A group of nurse managers is discussing cost effectiveness with hospital administrators. Which of the following statements indicates a strategy for cost effectiveness?

Rationale:

A. "Placement of the catheter is confirmed by a CT scan.": Catheter placement is typically confirmed by a chest X-ray, not a CT scan, to verify correct positioning and rule out complications such as pneumothorax. CT imaging is not routine for this purpose.

B. "You will be under general anesthesia for this procedure.": Placement of a nontunneled percutaneous central line is usually done under local anesthesia with possible mild sedation. General anesthesia is not required for this relatively short and minimally invasive procedure.

C. "The provider will wear a mask while performing the procedure.": A mask, along with sterile gloves, gown, and drape, is worn to maintain sterile technique and reduce the risk of catheter-related bloodstream infections. This is standard protocol during central line insertion.

D. "Your head will be elevated as high as possible while the catheter is inserted.": The client is usually placed in the Trendelenburg position (head down) during catheter insertion to distend neck veins and reduce the risk of air embolism—not in a high head-elevated position.

Rationale for correct choices:

• Administer oxygen at 2 L/min via nasal cannula: The client's oxygen saturation has dropped to 92% on room air, indicating mild hypoxia. Supplemental oxygen should be administered to improve myocardial oxygenation and reduce ischemia while further interventions are being prepared.
• Administer sublingual nitroglycerin: Nitroglycerin is a first-line medication for chest pain caused by suspected myocardial ischemia. It promotes vasodilation, reduces myocardial oxygen demand, and provides symptom relief. Administering it promptly can help prevent further cardiac damage.

Rationale for incorrect choices:

• Request a prescription for an increase in statin medication: Although the client has hyperlipidemia, increasing the statin dose is not an immediate priority during an acute chest pain episode. Lipid management is important long-term but does not address the acute ischemic event.
• Prepare the client for cardiac catheterization: Cardiac catheterization may eventually be necessary, but it is not the nurse’s first action. The priority is to stabilize the client’s symptoms (oxygenation and pain) before preparing for any invasive diagnostic or therapeutic procedure.
• Check a STAT cardiac troponin: Troponin has already been obtained and is within normal limits at this point. While serial troponins may be needed later, immediate nursing priorities focus on symptom relief and oxygenation rather than repeating the test right away.
• Request a prescription for a beta-blocker: Beta-blockers may be used in the treatment of suspected myocardial infarction to reduce heart rate and myocardial oxygen demand. However, their initiation typically follows pain relief, oxygenation, and diagnostic confirmation, not as the first nursing action.