Blog

The nurse practitioner is counseling a 42-year-old woman with hypertension and migraine with aura about contraception. Which option is most appropriate?

A 52-year-old male with a history of hypertension, hyperlipidemia, and type II diabetes presents to the emergency room with a 2-day history of right lower leg pain, redness, and swelling. He reports the symptoms began suddenly and have progressively worsened. He denies any recent trauma but mentions he had a small scratch on his leg from gardening about 5 days ago. He denies any recent long care rides or recent sedentary activity.  Vital signs: temperature 38.3°C (101°F), blood pressure 128/82 mmHg, heart rate 92 bpm, and respiratory rate 16/min on room air. Physical examination reveals a poorly demarcated area of erythema and edema on the right lower leg that is warm and tender to palpation. There is no streaking erythema. The left lower leg appears normal. The affected area is not exquisitely tender, and there is no crepitus or bullae formation. (Tintinalli’s Emergency Medicine) What is the most likely diagnosis?

A 71-year-old female with a history of hypertension, congestive heart failure (EF 35%), atrial fibrillation, and hyperlipidemia presents to the emergency department with progressive dyspnea and shortness of breath over the past week. She reports increased lower extremity swelling and orthopnea requiring three pillows to sleep. Physical examination findings: Vital signs: BP 148/88, HR 92, RR 24, SpO2 91% on room air, Temperature 98.90F  General: Mild respiratory distress, speaking in short sentences Cardiac: Regular rhythm, S3 gallop present, JVP elevated at 10 cm Pulmonary: Decreased breath sounds at the right base, dullness to percussion over the right lower lung field Extremities: 2+ pitting edema bilaterally to mid-calf Laboratory Results: WBC: 10.1 × 10³/µL (normal: 4.5-11.0) Hemoglobin: 11.2 g/dL (normal: 12.0-16.0 for females) Platelets: 245 × 10³/µL (normal: 150-400) Sodium: 133 mEq/L (normal: 136-145) Potassium: 3.8 mEq/L (normal: 3.5-5.0) Creatinine: 1.6 mg/dL (baseline 1.0 mg/dL) BUN: 32 mg/dL (normal: 7-20) BNP: 1,850 pg/mL (normal:

A 34-year-old woman with a history of moderate persistent asthma is admitted to the medical floor for an acute asthma exacerbation. She reports 4 days of progressive dyspnea, wheezing, and nocturnal cough despite using her albuterol inhaler every 2 hours at home. She states she ran out of her maintenance inhaler 2 weeks ago and has not refilled it. Vital signs are: BP 128/78, HR 118, RR 28, temperature 37.2°C (99°F), SpO2 91% on room air. Physical examination reveals diffuse expiratory wheezing throughout all lung fields, use of accessory muscles, and difficulty speaking in full sentences. Chest X-ray shows hyperinflation with flattened diaphragms and no infiltrates or pneumothorax. The decision is made to admit the patient to the medical floor for acute asthma exacerbation. In addition to oxygen, what is the most appropriate initial respiratory treatment regimen for this patient?  

A 67-year-old man presents to the emergency department and is found to have partial-thickness burns to the anterior trunk and both arms after a kitchen fire. The AGACNP estimates 12% TBSA partial thickness. He is hemodynamically stable and breathing comfortably, with no facial burns. Which disposition plan is most consistent with burn referral guidance?

A 67-year-old man presents to the emergency department and is found to have partial-thickness burns to the anterior trunk and both arms after a kitchen fire. The AGACNP estimates 12% TBSA partial thickness. He is hemodynamically stable and breathing comfortably, with no facial burns. Which disposition plan is most consistent with burn referral guidance?

A 74-year-old female with a history of severe COPD is being intubated in the ICU for acute hypercapnic respiratory failure secondary to pneumonia. The AGACNP is preparing to set the initial ventilator parameters. Patient demographics: Height: 5’5″ (165 cm) Body weight: 150 lbs (68 kg) Gender: Female What is the appropriate tidal volume range for this patient?

A 68-year-old patient presents to the pulmonology clinic with progressive dyspnea on exertion over 18 months and a persistent dry cough. Physical examination reveals bibasilar inspiratory crackles and digital clubbing. Pulmonary function tests show FEV1/FVC ratio of 0.82 with reduced total lung capacity. High-resolution CT reveals reticular opacities with honeycombing in the subpleural and basilar regions. Which condition is mostly the cause of his symptoms? 

A 68 year old male presents to the emergency department with sudden shortness of breath and pleuritic chest pain. He reports he has been on a 2 day road trip to visit family in a different state. His history includes hypertension, type II diabetes, tobacco use, and obesity (BMI 34).  Vitals: BP 159/90 mmHg, HR 121 bpm, RR 28 breaths/min, and oxygen saturation 91% on room air. Electrocardiogram (ECG): Shows sinus tachycardia with no specific signs of acute strain.  Chest X-ray: No obvious abnormalities Labs:  Hemoglobin: 14.2 g/dL Hematocrit: 42% White blood cell count: 8,500/mm³ Platelets: 210,000/mm³ INR: 1.1 PTT: 28 seconds  Creatinine: 0.9 mg/dL D-dimer: 8.5 µg/mL Which of the following is the most appropriate next step in the diagnostic work-up?

Which of the following pulmonary manifestations is characteristic of systemic lupus erythematosus?