Lester is a 48 year old male who is brought to the ER by the ambulance

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1)     Lester is a 48 year old male who is brought to the ER by the ambulance. Neighbors found him lethargic

and confused after an episode of binge drinking. IV fluid hydration was started. He perked up and was able to be part of some history taking. Physical examination revealed an are of erythema on the upper inner aspect of the left thigh. Lester does not remember any trauma or injury, but the area is extremely painful to palpation and the painful region extends several centimeters proximal to the erythema. One hour later when all diagnostic studies are available- lester says that the pain is markedly worse. Physical exam reveals that the original area of erythema is now almost purple, and there are two erythematous spots proximal to the original site. The AGACNP is suspicious for

a)     Brown recluse spider bite

b)     Necrotizing fasciitis

c)      Staphylococcal cellulitis

d)     Coagulopathy

 
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Based upon clinical examination and laboratory assessment the AGACNP diagnose

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1)     Based upon clinical examination and laboratory assessment the AGACNP diagnoses a patient with giant

cell arteritis. The next step in the patient management should be to

a)     Consult surgery for a temporal artery biopsy

b)     Consult rheumatology for medical management

c)      Order 60 mg of prednisone now and q.d.

d)     Order ceftriaxone 1 mg IV now

 
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 Crystal K. is a 13 year old female who arrives in the emergency room with her mother

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)     Crystal K. is a 13 year old female who arrives in the emergency room with her mother. Mom says she has

not felt well for the last day or two, but today she is very weak and feels sick to her stomach. Serum glucose is 529 mg/dL, serum ketones are present, and the bicarbonate level is 8 mEq/dL. Crystal’s PH is 7.14. crystal was rapidly infused 1L of normal saline solution. The next step in her care is to

a)     Begin sliding scale insulin

b)     Begin electrolyte replacement

c)      Maintain NSS at 1L/hr and insulin gtt at 0.1u/kg/hr

d)     Maintain NSS at 1L/hr and add 40 mEq HCO3-

 
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Clinically relevant difference between delirium and dementia

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1)     Clinically relevant difference between delirium and dementia include all of the following

except

a)     Time of onset

b)     Symptom presentation

c)      Response to management

d)     Age of the patient

 
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