After receiving a change-of-shift report, which patient admitted to the emergency department should the nurse assess first?

Choice A rationale
Stable angina is characterized by chest pain that occurs with exertion and is relieved by rest. If a patient with angina pectoris is experiencing chest pain at rest and needs to take three nitroglycerin pills to relieve the pain, this is not typical of stable angina.
Choice B rationale
A full-blown acute myocardial infarction (MI), or heart attack, typically presents with severe chest pain, shortness of breath, and other symptoms. While chest pain at rest could be a symptom of an MI, other symptoms would likely be present.
Choice C rationale
Unstable angina is characterized by chest pain that occurs at rest, is severe and prolonged, and is not relieved by nitroglycerin. Therefore, a patient with angina pectoris who is experiencing chest pain at rest and needs to take three nitroglycerin pills to relieve the pain could be experiencing unstable angina.
Choice D rationale
Pulmonary embolus, a blockage in one of the pulmonary arteries in the lungs, typically presents with sudden-onset shortness of breath, chest pain that may become worse upon deep breathing or coughing, and other symptoms. Chest pain at rest could be a symptom of a pulmonary embolus, but other symptoms would likely be present.

Choice A rationale
Low urine osmolarity and creatinine clearance are not the primary indicators of inadequate renal perfusion in a patient being stabilized after an acute coronary syndrome. These measures reflect the concentration of the urine and the kidney’s ability to filter waste from the blood, respectively. While they can be affected by renal perfusion, they are not the most direct or reliable indicators.
Choice B rationale
A decreasing serum blood urea nitrogen (BUN) level is not typically associated with inadequate renal perfusion. In fact, a high BUN level may indicate that the kidneys aren’t working properly. However, BUN levels can be influenced by many factors, including protein intake and liver function, so they are not the most reliable indicator of renal perfusion.
Choice C rationale
A urine output of less than 30 mL/hr is a common sign of inadequate renal perfusion. The kidneys need adequate blood flow to filter waste products from the blood and produce urine. If renal perfusion is inadequate, urine output can decrease.
Choice D rationale
A urine-specific gravity of less than 1.010 is not typically associated with inadequate renal perfusion. Specific gravity is a measure of the concentration of solutes in the urine. It can be influenced by hydration status and certain kidney disorders, but it is not a direct measure of renal perfusion.