A nurse is admitting a client who reports tightness in their chest that radiates to left arm. The nurse is reviewing the client's medical record. Select the four findings that require immediate follow-up.

A. Blood glucose level: The client’s blood glucose is 103 mg/dL, which is within normal limits. While monitoring glucose is important for a client with diabetes, this finding does not require immediate follow-up in acute chest pain and suspected myocardial infarction. B. Bowel sounds: Bowel sounds are present in all four quadrants, indicating normal gastrointestinal function. This assessment is routine and does not necessitate urgent follow-up compared with cardiovascular concerns. C. Blood pressure: The client’s blood pressure is 164/80 mm Hg, indicating hypertension. Elevated blood pressure can increase myocardial oxygen demand and worsen cardiac ischemia, making it important to address immediately. D. Pain level: The client reports chest tightness rated 7/10 with radiation to the left arm and associated nausea and diaphoresis. This presentation is characteristic of acute myocardial infarction and requires immediate intervention to reduce myocardial damage and prevent complications. E. Electrocardiogram findings: The ECG shows tachycardia with ST-segment elevation and T-wave changes, indicating myocardial injury or infarction. Immediate follow-up is critical to initiate reperfusion therapy and prevent further cardiac damage. F. Lung sounds: Lungs are clear to auscultation, which is expected and does not indicate acute respiratory compromise. No immediate follow-up is required in this context. G. Troponin T level: Troponin T is elevated at 0.40 ng/mL, confirming myocardial injury. This requires urgent follow-up to guide treatment and assess the extent of cardiac damage.