A 16-year-old female presents to the emergency room with a new complaint of chest pain. When performing a review of systems and physical examination, which of the following would substantially decrease your suspicion for a diagnosis of pulmonary embolism?

Correct Answer: C

Rationale: The correct answer is C: Rib tenderness. Rib tenderness is a symptom more commonly associated with musculoskeletal issues rather than pulmonary embolism. Pulmonary embolism typically presents with symptoms such as chest pain, shortness of breath, and sometimes cough. Fever is not a typical symptom of pulmonary embolism. Shortness of breath is a common symptom but not specific enough to substantially decrease suspicion for pulmonary embolism.

Correct Answer: A

Rationale: The correct answer is A: Assess the conjunctiva of the eye. Pallor is difficult to detect in dark-skinned individuals due to the lack of contrast. The conjunctiva of the eye provides a reliable area to assess for pallor as it is mucous membrane with blood vessels that can show changes in color. It is not accurate to assess for pallor by having the patient open the hand widely (B) as skin color on hands may vary. Looking at the roof of the mouth (C) may not accurately reflect pallor. Palpating for areas of mild swelling (D) does not assess for pallor, but rather for edema.

Correct Answer: D

Rationale: The correct answer is D because educating the client about the procedure is crucial for informed consent, cooperation, and reducing anxiety. This empowers the client to participate actively in their care. Assessing for shellfish allergies (A) is irrelevant unless a specific contrast agent is used. Placing the client on radiation precautions (B) is unnecessary for radioisotopic imaging. Sedating the client (C) may not be indicated and should be avoided if possible. Teaching the client about the procedure (D) addresses the immediate need and supports client safety and understanding.

Correct Answer: C

Rationale: The correct answer is C: Crimean Congo virus. This is the most likely causative agent of acute viral hemorrhagic fever following a tick bite due to its association with tick transmission. Crimean Congo virus is a tick-borne virus that causes severe hemorrhagic fever in humans. The other options, Hantavirus, Rift Valley virus, and Marburg virus, are not typically transmitted by ticks. Hantavirus is spread through rodent feces, Rift Valley virus is transmitted by mosquitoes, and Marburg virus is transmitted through direct contact with infected animals or their bodily fluids. Therefore, based on the history of tick bite, Crimean Congo virus is the most probable causative agent.

Correct Answer: C

Rationale: The correct answer is C, Factor VIII. Vitamin K is crucial for the activation of Factors II, VII, IX, and X in the coagulation cascade. Factor VIII is not dependent on vitamin K for its synthesis or activation, so it will not be affected by vitamin K deficiency. Factors II, VII, and IX will be affected as they require vitamin K for their activation. Therefore, Factor VIII is the only factor that will not be impacted by vitamin K deficiency.