Question

A nurse cares for a client with pericarditis and notes inverted T waves on the ECG. What priority intervention by the nurse is most appropriate?

A. Notify HCP
B. Assess the client for chest discomfort
C. Obtain vital signs including O2 sat
D. administer O2 100%

Answer 1

The most appropriate initial intervention by the nurse for a client with pericarditis and inverted T waves on ECG would be to assess the client for chest discomfort, providing immediate information on the clinical status.

Step-by-step explanation:

A nurse caring for a client with pericarditis who observes inverted T waves on the ECG should prioritize the assessment of the patient before jumping to other interventions. Considering that inverted T waves may indicate myocardial ischemia, a condition where insufficient oxygen is being delivered to the myocardium, the nurse should first assess the client for chest discomfort. This symptom assessment provides immediate information on the client's clinical status and potential worsening of their condition. After assessing the patient, the nurse would proceed with other steps such as notifying the healthcare provider, obtaining vital signs including O2 saturation, and administrating oxygen if prescribed or following protocol. In cases of acute pericarditis, looking out for signs like chest pain, difficulty breathing, and a dry cough is crucial as they indicate inflammation of the tissues surrounding the heart.