Mrs. X altered mental status is not due to focal neurologic deficit as she does not show focal neurologic signs. Some of the signs of focal neurologic deficit are impairment of the spinal cord, nerves and brain activities impairment of the nerves, spinal cord and brain affects certain areas of the body and causes weakness in the right leg and left arm. Mrs. X does not have impaired of the spinal cord, nerves and the brain according to the medical examination. Mrs. X does not have weakness in the left arm and right leg. The neurologic examination shows Mrs. X has no problem. Mrs. X has grip strength of 5/5 bilaterally. The Dorsi and plantar flexion is 5/5 bilaterally. Mrs. X has no focal spinal and costovertebral angle tenderness. Thus, the altered mental status is linked to a more comprehensive etiology. The altered mental status can be due to overdose of Percocet and use of narcotics. Mrs. X took 80 tablets of 10mg Percocet within 72 hours before she started experiencing the symptoms. In addition, Mrs. X has misused narcotics as evidenced by the family’s reaction. Overuse of narcotics and withdrawal can change the mental status of a patient. McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The Biologic Basis of Disease in Adults and Children (7th ed.). Maryland, MO: Mosby Elsevier. 2. Based on the available information what differentials can the NP absolutely rule out? Give a rationale as to why you are ruling out each differential. Differential diagnosis is conducted to rule out certain diseases and hence ensure the diagnosis is accurate. The NP should rule out some differential diagnoses. The NP should rule out a focal neurologic deficit diagnosis as Mrs. X does not show signs and symptoms of focal neurologic deficit according to the historical and examination data. Additionally, the NP should rule out influenza DFA diagnosis as the patient does not show signs of DFA influenza. They can rule out diarrhea as a result of influenza according to the examination done by the doctor the diarrhea is not be due to influenza, but narcotic withdrawal. Mrs. X has been misusing narcotics and she has not used the drugs since she became sick and this might have contributed to the diarrhea. Further, the NP should rule out narcotic overdose diagnosis as the patient does not show signs of narcotic overdose. McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The Biologic Basis of Disease in Adults and Children (7th ed.). Maryland, MO: Mosby Elsevier. 3. What differential diagnoses still need to be ruled out? Other differential diagnosis that still need to be eliminated is serotonin syndrome and encephalitis. She could be dehydrated, her urine is dirty she could have a U>