The patient was placed under observation and surgery was scheduled for open reduction and internal fixation (ORIF) of the femur fracture. After three hours in the observation bay, the patient suddenly became dyspneic, anxious, and expressed pleuritic chest pain.  Exam revealed the following: HR: irregular, 135 bpm; BP: 153/91 mm Hg; RR: 24; Temperature: 99.8°F; and a loud P2 component of the second heart sound. In this patient, these signs and symptoms are most likely attributable to which of the following: 

The following two questions are related to the same clinical scenario (patient). A 77-years-old patient with a significant history of COPD was admitted for a workup before an elective laparoscopic cholecystectomy. The nurse practitioner was asked for advice on perioperative management of chronic CO2 retention and severe lung disease.  On room air, the patient’s ABG was as follows: pH: 7.50; PCO2: 56; PO2: 63; HCO3: 48: BE: 22.7. Based on these results, the AGACNP calculated the age adjusted A-a Oxygen Gradient (A-a O2 G) to be:

The following two questions are related to the same clinical scenario (patient). The nurse practitioner is called to the emergency department to review the laboratory results of a morbidly obese 65-years-old patient with a history of hypertension admitted for lethargy, fatigue, and daytime somnolence. Basic chemistry and CBC were unremarkable except for a Hgb of 19 gm/dL.  The arterial blood gases (ABG) in room air resulted in pH: 7.33; PO2: 47; PCO2: 64; HCO3: 29 Based on these results, you determine the patient is exhibiting:

The following two questions are related to the same clinical scenario (patient). A 32-years-old patient was admitted to the emergency department with respiratory distress at rest precipitated by a visit to an art gallery. The patient presented diaphoretic, with non-productive cough, and complaining of chest tightness. On exam, the patient presented with a heart rate of 125 bpm, respiratory rate of 32 breaths per minute, and hyperresonance on auscultation. Chest radiography showed hyperinflation, and the initial ABG values indicated a respiratory alkalosis with mild hypoxemia. The AGACNP accurate diagnostic impression was:

A 19-years-old patient was received in the emergency room with altered cognition, complaining of nausea, vomiting, and headache. The accompanying relative of the patient disclosed a significant history of the patient’s suicide attempts. Results suggestive of carbon monoxide poisoning will be:

The following three questions are related to the same clinical scenario (patient). A 63-years-old known chronic hypertensive patient was admitted to the ICU with a hypertensive crisis and a refractory blood pressure of 215/110 mm Hg.  A sodium nitroprusside intravenous drip was started.  After 6 hours of continuous infusion at 5mcg/kg/min, the patient became confused, tachycardic, tachypneic, and oliguric.  The nurse noticed unusual skin flushing and summoned the AGACNP to the bedside. Upon assessment, the practitioner corroborates the nurse’s findings and immediately suspects:

Evaluating the oxyhemoglobin dissociation curve for an adult, the AGACNP understands that a decrease in hemoglobin affinity for oxygen shifts the curve to the right. Select the clinical data that best represents this shift.

Additional study findings revealed elevated mean pulmonary artery pressure (mPAP) and an elevated pulmonary artery wedge pressure (PAWP). Based on all diagnostic findings, physical exam, and the patient’s comorbidities, your best plan to treat this patient’s condition will include:

A 79-years-old patient was admitted to the ICU after presenting to the emergency department 12 hours before with shortness of breath, fever, tachycardia, and neglecting food intake for the past two days. Past significant history was positive for gastroesophageal reflux disease (GERD). In the ICU, the AGACNP assessed the patient and noted the patient to be confused, tachycardic, tachypneic, and with a productive cough. Chest radiography showed a localized right middle lobe diffuse infiltrate pattern. The AGACNP diagnostic impression is:

The following three questions are related to the same clinical scenario (patient) A 29-year-old patient was admitted to the Trauma Resuscitation Unit after a motor vehicle crash (MVC). On arrival, the patient presented with a Glasgow Coma Scale (GCS) of 15, blood pressure (BP) of 126/82 mm Hg, a heart rate (HR) of 89 beats per minute, a respiratory rate (RR) of 19 breaths per minute, a temperature of 99.5°F, O2 Saturation at 96%, and a negative FAST. The patient complained of severe pain in the left lower extremity.  A large-bore catheter was placed in the antecubital, Lactated Ringer bolus was started, and the patient was taken to the radiology suite for x-rays. The x-rays of the left lower limb revealed a fracture of the femur and extravasation of fluid in the pelvic cavity.  The AGACNP identifies that this patient is most at risk of developing the following: