Your 23-year-old diabetic patient was found unresponsive with increased respirations, hypotension, and bradycardia. Family members state he recently had a tooth pulled and was prescribed Vicodin. Which of the following is most likely to cause the patient's presentation?

Correct Answer: D

Rationale: The correct answer is D: Narcotic overdose. The patient's presentation of increased respirations, hypotension, and bradycardia is consistent with narcotic overdose, specifically from Vicodin, which contains hydrocodone. Narcotics can cause respiratory depression leading to increased respirations as a compensatory mechanism, hypotension due to vasodilation, and bradycardia. Myasthenia gravis (A) would present with muscle weakness, not the symptoms described. Metabolic alkalosis (B) would not typically present with the combination of symptoms described. Ketoacidosis (C) is more commonly associated with uncontrolled diabetes and would present with different symptoms such as fruity breath, dehydration, and altered mental status.

Correct Answer: C

Rationale: The correct answer is C: She is an emancipated minor granted by the court. This is true because an emancipated minor is legally recognized as an adult and can make medical decisions without parental consent. Emancipation typically requires a court order that grants the minor the legal status of an adult. In this case, the patient is sixteen and does not need parental consent because she has been granted emancipation by the court. Choice A (implied consent) is incorrect because implied consent generally applies in emergency situations where the patient is unable to provide consent. In this case, the patient is conscious and capable of providing consent. Choice B (not an American citizen) is incorrect because citizenship status does not impact a minor's ability to provide consent for medical treatment. Choice D (orphaned minor living alone) is incorrect because being orphaned does not automatically grant a minor the legal status to make medical decisions without parental consent.

Correct Answer: B

Rationale: The correct answer is B: To prevent atelectasis from occurring at the end of exhalation. Pursed lips and sighing-type respirations help create positive pressure in the airways, preventing collapse of small airways and maintaining lung inflation. Pursed lips prolong exhalation, which helps keep airways open, reducing the risk of atelectasis. Choices A, C, and D are incorrect because pursed lips and sighing-type respirations do not directly relate to expelling foreign bodies, preventing pleural friction rub, or increasing the size of air sacs in the lungs.

Correct Answer: D

Rationale: The correct answer is D because performing diagnostic peritoneal lavage or a FAST exam is crucial in evaluating for intra-abdominal injuries after blunt trauma. This will help determine if there is internal bleeding or organ damage requiring immediate intervention. A: Performing external fixation of the pelvis is not the immediate priority in this scenario as internal injuries need to be ruled out first. B: Obtaining abdominal and pelvic CT-scans may provide detailed information, but they are time-consuming and not the immediate priority for a potentially unstable patient. C: Performing arterial embolization of the pelvic vessel is not the initial priority as the patient's internal injuries need to be evaluated first.

Correct Answer: D

Rationale: The correct answer is D: Urinary output. Urinary output is the most reliable guide to volume replacement during resuscitation because it directly reflects the perfusion of vital organs and the body's ability to eliminate excess fluid. Adequate urinary output indicates effective fluid resuscitation, while decreased urinary output may indicate inadequate perfusion and the need for further volume replacement. Monitoring urinary output helps ensure appropriate fluid balance and prevents complications such as fluid overload or organ damage. Other choices are not as reliable for volume replacement guidance: A: Heart rate can be influenced by various factors such as pain, stress, medications, and underlying medical conditions. B: Hematocrit reflects the concentration of red blood cells in the blood, which may not accurately reflect volume status during resuscitation. C: Blood pressure can be affected by many factors such as medications, pain, and underlying conditions, making it less reliable as a sole guide for volume replacement.