You are a student in the last term of a BSN Program. You are preparing for an end of term exam. To help you prepare, your instructor developed three real world clinical scenarios to provide opportunities for you to apply clinical reasoning and clinical judgement. The instructor stated, “You received reports on these clients. Decide which one you need to see first and then make appropriate nursing decisions based on relevant information to promote positive client outcomes.” The three scenarios include: Instructions Record your answers to these statements. Rank the three scenarios provided in order of priority related to which client you will assess first, second and third. Defend your selection for the three ranked scenarios. Review the data below for the priority client to determine what to assess first. Chest X-ray no abnormalities noted Abdominal X-ray :diffuse gas throughout the small intestine Hyperactive bowel sounds in all 4 quadrants and abdomen painful to touch Pain level 10/10 Sodium (Na+) 147 mmol/L Potassium (K+) 2.9 mmol/L Chloride (Cl-) 100 mmol/L Magnesium (Mg2+) 1.4 mg/dL Calcium (Ca2+) 9.2 mg/dL Phosphorus (P+) 2.3 mg/dL Glucose 188 mg/dL Serum albumin 3.0 g/dL  Amylase 185 unit/L Serum Creatinine 0.5 mg/dL BUN 15 mg/dL Alkaline Phos. 155 unit/L • Protein 8.6 g/dL Bilirubin 3.5 mg/dL Formulate three hypotheses based on cues provided Select the priority hypothesis Defend your selection Describe an evaluation plan for the priority hypothesis based on expected client outcomes Describe the next steps in the clinical judgement model including: Actions if satisfied with client outcomes Actions if not satisfied with client outcomes

Case StudyChief complaint: “I’m here for a medication refill because I ran out of my medicines”.HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.PMH: Primary Hypertension, Previous history of MI 1 year agoSurgeries:1 year ago-Left Anterior Descending (LAD) cardiac stent placementAllergies: PenicillinVaccination History: Up-to-dateSocial history:High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.Family history:Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.ROS:Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.Psychiatric: Non-contributory.Physical examination:Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-laboredHEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.A:Primary Diagnosis: Congestive Heart Failure (CHF)Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)Differential Diagnosis: Peripheral Vascular Disease (PVD)Plan:Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis painLabs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.Additional lab results:Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %BNP – not available.As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).Questions:1. According to the ACC/AHA guidelines, what medications should this patient be prescribed?2. Does he need medication(s) given his history of MI?--3..- APA format4..-minimum 250 words5..-must have 3 references no older than 5 years old