52yo man comes to the physician for a f/up exam. he has a 4y hx of htn and a 1y hx of hypokalemia. current meds include labetolol, enalapril and kcl. his bp is 154/90. the remainder of the exam shows no abnormalities. his fasting serum aldosterone: renin ratio is increased. a ct scan shows a 1cm l adrenal mass. adrenal vein sampling before and after administration of acth shows b/l hypersecretion of aldosterone. which of the following is the most appropriate next step in management?
a. candesartan therapy
b. furosemide therapy
c. spironolactone therapy
d. b/l adrenalectomy
e. u/l adrenalectomy

20 times a minute is usually the average respritory rate of an adult. additionally the patient is breathing on his own, is clearly maintaining his airway, and is intaking a sufficient amount of air. you shouldn't use a bag valve mask, cpap, or other form of positive pressure ventilation, unless the patient has lost control of his airway, and is not breathing (apneic) or has rapid breathing or slow and shallow respirations. this patient would most likely and should be put on an non-rebreather mask or nrb attached to 100% high flow oxygen at 15 l/min. don't use a nasal cannula, as the amount of oxygen it provides is limited with a rate of 6 l/min.