe