A nurse is collecting data from a client prior to administering a calcium channel blocker (CCB) for treatment of hypertension. For which of the following findings should the nurse contact the provider?

(A) “Incorporate walking into your daily routine.”: This is the most appropriate instruction for a client with peripheral arterial disease (PAD). Regular exercise, such as walking, can help improve circulation, increase the distance a person can walk without pain, and promote overall cardiovascular health. It’s important to start slow and gradually increase the duration and intensity of the exercise as tolerated. The client should be advised to stop and rest if they experience any pain.

(B) “Elevate your legs while in bed.”: While elevating the legs can help reduce swelling in some conditions, it’s not typically recommended for clients with PAD. Elevation can actually decrease arterial blood flow to the legs, which could worsen symptoms.

(c) “Shop for new shoes during the morning hours.”: This instruction is more relevant for clients with conditions that cause foot swelling, such as heart failure or venous insufficiency. In PAD, the size of the feet does not typically change throughout the day.

(D) “Wear knee length stockings.”: Compression stockings are often used to improve venous circulation in conditions like deep vein thrombosis or chronic venous insufficiency. However, they’re not typically recommended for clients with PAD as they can restrict arterial blood flow.

A. Insert the IV catheter:

Inserting an IV catheter is necessary to administer IV fluids and medications. However, it is not the most immediate need. The priority is to address the client's oxygenation status first to stabilize them before proceeding with other interventions.

B. Obtain a blood sample:

Obtaining a blood sample for cardiac enzyme levels is important to diagnose a myocardial infarction. Nevertheless, this step should be taken after ensuring the client is receiving adequate oxygen, as hypoxia needs to be addressed immediately.

C. Attach the leads for a 12-lead ECG:

Attaching the leads for a 12-lead ECG is crucial for diagnosing the client's cardiac condition. However, it should be done after initiating oxygen therapy, as improving the client's oxygenation status is more urgent and can help stabilize the client for further diagnostic procedures.

D. Initiate oxygen therapy:

Initiating oxygen therapy is the most critical first action. The client is experiencing severe chest pain, shortness of breath, and signs of cyanosis, indicating that their oxygen levels are insufficient. Providing oxygen at 4 L/min via nasal cannula will help alleviate hypoxia, improve the client's condition, and provide time for further diagnostic and therapeutic interventions.