A 45-Year-Old Man Is Alert and Oriented, Complaining of Chest

question 41

Multiple Choice

A 45-year-old man is alert and oriented, complaining of chest pain. He describes a two-day history of worsening pain, described as a burning sensation below his left breast that radiates across his chest. He states that the pain seems to get better right after eating, but then worsens again. Medical history includes myocardial infarction, hypertension, and type 2 diabetes. His medications include Inderal, Vasotech, Glucotrol, and Lopid. Physical examination reveals cool, dry skin; clear lungs; and no JVD or peripheral edema. HR = 102, BP = 132/86, RR = 12, SaO₂ = 98%. The patient is on oxygen by nasal cannula at 4 liters per minute. Which of the following should be done next?

• A) Give 81 mg aspirin by mouth.
• B) Start precautionary IV of normal saline and transport.
• C) Give 0.4 mg nitroglycerin sublingually.
• D) Do a 12-lead ECG.

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Definitions:

Horney

Karen Horney, a psychoanalytic theorist known for her theory of neurotic needs and her work on neurotic personality development.

Reaction Formation

A defense mechanism where an individual behaves in a manner opposite to their actual feelings or desires, often to hide their true impulses.

Neurotic Competitiveness

An indiscriminate need to win at all costs.

Hyper-Competitive

An intense and excessive desire to win and be more successful than others in every situation.