In acute diaphragmatic pleurisy involving the central part of the diaphragm, the patient is likely to complain of pain in:

Correct Answer: A

Rationale: Acute diaphragmatic pleurisy, inflammation of the pleural lining over the diaphragm's central portion, typically causes referred pain to the neck and shoulder (A) via the phrenic nerve (C3-C5), which innervates the diaphragm and shares dermatomes with the supraclavicular region. Lateral chest pain (B) aligns with parietal pleura irritation, not central diaphragmatic. Central chest pain (C) suggests mediastinal or cardiac issues, not diaphragmatic referral. Interscapular pain (D) lacks nerve linkage here, and right lower quadrant pain ties to abdominal pathology, not pleural. This referred pattern, distinct from local chest wall pain, is key in diagnosing diaphragmatic involvement e.g., in pneumonia or subphrenic abscess guiding imaging or intervention, a critical chest pain differentiation in clinical practice.

Correct Answer: D

Rationale: Umbilication of a solitary pulmonary nodule's border (D) irregular, notched edge suggests malignancy (e.g., adenocarcinoma), reflecting aggressive growth. Dense (A), core (B), laminated (C), or flecked calcification often indicate benignity (e.g., granuloma, hamartoma) calcification patterns stabilize lesions. Malignant nodules lack uniform calcium, growing unevenly, key in CT analysis for biopsy decisions in chest oncology nursing.

Correct Answer: B

Rationale: Mediastinal emphysema air in mediastinum stems from tracheal perforation (B), e.g., trauma or barotrauma, leaking air (crunching sound, Hamman's sign). Collaterals (A) fit SVCS. Elderly debilitation (C) is nonspecific. Perforation's air escape is key, needing urgent imaging (e.g., CT), guiding intervention in chest emergencies.

Correct Answer: A

Rationale: Methotrexate, an antimetabolite, causes myelosuppression, hepatitis (A) folate inhibition suppresses marrow, damages liver (e.g., ALT >100 U/L). Protein defects (B) fit asparaginase. Neuropathy (C) is vincristine. Cystitis (D) is cytoxan. Psychosis is prednisone. Methotrexate's toxicity is key in nursing for leucovorin rescue and liver function tests.

Correct Answer: D

Rationale: Idiopathic thrombocytopenic purpura (ITP) immune platelet destruction starts with glucocorticoids (E e.g., prednisone 1 mg/kg), raising counts (e.g., >50,000/μL) by blocking phagocytosis. Transfusion (A) is for bleeding. Testosterone (B) is obsolete. Splenectomy (C) is second-line. 6-MP (D) is leukemia-related. Steroids' efficacy is key in nursing for rapid response and monitoring purpura.