A hypertensive patient has been admitted in a ward for observation. He informs the attending nurse about squeezing pain in the chest even at rest. Which of the following action is necessary for the patient?

1. A

   Give ibuprofen tablet to reduce pain

2. B

   Advise the patient to move out for fresh air

3. C

   Rest to the patient and call the attending doctor

4. D

   Inform the patient that he is fine nothing to worry

Appeared in: BHU NO - 2015

Explanation

• Squeezing chest pain at rest is a hallmark symptom of unstable angina or a myocardial infarction (MI), which are medical emergencies.
• The immediate priority is to reduce the heart's oxygen demand by placing the patient at complete rest.
• Simultaneously, the nurse must urgently notify the attending physician to initiate emergency cardiac protocols for diagnosis (e.g., ECG) and treatment.

Why Other Options Were Wrong

• Option A: Ibuprofen, an NSAID, is contraindicated in suspected MI as it can increase the risk of cardiovascular events and interfere with the antiplatelet effect of aspirin.
• Option B: Any physical activity, including walking, increases the heart's workload and oxygen consumption, which can worsen myocardial ischemia and extend the area of infarction.
• Option D: Dismissing a potentially life-threatening symptom is negligent. It delays critical treatment and undermines patient trust. Chest pain should always be taken seriously until proven otherwise.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Immediate nursing management of a patient with suspected acute coronary syndrome (ACS) or myocardial infarction (MI) to guide bedside assessment, documentation, and the next nursing action.
• Recognizing the signs of an acute coronary syndrome and acting swiftly is a core nursing competency that directly impacts patient survival and reduces myocardial damage.
• The nurse is often the first healthcare professional to witness these events. Prompt and correct initial actions, like ensuring rest and escalating care, are life-saving interventions.
• What if? - If the patient's chest pain was described as sharp, localized, and worse on deep inspiration, the nurse might suspect a pulmonary or musculoskeletal cause (like pleurisy or costochondritis) instead of a cardiac one. While still requiring a doctor's evaluation, the urgency level might be slightly different, and the initial focus would be on respiratory assessment.

How to Approach the Question

• First, identify the key clinical details in the scenario: a patient with a history of hypertension is experiencing 'squeezing pain in the chest' even 'at rest'.
• Recognize that this combination of symptoms points strongly towards a cardiac emergency, such as unstable angina or a myocardial infarction (MI).
• Evaluate each option based on the primary goals for managing a suspected MI: 1) Decrease the heart's workload and oxygen demand, and 2) Get immediate medical intervention.
• Eliminate Option A (Ibuprofen) because NSAIDs are harmful in this context.
• Eliminate Option B (Move for fresh air) because physical activity is dangerous as it increases cardiac workload.
• Eliminate Option D (False reassurance) because it is negligent and delays life-saving care.

Concept Tested & Keywords

• Concept Tested: Immediate nursing management of a patient with suspected acute coronary syndrome (ACS) or myocardial infarction (MI).
• Stem keywords: hypertensive patient, squeezing pain in the chest, at rest, nursing action
• Lead-in keywords: necessary action
• Clinical cues: Chest pain at rest is a red flag for unstable angina or MI.
• Clinical cues: History of hypertension increases cardiovascular risk.

Question ID

QhVOvGPFJy1BSSpGwoR-Py

Copy ID

Reference Book

E6 Medicine Macleod Clinical Examination 15e p. 416-418

E6 Nursing Fundamentals Potter Perry 12e Part 1 p. 245-247