Question

The nurse triages clients in the outpatient pain clinic. Which client does the nurse see first?

1. A client with a history of a herniated lumbar disc and who reports severe pain radiating down the left leg.
2. A client with a history of migraine headaches and who reports a headache and light sensitivity.
3. A client with a history of kidney stones and who tearfully reports severe right flank pain.
4. A client with a history of coronary artery disease and who reports mid-epigastric pain radiating to the neck.

Answer 1

The nurse should prioritize the client with symptoms indicative of an acute myocardial infarction: mid-epigastric pain radiating to the neck, which is a potential sign of a heart attack. The option (D) is correct.

Step-by-step explanation:

The nurse should see the client with a history of coronary artery disease reporting mid-epigastric pain radiating to the neck first. This presentation is concerning for acute myocardial infarction (AMI), which is a medical emergency. Of the given options, this client's symptoms are the most concerning because they could indicate an impending or current heart attack. Pain related to coronary artery disease may present as referred pain, where the individual experiences pain in areas not directly associated with the source of the pain, because of the way nerves from the heart enter the same areas of the spinal cord that receive signals from other upper body regions.

The other clients have significant conditions—herniated lumbar disc, migraines, and kidney stones—which also require timely evaluation, but these are not immediate life-threatening emergencies compared to the symptoms suggestive of an AMI. Therefore, option (D) is correct.