What action would be most helpful to the nurse in determining whether the chest pain of a patient who has just entered the emergency department is cardiac in origin?

Question

1. Gathering a complete medical history
2. Performing a 12-lead ECG
3. Administering NTG to see if the pain goes away
4. Asking the patient if performing a Valsalva maneuver reduces the pain

Answer 1

2
Rationale 1: Reviewing a complete history will waste time in what might be an emergent situation.
Rationale 2: A 12-lead ECG is performed immediately if the symptoms are suggestive of pain that is cardiac in origin.
Rationale 3: Just experimenting with a drug such as NTG should not be the first choice for differentiating the source of the chest pain. Also it is unsafe to give a drug without a specific reason or cause.
Rationale 4: Performing the Valsalva maneuver will increase abdominal and thoracic pressures and can cause vagal stimulation that will result in decreased heart rate. It should not be suggested unless tachycardia is present and emergency equipment is available in case of cardiac arrest. This is not a method of differentiating the types of chest pain.