The PMNP is evaluating a patient who is being treated for obsessive compulsive disorder with fluoxetine 60 mg daily. The patient has been on fluoxetine for months without any concerning adverse effects, but today the patient reports that for the past few weeks she has had a distinct sense of agitation, racing heart, nausea, and has been really clumsy. Suspecting serotonin syndrome, the NP assess for:

A. New onset delusional thought

B. Constipation

C. Irritability

D. Recent use of OTC cough medicine

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YouTube: https://www.youtube.com/watch?v=VcyTSz7d4M4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=76

The PMHNP is on call at the residential treatment facility and is called to urgently see a patient being treated for methamphetamine use disorder. The patient was admitted earlier this day and being and was still being assessed for appropriate psychotherapy and medication needs. Facility staff was performing routine observation rounds and found the patient unresponsive. You arrive at the bedside and find the patient to be unresponsive, with a blood pressure of 78/50 mm Hg and a respiratory rate of 7 breaths/minute.

The appropriate response is to:

A. Immediately review the records for all known substances of abuse

B. Administer intranasal naloxone

C. Begin CPR

D. Place oxygen and IV access

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YouTube: https://www.youtube.com/watch?v=VQTxgzSWDgk&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=75

A 32-year-old female patient tells the PMHNP in the course of an office visit that her toddler’s pediatrician has suggested that the 3-year-old be referred for further assessment because his MCHAT-R score was high. Your patient is upset and does not think that the result was correct. Which of the following findings in the child would support an elevated MCHAT R score?

A. The child is mostly non-verbal and uses gestures to communicate

B. The child’s growth is not maintaining a consistent pattern

C. A 5 day history of painful vesicular lesions over the penile glands, with some lesions now crusting over.

D. A one week history of N void dysuria without penile discharge.

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YouTube: https://www.youtube.com/watch?v=4xazBfI7jZE&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=74