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.

Rationale: A. Blood glucose level: The client’s blood glucose is 103 mg/dL, which falls within the normal reference range of 74 to 106 mg/dL. Although the client has a history of type 2 diabetes mellitus, this value does not indicate acute hypo- or hyperglycemia. It does not contribute to the current emergent presentation. B. Bowel sounds: Bowel sounds are present in all four quadrants, indicating intact gastrointestinal motility. This assessment finding does not relate to the client’s acute cardiac symptoms. There is no evidence suggesting an abdominal or gastrointestinal emergency requiring immediate intervention. C. Blood pressure: The blood pressure is 164/80 mm Hg, indicating systolic hypertension. Elevated blood pressure increases myocardial oxygen demand and can worsen ischemia during an acute coronary event. In the setting of chest pain and ST-segment elevation, uncontrolled hypertension requires prompt management to reduce cardiac workload and limit myocardial injury. D. Pain level: The client reports chest pain rated 7 out of 10 with radiation to the left arm, accompanied by diaphoresis and shortness of breath. Persistent, severe chest pain suggests ongoing myocardial ischemia. Immediate follow-up is necessary to initiate interventions such as oxygen, nitrates, antiplatelet therapy, and rapid reperfusion strategies. E. Electrocardiogram findings: The 12-lead ECG shows tachycardia with ST-segment elevation and T-wave changes, which are classic indicators of acute ST-elevation myocardial infarction (STEMI). ST elevation reflects transmural myocardial injury requiring urgent reperfusion therapy. This finding demands immediate action to prevent irreversible myocardial necrosis. F. Lung sounds: Lung sounds are clear in all lobes, indicating no evidence of pulmonary edema or acute respiratory compromise at this time. This assessment does not signal an immediate complication requiring intervention. G. Troponin T level: The troponin T level is 0.40 ng/mL, significantly above the reference range of less than 0.1 ng/mL. Elevated troponin indicates myocardial cell injury and necrosis. In combination with ST-segment elevation and clinical symptoms, this confirms acute myocardial infarction requiring urgent treatment.