A nurse is caring for a client who develops the rhythm below. The client is unresponsive, pulseless, and apneic. Which of the following actions should the nurse expect to do first?

A) It is pain that can be relieved with rest:
Stable angina is typically predictable and occurs during physical exertion or emotional stress when the heart’s oxygen demand exceeds its supply. The pain associated with stable angina usually resolves with rest or after the cessation of the activity that triggered it. Additionally, nitroglycerin can help alleviate the discomfort by dilating blood vessels and improving blood flow to the heart muscle.

B) It is normal pain that will go away on its own:
Although stable angina pain may resolve on its own when the precipitating factor (e.g., exercise or stress) is removed, it is not considered "normal" pain. The pain is a symptom of underlying coronary artery disease (CAD), indicating that the heart muscle is not getting enough oxygen. It’s important for the client to manage angina carefully, as it may progress to more serious forms, such as unstable angina or myocardial infarction (heart attack), if not addressed appropriately.

C) It is pain that is not relieved by taking nitroglycerin:
Nitroglycerin is commonly effective in relieving stable angina by relaxing the coronary arteries and improving blood flow to the heart. If a client’s angina is not relieved by nitroglycerin, it may indicate that the angina is no longer stable (i.e., it has become unstable angina) or that a more serious cardiovascular event is occurring, such as a heart attack.

D) It is pain that requires a cardiac catheterization:
Cardiac catheterization is a diagnostic and interventional procedure typically used when a patient has unstable angina or a history of myocardial infarction or when other treatments have failed. However, stable angina usually does not require immediate catheterization unless the pain is refractory or there is evidence of significant coronary artery blockage. The most common management for stable angina is lifestyle modifications, medications (e.g., nitroglycerin, beta-blockers, calcium channel blockers), and addressing risk factors for coronary artery disease.

A) Unilateral upper extremity weakness:
Guillain-Barré Syndrome (GBS) typically presents with bilateral weakness, not unilateral. The weakness in GBS typically begins symmetrically in the lower extremities and ascends upward toward the upper body, including the arms, face, and respiratory muscles. Therefore, unilateral weakness is not characteristic of GBS, and its presence should prompt further investigation into other possible causes.

B) Bilateral ascending weakness:
One of the hallmark signs of Guillain-Barré Syndrome is ascending weakness, which means that the weakness usually starts in the lower extremities (legs) and progresses upwards to the upper extremities, face, and potentially the respiratory muscles. This bilateral ascending paralysis is a classic feature of GBS and occurs due to the immune system attacking the myelin sheath of peripheral nerves. The nurse should be vigilant for signs of progressive weakness, as GBS can quickly lead to respiratory failure and requires prompt intervention.

C) Mask-like facial expressions:
Mask-like facial expressions are more commonly associated with Parkinson's disease, not Guillain-Barré Syndrome. Parkinson’s disease is characterized by a reduction in facial expressiveness due to the loss of dopaminergic neurons, leading to a fixed, unblinking, or "masked" appearance. While facial involvement can occur in GBS as the weakness ascends, it is not typically described as a "mask-like" expression.

D) Pill rolling actions made by the client's fingers:
Pill-rolling is a characteristic tremor often associated with Parkinson's disease and involves the repetitive motion of the fingers, as if rolling a pill. It is a resting tremor seen in Parkinson's disease and not in Guillain-Barré Syndrome. GBS primarily presents as weakness and loss of motor function, rather than tremors or other involuntary movements.