A 17 year old male presents to the urgent care with complaints of being stung by a wasp on the arm while cleaning out an old storage unit. The sting area is mildly erythematous without drainage and very mildly tender to touch. The patient complains “it just itches so bad”.  Vital signs: Pulse 66, BP 114/71, RR 16, O2 99% on room air, temp 97.9F   What is the most appropriate treatment plan? 

The female AGACNP is caring for an elderly man whom she just informed has a right lower lobe lung mass, found on a CT scan. The man is visually upset, so the female AGACNP rests a hand on his shoulder to offer comfort; however, the male patient now seems even more upset after the touch.    Which culture should the AGACNP remember to avoid touch when showing concern? 

When interviewing a patient who has tested positive for methamphetamine, which type of question(s) is most appropriate? 

In which culture is lack of eye contact a demonstration of respect? 

For a patient suffering from the psychomotor agitation related to MDMA intoxication, which medication and dose is recommended? 

The emergency department provider contacts the AGACNP to admit an 89 year old male with non-small cell lung cancer who now has a right lower and upper lobe pneumonia.  Vital signs: Pulse 105, BP 89/51, RR 22, O2 89% on 4L NC, Temp 101.4F   Which of the following would be most appropriate to ask about when interviewing this patient? 

A 35 year old male with known anxiety, depression, and poly-substance abuse presents to the emergency department after a friend found him on his cough and could barely wake him up. He reports he found vomit down the side of the couch.    Vitals: Pulse 75, BP 98/52, RR 35, O2 94% on 2L NC, Temp 99.9F   Labs: WBC 11K, H&H 17.9 & 41.2, Plt 179K. Na+ 132, K+ 2.9, glucose 71, anion gap 22, BUN 23, Cr 1.2, Mg+ 1.2.  Serum drug screen: + THC and tricyclic antidepressants acetaminophen:

When using an interpreter to discuss a poor prognosis with a patient, the matter and manner of the issue is whose responsibility? 

A 29 year old male presents to the emergency department with his significant other who complains that the patient “isn’t acting right”. On triage exam, the registered nurse notes rapid deep breathing, mild lethargy, and reports the patient appears inebriated.  Vital signs: Pulse 135, BP 101/54, RR 38, O2 95% on room air, Temp 99.1F The triage nurse categorizes the patient as a level 2 and moves the patient to an exam room.  The AGACNP interviews and examines the patient. The patient and significant other deny any major medical problems. He reports he smokes cigarettes though he denies alcohol consumption or drug use. He works as a mechanic at an auto body shop.  Chest x-ray: no acute findings Labs: WBC 6K, H&H 17.6 & 42.3, Plt 456K. Na+ 136, K+ 3.9, glucose 87, BUN 29, Cr 2.5, Mg+ 1.7. Lactic acid 5.5. Procalcitonin 0.5.  ABG: pH 7.22, CO2 18, O2 80, HCO3 8 Drug screen: negative except for THC The AGACNP then interviews the patient and significant other again and asks more about psychiatric history. The significant other states they have “an on-and-off relationship” and recently broke up again. The significant other had gone to the patient’s home to retrieve some belongings when the patient was not acting normally.  What substance or substances should the AGACNP ask, and possibly assume, if the patient consumed? 

True or false. Acute grief typically requires pharmaceutical treatment.