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 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 45-year-old man presents to the clinic with a 5-day history of fever (temperature 38.9°C/102°F), diffuse pruritic rash, and facial edema. He started taking carbamazepine 4 weeks ago for newly diagnosed trigeminal neuralgia. He reports that the rash initially began on his trunk and has progressively spread to his extremities. On examination, he has a generalized morbilliform eruption with areas of confluence on the trunk, along with periorbital edema and bilateral cervical lymphadenopathy. Laboratory studies show: WBC: 13,500/μL with 18% eosinophils Atypical lymphocytes: 12% Hemoglobin: 14.2 g/dL Platelets: 140,000/μL AST: 285 U/L (normal: 10-40) ALT: 320 U/L (normal: 10-40) Alkaline phosphatase: 95 U/L (normal: 30-120) Total bilirubin: 1.8 mg/dL (normal: 0.1-1.2) Creatinine: 1.8 mg/dL (baseline: 0.9 mg/dL) Sodium: 138 mEq/L Potassium: 4.2 mEq/L Which of the following features are characteristic of DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome? Select all that apply.

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 52-year-old man presents to the urgent care clinic with a 2-day history of a painful, red rash on his right forearm. He reports the area started as a small red spot that has expanded. He denies any recent trauma. States he is a factory worker.  Vital signs: Temperature 99.2F, blood pressure 132/78 mmHg, heart rate 88 bpm, RR 18bpm, O2 99% on room air. Physical examination reveals a bright red, indurated plaque with a sharply demarcated, raised border on the right forearm. The area is warm and tender to palpation. There is no crepitus, fluctuance, or purulent drainage. No lymphangitic streaking is noted, but there is mild right axillary lymphadenopathy. What is the most appropriate treatment for this patient?

Streptococci pneumoniae and Pseudomonas aeruginosa are the most common causative pathogens of erysipelas and cellulitis. True or false? 

A 68 year old male with a history of hypertension, type II diabetes, and tobacco use is diagnosed with a pulmonary embolism after a 2 day road trip across the country. Imaging on initial evaluation showed no evidence of right heart strain.  Vitals: BP 145/90 mmHg, HR 110 bpm, RR 22 breaths/min, and oxygen saturation 92% on room air Labs:  Hemoglobin: 14.2 g/dL Platelets: 210,000/mm³ INR: 1.1 PTT: 28 seconds (normal: 25-35 seconds) Creatinine: 0.9 mg/dL (normal: 0.6-1.2 mg/dL) D-dimer: 8.5 µg/mL (normal

What is sucrose is composed of?

A 62-year-old male with chronic dyspnea on exertion undergoes pulmonary function testing. Results show: FEV1: 58% of predicted FVC: 82% of predicted FEV1/FVC ratio: 0.62 (62%) DLCO: 65% of predicted Post-bronchodilator FEV1: Increases by 8% (160 mL) These pulmonary function test results are consistent with obstructive lung disease. True or false? 

A 56-year-old male is admitted to the hospital with new-onset atrial fibrillation. His medical history is significant for HTN, HLD, obesity (BMI 38), and obstructive sleep apnea. He also reports increased daytime somnolence. During admission, medication reconciliation and history review, he reports that he does not regularly use his prescribed CPAP machine at home because it is uncomfortable. Which patient education statement is most appropriate?