A nurse is admitting a client who reports tightness in their chest that radiates to left arm. For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

Rationale for correct choices • Metoprolol 15 mg IV bolus: The client has tachycardia with irregular rhythm and elevated blood pressure, indicating increased cardiac workload. Metoprolol, a beta-blocker, reduces heart rate, myocardial oxygen demand, and blood pressure, which is essential in managing acute coronary syndrome (ACS). Monitoring heart rate and blood pressure during administration is necessary to avoid bradycardia or hypotension. • Oxygen at 2 L/min via nasal cannula: Oxygen saturation is 93% on room air with shortness of breath and chest pain, indicating mild hypoxemia. Supplemental oxygen improves tissue oxygenation and reduces cardiac stress during an acute ischemic event. Continuous monitoring ensures effectiveness and prevents hyperoxia. • Draw electrolytes along with Hgb and Hct: Electrolytes and hemoglobin/hematocrit are important for evaluating cardiac and perfusion status, especially in acute myocardial injury. Imbalances in potassium, magnesium, or calcium can worsen arrhythmias, and baseline labs guide safe administration of medications such as beta-blockers or antiarrhythmics. • Morphine 6 mg IV bolus every 3 hr as needed for pain: The client reports severe chest pain (7/10) with diaphoresis, nausea, and anxiety. Morphine reduces pain, decreases sympathetic stimulation, and lowers myocardial oxygen demand. It also alleviates associated anxiety, which can improve hemodynamic stability. • Nitroglycerin 0.5 mg SL now may repeat every 5 min up to 3 doses: Nitroglycerin helps relieve ischemic chest pain by dilating coronary vessels and decreasing preload. In the context of ST-segment elevation and ongoing chest discomfort, SL nitroglycerin is appropriate to manage symptoms and improve myocardial perfusion. Blood pressure must be monitored for hypotension. • Obtain daily weight: Daily weight is more relevant for fluid management in heart failure or chronic conditions. While useful for long-term monitoring, it is nonessential for acute management of myocardial ischemia in this scenario. • Atropine 0.5 mg IV bolus every 5 min up to 2 mg if heart rate drops below 60: The client is currently tachycardic (110/min) with irregular rhythm. Atropine, which increases heart rate, is contraindicated because it would worsen tachycardia and myocardial oxygen demand. It is only indicated for bradycardia, not the client’s current presentation.