Your adult patient presents with shortness of breath and chest pain. She reports the pain began last night and has worsened. She is breathing 28 times per minute with a SpO2 of 96 percent on room air. She reports the pain worsens when asked to take a deep breath. Lung sounds are equal with a grating sound heard on inhalation. The patient's heart rate and blood pressure are normal. She is showing a sinus rhythm with a first-degree atrioventricular block present in lead II on the ECG. Which of the following is most likely the cause of her complaints?

Correct Answer: A

Rationale: The correct answer is A: Pleurisy. Pleurisy is inflammation of the pleura, the lining around the lungs. In this case, the patient's symptoms of chest pain worsened by deep breathing, grating sound on inhalation, and normal heart rate and blood pressure indicate pleurisy. The grating sound, known as pleural friction rub, is characteristic of pleurisy. The absence of significant cardiac abnormalities rules out acute myocardial infarction. Asthma typically presents with wheezing and bronchospasm, while bronchitis involves cough and sputum production, neither of which are seen in this patient. Pleurisy is the most likely cause based on the patient's presentation and physical exam findings.

Correct Answer: A

Rationale: The correct answer is A: Bilateral pupil dilation. In cases of herniation, increased intracranial pressure can lead to compression of the cranial nerves, resulting in bilateral pupil dilation. This is known as the "blown pupil" sign. Unilateral, unequal, or non-reactive pupils (Choice B) could indicate other issues like trauma or nerve damage. Bilaterally unequal and non-responsive pupils (Choice C) are not typical of herniation. Sluggish response with equal pupils (Choice D) may suggest a different neurological condition but not specifically herniation.

Correct Answer: D

Rationale: The correct answer is D: Naloxone. Meperidine is an opioid, and naloxone is an opioid antagonist that can reverse opioid overdose effects. Step 1: Identify the ingested substance (meperidine is an opioid). Step 2: Choose the appropriate antidote (naloxone for opioid overdose). Step 3: Administer naloxone to reverse respiratory depression and other opioid effects. Activated charcoal (A) is used to absorb toxins in the gastrointestinal tract, not opioids. Atropine (B) is an anticholinergic drug used for bradycardia and not effective for opioid overdose. Romazicon (C) is a benzodiazepine receptor antagonist and not used for opioid overdose reversal.

Correct Answer: C

Rationale: The correct answer is C: Directly into the vallecula. Placing the tip of the Macintosh blade directly into the vallecula helps lift the epiglottis and provides a clear view of the vocal cords during intubation. Placing it under the epiglottis (choice A) may obstruct the view. Placing it below the vallecula (choice B) may not provide adequate elevation. Placing it directly on the epiglottis (choice D) may cause trauma and difficulty in visualizing the glottis.

Correct Answer: C

Rationale: The correct answer is C. Clinical evidence of inadequate organ perfusion must be present to establish a diagnosis of shock. This is because shock is characterized by inadequate tissue perfusion leading to organ dysfunction. It is a state of systemic hypoperfusion resulting in cellular and metabolic imbalances. A is incorrect because a specific systolic blood pressure cutoff alone is not sufficient to diagnose shock. B is incorrect as the presence of a closed head injury is not a requirement for diagnosing shock. D is incorrect because a lack of response to intravenous fluid infusion is not the sole criteria for diagnosing shock.