A 65-year old female with a 35-pack year history of smoking presents for a routine checkup of hypertension controlled with lisinopril 20mg daily, hydrochlorothiazide 25mg daily, and amlodipine 10mg daily.  She states she has noticed some swelling of her ankles and her legs feel tired and achy when she is walking her normal 1 mile each day so she has to stop and rest.  Based on the patient information, the most important order for the NP to place will be     

A 66-year old female presents to the primary care office with CC: “my eyes are yellow.”  The patient has noticed her skin is very itchy, she is feeling more tired, and generally does not feel well.   She is having some back pain and notes her urine looks dark.  A urine dip in the clinic reveals a high level of bilirubin.   The NP knows the bilirubinuria is a sign of  

Mr. M, a 72-year old male, has a history of aortic stenosis.  The last Echo, 6 months ago, showed worsening of the stenosis but the cardiologist told him he is not yet a candidate for surgery. He presents to his primary care NP for his 6 month chronic disease checkup.  The NP asks the patient if he is having what symptoms that would indicate the stenosis has reached a critical point requiring surgery? 

A diagnosis of functional somatic syndrome is associated with all of the following except: 

Why is it difficult to breathe at high elevations, especially without prior acclimation?

The two laboratory tests, that when abnormal, indicate worsening hepatocellular function are 

Which of the following statements is true about the Permian-Triassic mass extinction event?

Under the Clean Air Act, concentrations of criteria pollutants are monitored ____.

Which of the following is an amplifying/positive climate feedback?

This Southern Ocean keystone species is at particular risk from climate change, potentially triggering a cascade of impacts throughout the entire food web.