A nurse is assisting with the care of a client on a medical surgical unit who was admitted from the emergency department.

Exhibits

For each assessment finding on Day 2 click to specify if the finding is due to lisinopril, carvedilol, or furosemide. Each finding may be related to more than 1 medication.

A. Physicians' Desk Reference (PDR). The PDR is a comprehensive drug reference that provides essential information on medications, including indications, dosages, contraindications, adverse effects, and interactions. It is a reliable resource for nurses to review before administering an unfamiliar medication.
B. State Nurse Practice Act (NPA). The NPA defines the scope of nursing practice and legal responsibilities but does not provide specific drug information. While it guides nurses on legal and ethical aspects of medication administration, it is not a medication reference.
C. Agency for Healthcare Research and Quality (AHRQ). AHRQ focuses on improving healthcare quality and patient safety but does not serve as a primary source for drug-specific information. It provides guidelines and research on best practices rather than detailed medication data.
D. Quality and Safety Education for Nurses (QSEN). QSEN aims to improve nursing education and competency in patient safety but does not offer detailed drug reference materials. It emphasizes principles such as evidence-based practice and quality improvement rather than specific medication details.

• Administer sublingual nitroglycerin. Nitroglycerin is a first-line treatment for angina or suspected myocardial infarction. It dilates coronary arteries, improving blood flow and reducing myocardial oxygen demand.
• Apply supplemental oxygen. Routine oxygen administration is no longer recommended unless the client is hypoxic (oxygen saturation below 90%) because excessive oxygen can lead to vasoconstriction and worsen myocardial injury.
• Obtain a 12-lead ECG. While an ECG is important for diagnosing myocardial infarction, the priority in an acute chest pain episode is symptom relief and hemodynamic stability. The ECG should already have been obtained at admission.
• Administer morphine sulfate IV. Morphine is used to manage severe chest pain that is not relieved by nitroglycerin. It reduces myocardial oxygen demand, preload, and anxiety, which can help relieve symptoms.
• Monitor vital signs. Continuous monitoring is essential, but it is not the most immediate intervention in an acute episode of worsening chest pain. The focus should be on relieving ischemia and reducing myocardial workload.
• Educate the client about smoking cessation. While smoking cessation is critical for long-term cardiovascular health, education is not a priority when the client is experiencing acute chest pain requiring immediate intervention.