The nurse working in an urgent care clinic admits a 38-year-old woman with report of chest pain radiating to the jaw, diaphoresis, cool extremities, and nausea
While waiting for the doctor to see the client, the nurse's priority intervention is: 1. Administration of nitroglycerine.
2. To obtain a signed operative consent.
3. To draw blood for cardiac enzymes.
4. To administer oxygen.
4
Rationale: The client's symptoms demonstrate cardiac ischemia, and this is reversed by improving oxygenation of the tissue, which can be accomplished by increasing blood flow and providing supplemental oxygen. The nurse cannot administer nitroglycerine to increase blood flow without a physician's order, but can administer emergency oxygen until the doctor arrives. Drawing blood for laboratory testing requires a physician's order, and it is unlikely the urgent care center will be performing surgery.
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