An emergency department nurse triages clients who present with chest discomfort. Which client should the nurse plan to assess first?

Question

a. A 42-year-old female who describes her pain as a dull ache with numbness in her fingers
b. A 49-year-old male who reports moderate pain that is worse on inspiration
c. A 53-year-old female who reports substernal pain that radiates to her abdomen
d. A 58-year-old male who describes his pain as intense stabbing that spreads across his chest

Answer 1

ANS: D
All clients who have chest pain should be assessed more thoroughly. To determine which client should be seen first, the nurse must understand common differences in pain descriptions. Intense stabbing, vise-like substernal pain that spreads through the client's chest, arms, jaw, back, or neck is indicative of a myocardial infarction. The nurse should plan to see this client first to prevent cardiac cell death. A dull ache with numbness in the fingers is consistent with anxiety. Pain that gets worse with inspiration is usually related to a pleuropulmonary problem. Pain that spreads to the abdomen is often associated with an esophageal-gastric problem, especially when this pain is experienced by a male client. Female clients may experience abdominal discomfort with a myocardial event. Although clients with anxiety, pleuropulmonary, and esophageal-gastric problems should be seen, they are not a higher priority than myocardial infarction.