What should be the nurse's first response to a patient displaying acute chest pain?

The most appropriate first response when a patient presents with acute chest pain is to perform an initial assessment and obtain an ECG. This step is crucial because it allows the nurse to quickly ascertain the nature and severity of the patient's condition, as well as any potential underlying causes of the chest pain.

An initial assessment would involve checking the patient's vital signs, obtaining a detailed history of the pain (such as onset, duration, character, and associated symptoms), and conducting a physical examination. Simultaneously, obtaining an electrocardiogram (ECG) can help identify any changes consistent with myocardial ischemia or infarction, which is critical in guiding further treatment.

While administering nitroglycerin, providing oxygen, and calling a code blue may be necessary interventions depending on the findings, these should occur after a thorough initial assessment and ECG have been performed, particularly in a stable patient scenario. This approach ensures that interventions are based on accurate clinical information and tailored to the patient's specific needs. By prioritizing assessment and diagnosis, the nurse establishes a foundation for effective and timely management of the patient's condition.