Patient Information: Name: Mary Johnson Age: 72 Admitting Diagnosis: Acute on chronic heart failure exacerbation Medical History: Hypertension, Type 2 Diabetes, Obesity Current Complaints: Shortness of breath, fatigue, lower leg swelling Vital Signs: BP: 140/88 mm Hg HR: 95 bpm RR: 24 SpO₂: 91% on 2 L/min nasal cannula Laboratory Results: BNP: 1,200 pg/mL Potassium: 3.1 mEq/L Creatinine: 1.6 mg/dL Glucose: 186 mg/dL Current Medications: Furosemide IV Lisinopril Metoprolol Insulin glargine   The nurse is reviewing the current care plan. Drag each intervention to the appropriate category based on the patient’s current clinical status.

A 62-year-old with a history of type 2 diabetes mellitus, hyperlipidemia, and hypertension undergoes coronary angiography after presenting with exertional angina and is found to have a non-STEMI. The results reveal significant multi-vessel coronary artery disease (CAD)  involving the left anterior descending (LAD), right coronary artery (RCA), and left circumflex artery (LCx), with reduced left ventricular ejection fraction (LVEF) of 35%.  Which of the following is the most appropriate indication for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI)?

A 49-year-old male is brought to the emergency department via emergency medical services (EMS) after a motorcycle accident. He complains of severe pain in his lower right leg. The extremity has already been splinted by EMS prior to arrival. On examination, there is obvious deformity and swelling at the midshaft of the right tibia. The skin is intact but tight and shiny. Dorsalis pedis pulse is not palpable on the affected side, and the foot appears pale and cool to the touch. What is the most appropriate next step in management?

Case Study: Septic Shock   Scenario: A 55-year-old patient with a history of diabetes presents to the emergency department with signs and symptoms of septic shock, including fever, hypotension, tachycardia, and confusion. Blood cultures were just drawn, and recent laboratory results show elevated white blood cell count, elevated lactate, and renal impairment (elevated creatinine). The patient is not responding to the initial fluid resuscitation.   Vital Signs: BP: 80/50 mmHg HR: 115 bpm RR: 28 SpO₂: 88% Lab Results: White Blood Cell Count: 18,000/µL Lactate: 4.2 mmol/L Creatinine: 2.1 mg/dL Arterial blood gas: pH: 7.29 PaCO2: 32 mmHg HCO3: 18 mEq/L    Which of the following interventions should the nurse prioritize as an immediate action and which should be delayed?

A 68-year-old male is admitted to the hospital for a COPD exacerbation. On admission, he also complains to the AGACNP of acute pain and swelling in his right great toe. The joint is warm and tender on examination. History: HTN, COPD, DM Type II, gout, and tobacco use Vitals: BP 154/88, Pulse 101, RR 26, O2 92% on 4L NC, Temp 98.4F Labs:  WBC: 13,500 /µL Hemoglobin: 13.2 g/dL Creatinine: 1.9 mg/dL BUN: 35 mg/dL eGFR: 42 mL/min/1.73m² Serum Uric Acid: 9.6 mg/dL Lactic Acid: 1.5 mmol/L CRP: 8.1 mg/dL Urinalysis: Normal Admission medications:  Methylprednisolone (Solu-Medrol) IV 80 mg every 8 hours DuoNeb (albuterol/ipratropium combo) nebulized every 8 hours  Albuterol (Ventolin) nebulizer 2.5 mg every 4–6 hours PRN Pantoprazole 40 mg PO daily Heparin 5000 units subcutaneously every 8 hours   What is the most appropriate treatment plan? 

Mr. Thompson, a 68-year-old man, comes to the clinic for a routine visit. He mentions having to get up several times at night to urinate and feeling like he can’t completely empty his bladder. He denies any pain but says his symptoms are “getting annoying.” His provider suspects benign prostatic hyperplasia (BPH).   To further evaluate the severity of Mr. Thompson’s symptoms, which question should the nurse ask?

A patient with suspected septic shock is transferred from the emergency department to the ICU. The nurse notes the following: The patient has received 3 liters of IV crystalloid fluid. Blood cultures have been drawn. Antibiotics were started 1 hour ago. Current vitals: BP: 80/52 mm Hg HR: 126 bpm SpO₂: 93% on room air Temp: 39.5°C (103.1°F)   Despite initial treatment, the patient remains hypotensive. Which intervention should the nurse implement next to stabilize the patient’s condition?

A 68-year-old patient is brought to the ED with sudden confusion, dyspnea, and lethargy. The nurse reviews the following arterial blood gas (ABG) results: pH: 7.25  PaCO₂: 68 mm Hg  HCO₃: 24 mEq/L  PaO₂: 58 mm Hg The nurse concludes the patient is experiencing .

3 pts. Candace presents to the clinic with her mom. Her mom is concerned about a bad tooth she has on his upper jaw. Below is an intraoral picture of the tooth and the radiograph.       You’re dentist determined the tooth needed to be extracted and asked your opinion if a space maintainer should be placed and which kind? What are the options for a space maintainer (if indicated) based on the radiographs and the teeth remaining in the mouth? Explain your reasoning.

You may use notes and the textbook during the proctored final exam.