A nurse is caring for a client who has been on hemodialysis for the past 5 years. The client is refusing hemodialysis and says, "I'm tired of wasting my life; I would rather die." Which of the following statements should the nurse make?

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.

Rationale:

A. Check the label of the medication twice prior to administration: Safe medication practice requires the nurse to check the medication label three times, when retrieving, preparing, and before administering to minimize the risk of medication errors.

B. Use two identifiers to verify the client's identity: Using two patient identifiers, such as name and date of birth, ensures the medication is given to the correct individual. This step is crucial for patient safety and is a core component of safe medication administration practices.

C. Document administration of the client's routine medications at the beginning of the shift: Medications should only be documented after they have been administered. Pre-charting medication administration can lead to errors if the medication is delayed, omitted, or refused.

D. Ensure the medication is administered within 3 hr of the scheduled time: Medications are typically required to be administered within 30 minutes to 1 hour of the scheduled time unless otherwise specified. A 3-hour window is too broad and may compromise therapeutic effectiveness.