T. is a 39-year-old male who presents to the hospital emergency room with a

chief complaint of profound substernal chest pain. Results of the 12-lead ECG and cardiac enzymes test are normal. Vital signs are as follows: temperature 101.9°F, pulse 129 bpm, respirations 26 breaths per minute, and blood pressure 90/60 mm Hg. The patient is pale and clearly unwell, and physical examination reveals a systolic pericardial crunching sound. Which of the following additional pieces of history would make the AGACNP suspect acute mediastinitis?

A.A 48 pack year smoke history

B. A 2-day history of vomiting

C. Aortic valve regurgitation

D.Cardiac tamponade

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