In relation to left ventricular flow: Flow represented in red hues is considered to be LV _________? _______ Flow represented in blue hues is considered LV _________? _______ NOTE: Not in relation to the transducer positioning    

An intubated patient is receiving enteral nutrition. Today she has a new onset fever, leukocytosis, and increased sputum production. Chest x-ray demonstrates right lower lobe (RLL) infiltrate. Which of the following interventions is most beneficial to decrease the incidence of this complication?

A 65-year-old female is scheduled for spinal surgery. She has a past medical history of CAD and HTN, atrial fibrillation. Her pre-op CXR is shown below. CXR4.jpg Which of the following is most helpful in predicting her risk of postoperative of respiratory failure?

3. A nurse is educating a client about fiber intake. Which statement indicates understanding?  

The AG-ACNP is caring for a 79-year-old male who has been successfully resuscitated. He had a sudden, witnessed collapse in a shopping mall where he was found to be in pulseless VT. He has a prior history of CAD with a single coronary stent placed 2 years ago. He now has stable vital signs but remains comatose. His 12-lead ECG shows ST segment depressions in the anterior leads. Which statement regarding the role of cardiac catheterization in his care is true?  Cardiac catheterization is:

1. Which of the following nutrients provides the most energy per gram?

A 26-year-old woman with no prior medical history presents to the emergency department (ED) with progressively worsening dyspnea for 1 week. Her symptoms are preceded by 3 days of fever, rigors, and nasal congestion. She is afebrile with HR of 116 beats/min and BP of 92/70 mmHg. Physical examination reveals bilateral rales, elevated jugular venous pressure, 2/6 systolic murmur at the left lower sternal border, cool extremities, and 2+ bilateral lower extremity edema. Echocardiogram reveals LVEF of 20%, nondilated LV (LV end-diastolic diameter of 3.4 cm), global hypokinesis, mild mitral regurgitation, and a normal right ventricular function. Labs are significant for creatinine of 1.6 mg/dL, aspartate aminotransferase (AST) of 385 U/L, alanine aminotransferase (ALT) of 413 U/L, troponin I of 4.8 ng/mL, and serum lactic acid of 2.8 mmol/L. Intravenous diuretics and dobutamine are initiated. Within 24 hours of admission, the patient develops hypotension and worsening heart failure refractory to inotropes and vasopressors. Urine output is 125 cc in the last 6 hours.  Which of the following is the best next step in her management to stabilize her?

A 45-year-old male with morbid obesity (BMI 55) presents to the ED at 6 AM with right leg pain, and cellulitis that has kept him awake all night. He is admitted to the ward and his fevers and skin examination are improved with antibiotics during the first 16 hours of hospitalization. At 2 AM you are called to evaluate the patient for ICU admission because of somnolence and hypoxemia (SpO2 falling to high 70s on 2LNC). The rapid response team had difficulty waking the patient and ABG was performed before your arrival in the patient’s room: 7.29/74/52. Following arterial puncture, the patient woke up and by your arrival he is able to converse but remains sleepy with eyes closed, denying dyspnea, with SpO2 now 92% on 2LNC, and normal work of breathing. Medication history was reviewed, and no opiates have been administered. The ward team is requesting ICU transfer because of acute hypercarbic respiratory failure and initiation of BiPAP. You review recent laboratory test results and note that serum bicarbonate has been 38 to 40 over the last 6 months.Which of the following statements is true?

A patient presents with a new onset of chest pain, diaphoresis, ST segment depression in two contiguous leads, and a troponin I level of 0.5.  Of the following, the most likely diagnosis is:

A 38-year-old, 155 cm, 50 kg, previously health female presents to the ICU with altered mental status, tachycardia, hypotension, and high fever. She is intubated for airway protection. Her laboratory test results reveal a markedly elevated T3 and T4 level with a decrease in thyroid-stimulating hormone level consistent with thyroid storm. Her arterial blood gas shows a pH of 7.24, PaO2 of 80, PaCO2 of 52, and HCO3 of 22. Her ventilator settings are volume control, tidal volume of 350 mL, respiratory rate of 14, positive end expiratory pressure (PEEP) of 5, FiO2 of 50%. Which of the following is the next appropriate step in management?