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The nurse has received the following provider orders for a patient in cardiogenic shock with a blood pressure of 70/35 mm Hg. Which order should the nurse implement first?

A 78-year-old man presents with fatigue, decreased appetite, and mild confusion for the past two weeks.Laboratory Results:• Creatinine: 2.9 mg/dL (baseline unknown)• BUN: 52 mg/dL• Potassium: 5.8 mEq/LPhysical Exam Findings:• Suprapubic fullness noted on palpation• Bladder scan shows post-void residual of 550 mLWhat is the most likely underlying cause of this patient’s renal insufficiency?

An 80-year-old woman is brought to the clinic by her daughter due to increasing confusion, dry mouth, and difficulty urinating over the past 3 days. She has also experienced new-onset constipation and blurry vision.• Medical History: Hypertension, overactive bladder, insomnia• Medications:   Amitriptyline 25 mg nightly (for neuropathic pain)   Oxybutynin 5 mg BID (for overactive bladder)   Diphenhydramine 50 mg nightly (for sleep)• Physical Exam:   BP: 128/76 mmHg, HR: 94 bpm   Pupils: Dilated and sluggish reaction to light   Mucous membranes: Dry   Bladder: Palpable, distendedWhich of the following is suspected as the underlying cause of this patient’s clinical presentation?

Which of the following is NOT a goal of medication therapy for COPD?

A 72-year-old man presents to the clinic with progressive shortness of breath and chronic cough with white sputum for the past 2 years. He denies chest pain, fever, or recent infections, but reports occasional wheezing and fatigue. His PMH includes hypertension and former smoker (45-pack-year history, quit 5 years ago). He takes lisinopril 10 mg daily and albuterol 1 puff PRN daily. Physical Exam:• Vitals: BP 130/80 mmHg, HR 84 bpm, RR 20/min, SpO₂ 93% on room air• Lungs: Decreased breath sounds, prolonged expiratory phase, scattered wheezing, mild pursed-lip breathing, decreased chest wall expansion and a barrel chest appearance.• Cardiovascular: No murmurs, no peripheral edemaSpirometry Results (Post-Bronchodilator Test):• FEV₁/FVC Ratio: 0.65• FEV₁: 65% of predicted• Improvement with bronchodilator: Minimal (

A 32-year-old woman comes for her lab results after getting her routine annual well-woman exam. She has had one-lifetime sexual partner, normal Pap smears in the past, and +HPV history, but no history of other STIs. Her results illustrated a normal pap smear, and her HPV test was positive for high-risk HPV 16. What is the next step in management based on ACOG guidelines?

A 14 y/o adolescent male patient with type 1 diabetes mellitus returns for a follow-up visit. He reports following the prescribed insulin regimen but he continues to have elevated HbA1c levels of 8.7%. The nurse practitioner reviews the blood glucose logs showing consistent readings above 200 mg/dL before meals. What should the nurse practitioner do to modify the treatment plan?

A 3-month-old infant presents with tachypnea, poor weight gain and difficulty feeding. On auscultation, a harsh holosystolic murmur is heard at the lower left sternal border. What is the most likely diagnosis?

A 68-year-old female presents to the clinic with fever (100.5°F), chills, a productive cough, and fatigue for the past three days. She denies confusion, nausea, or vomiting. She has been able to eat and drink normally. Her medical history includes hypertension (HTN) and hyperlipidemia (HLD). She is otherwise well and able to ambulate independently.Her vital signs are:• Blood Pressure: 118/72 mmHg• Heart Rate: 88 bpm• Respiratory Rate: 22 breaths per minute• Temperature: 100.5°F• Oxygen Saturation: 95% on room airLaboratory Findings:• White Blood Cell Count (WBC): 12,500/mm³• Blood Urea Nitrogen (BUN): 18 mg/dLBased on the CURB-65 criteria and the above information, which of the following factors contributes to the patient’s score?

A nurse practitioner is initiating HMG-CoA reductase inhibitor (statin) therapy for a 45-year-old patient with hyperlipidemia. Which prescribing consideration is most important when managing patients on statins?