The nurse is reviewing the laboratory data of a client diagnosed with coronary artery disease. Which set of laboratory results indicates a need for client teaching regarding dietary modifications?

Choice A reason: Performing a 12-lead electrocardiogram and calling a rapid response is not the first action that the nurse should take. A 12-lead electrocardiogram is a test that measures the electrical activity of the heart and can help diagnose a heart attack or other cardiac problems. ¹ A rapid response is a team of healthcare professionals that can provide immediate care to a client who is experiencing a life-threatening emergency. ² However, these actions are not the priority for a client who has chest pain while brushing their teeth. The nurse should first assess the client's condition and provide comfort measures before performing any tests or calling for help.

Choice B reason: Withholding the client's medications until the healthcare provider arrives is not the first action that the nurse should take. The client's medications may include drugs that can relieve chest pain, such as nitroglycerin, aspirin, or beta-blockers. ³ These drugs can help dilate the blood vessels, prevent blood clots, or reduce the workload of the heart. ³ The nurse should not withhold these medications, as they may help the client's condition and prevent further complications. The nurse should check the client's medication orders and administer them as prescribed.

Choice C reason: Instructing the client to stop the activity and provide a chair is the first action that the nurse should take. Chest pain is a common symptom of coronary artery disease, which is a condition where the arteries that supply blood to the heart become narrowed or blocked by plaque. ⁴ Chest pain can be triggered by physical or emotional stress, such as brushing the teeth, which can increase the heart rate and blood pressure. ⁵ The nurse should instruct the client to stop the activity and provide a chair, as this can help reduce the stress on the heart and ease the chest pain. The nurse should also monitor the client's vital signs and oxygen saturation, and provide oxygen if needed.

Choice D reason: Calling the healthcare provider immediately about the client's complaint is not the first action that the nurse should take. The healthcare provider may need to be notified about the client's condition, especially if the chest pain is severe, persistent, or accompanied by other symptoms, such as shortness of breath, nausea, or sweating. ⁵ However, the nurse should first assess the client's condition and provide comfort measures before calling the healthcare provider. The nurse should also be prepared to initiate emergency protocols if the chest pain does not improve or worsens.

Choice A reason: Furosemide 40 mg PO daily is not the medication that the nurse should administer for chest pain. Furosemide is a diuretic that reduces fluid volume and lowers blood pressure, but it does not relieve anginal pain.

Choice B reason: Diltiazem 30 mg PO daily is not the medication that the nurse should administer for chest pain. Diltiazem is a calcium channel blocker that relaxes the blood vessels and lowers blood pressure, but it does not act quickly enough to relieve acute anginal pain.

Choice C reason: Metoprolol 25 mg PO bid is not the medication that the nurse should administer for chest pain. Metoprolol is a beta blocker that slows down the heart rate and lowers blood pressure, but it does not act quickly enough to relieve acute anginal pain.

Choice D reason: Nitroglycerin 0.4 mg SL PRN is the medication that the nurse should administer for chest pain. Nitroglycerin is a nitrate that dilates the coronary arteries and increases blood flow to the heart, thus relieving anginal pain. It is given sublingually (under the tongue) as needed for chest pain.