A nurse is caring for a client in the emergency department (ED). The client presents with substernal chest pain that comes and goes.

• The client states that the pain has been occurring for the last 6 hours.
• The pain, at times, radiates down the left arm.
• The client also reports intermittent nausea.
• The client appears pale and slightly diaphoretic.
• The client rates current pain as 8 on a scale of 0 to 10. The nurse is planning care for the client.

For each potential prescription, indicate whether it is indicated, nonessential, or contraindicated.

Choice A - Indicated:

• Administering oxygen to maintain oxygen saturation >94% is recommended in suspected acute coronary syndrome (ACS) to prevent myocardial hypoxia.
• Oxygen therapy is not routinely given if SpO₂ is ≥94%, but if there are signs of hypoxia, respiratory distress, or low saturation, it is appropriate.

Choice B - Contraindicated:

• Intubation is not indicated unless the patient has severe respiratory distress or impending respiratory failure.
• This client is not in respiratory failure (no severe dyspnea, altered consciousness, or worsening hypoxia).

Choice C - Indicated:

• Continuous ECG monitoring is essential in suspected ACS to detect arrhythmias, ischemia, and ST changes.
• ECG findings will guide early intervention, including medication administration (e.g., aspirin, nitroglycerin) or reperfusion therapy.

Choice D - Nonessential:

• Family history of cardiovascular disease is important for risk assessment but is not a priority in an acute setting.
• While it can help with long-term management, immediate interventions (oxygen, ECG, medications) take precedence.