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A 56-year-old man is admitted to the medical floor for management of acute decompensated heart failure. His wife mentions that he snores loudly at night and she frequently observes him stop breathing for 10-20 seconds, followed by gasping or choking sounds. The patient reports chronic daytime fatigue and falling asleep frequently during the day. His medical history includes hypertension, type 2 diabetes, obesity (BMI 36 kg/m²), and atrial fibrillation. Neck circumference 19 inches. Cardiovascular exam reveals an irregular rhythm and 2+ pitting edema bilaterally. Retrognathia is noted. Oropharyngeal exam shows a crowded airway with enlarged tonsils and low-lying soft palate (Mallampati class IV).  Chest x-ray showing small pleural effusions, otherwise clear lungs. The AGACNP is concerned for repetitive dynamic collapse of the upper airway during sleep. What action by the AGACNP is most appropriate? 

A 56-year-old with 35% TBSA burns is in the ICU on day 6. Over 12 hours he develops progressive tachycardia, progressive tachypnea, new feeding intolerance, and platelet count drops from 190,000 to 85,000. The wound shows new dark discoloration with rapid conversion of previously viable partial-thickness areas to necrosis. Blood pressure becomes refractory to fluids. What is the most appropriate management strategy?

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?

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?