Final answer:
The nurse's first priority when a patient experiences sudden chest pain is to raise the head of the bed and then call for the rapid response team. This provides immediate relief and secures emergency support. After that, the nurse should assess the pain and administer medications as needed.
Step-by-step explanation:
When a nurse is caring for a patient who suddenly experiences chest pain, the first priority is to assess the situation to determine the severity of the condition. Among the options provided, the most immediate action would be to raise the head of the bed if the patient's condition allows it, as this can help alleviate the pain by reducing the workload on the heart and improving respiratory function. Subsequently, the nurse should call for help, which could include the rapid response team, as this indicates a likely emergency. Asking the patient to rate and describe the pain and then administer pain relief medications can be done in sequence after securing emergency support and stabilizing the patient's position.
The onset of chest pain, like angina pectoris or symptoms suggesting an acute myocardial infarction (MI), requires quick action. Symptoms accompanying chest pain can include difficulty breathing, shortness of breath, irregular heartbeat, and lightheadedness. Differential diagnosis is critical as chest pain can be indicative of several different conditions; thus, the nurse should promptly initiate protocols designed for such emergencies before proceeding with further interventions.