A 64-year-old man is brought to the emergency department unconscious. He undergoes a CT of the chest, which reveals a pulmonary embolism. He is considered for immediate therapy with heparin. Because the man is unconscious, a history cannot be obtained from him. Which of the following would represent a contraindication to heparin therapy?

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: Second-generation H1 antagonists (e.g., loratadine) are less lipophilic, reducing blood-brain barrier crossing, thus causing less sedation than first-generation ones (e.g., diphenhydramine). 'This drug will not make me as sleepy' shows the patient grasps this benefit, improving daily function. Alcohol still risks sedation. Dry mouth and urinary issues are anticholinergic effects less reduced in second-generation drugs. Choice D confirms understanding of the primary advantage.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: A

Rationale: Omeprazole, a PPI, reduces acid by inhibiting proton pumps, most effective before meals when acid production peaks, optimizing GERD relief. With antacids reduces efficacy'PPIs need acidic pH. Crushing destroys enteric coating. Bedtime-only misses daytime acid. Pre-meal dosing aligns with omeprazole's mechanism, critical in GERD where timing enhances healing, making A the key instruction.

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.