A client is admitted to the telemetry unit. Which of the following nursing assessments would have the highest priority for further investigation?
1. The client complains of intermittent chest pain during mild exercise.
2. The client's father has a history of smoking.
3. The client has a history of urinary retention.
4. The client complains of fatigue and dyspnea after walking up several flights of stairs.
The client complains of intermittent chest pain during mild exercise.
Rationale: The client's history of intermittent chest pain during mild exercise signals the highest need for the further investigation into the client's cardiovascular status. The past history of urinary retention may be of concern if the client will be receiving medications that could cause urinary retention or if surgery is planned, but should not be a high priority initially. The complaint of fatigue and dyspnea with climbing stairs may need further investigation, but also may not be significant, depending upon how many flights of stairs the client climbs and whether chest pain or discomfort develops. The father's history of smoking is relevant based upon second-hand smoke exposure.
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