Introduction
Scenario setup
In the ED, a 55-year-old with known CAD reports 9/10 chest pressure with nausea. BP 88/60, HR 110, RR 26, SpO₂ 90% on 4 L. ECG shows ST elevations in contiguous leads. The client is cool and clammy.
This is STEMI physiology with shock features—perfusion failure and time-critical reperfusion. RN priorities: resuscitation support, continuous monitoring, medication administration per order, and preparation for reperfusion (PCI vs thrombolysis per protocol). RN traps: prioritizing paperwork, leaving unstable clients to get equipment alone without handoff, or delaying notification. Expect team coordination and reassessment loops. This case-study format is intentional: boards reward trajectory thinking—what changed, what is unstable, and what you do next for the role named in the stem. For NCLEX-RN (United States), read the assignment line before you eliminate answers. Slow read: re-scan the stem for vitals trends, oxygen settings, allergies, and time since onset—case items often hide the decisive clue in a single line. On the exam, writers often pair with —notice the mismatch before you commit. If the stem names a , reread that line; are classic trap answers even when the clinical topic is familiar.