Final answer:
The first action to implement for a cardiac patient with new-onset chest pain is to increase the oxygen supply, hence the correct answer is A. Apply 4 L of oxygen as ordered.
Step-by-step explanation:
A client with stable angina has reported new-onset chest pain and changes in vital signs. The most appropriate initial nursing action, in this case, would be to increase oxygen delivery. As per the Advanced Cardiac Life Support (ACLS) guidelines, increasing oxygen can help alleviate cardiac-related chest pain caused by myocardial ischemia, which is the likely cause of anginal pain. So the first action the nurse should implement is A. Apply 4 L of oxygen as ordered.
It is critical to address the patient's oxygenation status prior to administering medications like opioids for pain control or other interventions, as hypoxemia can exacerbate ischemia. The patient already has a known cardiac history, and the slight drop in blood pressure along with the increased respiratory rate may indicate that the patient's condition is worsening. Once the oxygen is applied, subsequent measures should include reassessment of the patient's symptoms and vital signs, administering opioid as prescribed if appropriate, and considering fluid resuscitation if the patient is showing signs of hypovolemia or cardiogenic shock.
The nurse should implement action B, which is to administer a fluid bolus of 0.9 normal saline, as the first step in managing the client's chest pain and low blood pressure. The symptoms of chest pain, diaphoresis, and pale appearance, along with the low blood pressure, suggest that the client may be experiencing a hypovolemic shock due to inadequate fluid volume. Administering a fluid bolus will help increase the client's fluid volume, improve blood flow, and potentially alleviate the symptoms.
Actions A and C are not the first priority because oxygen administration and opioid administration do not directly address the underlying cause of the client's symptoms.
Action D, obtaining a full set of vital signs, including temperature, is important to assess the client's overall condition, but it is not the first priority when the client is presenting with symptoms of hypovolemic shock.