A nurse suspects cardiogenic shock after a myocardial infarction. Which action is the priority?

• A. Administer analgesics for pain
• B. Provide a large intravenous fluid bolus
• C. Place patient in Trendelenburg position
• D. Administer supplemental oxygen and position to optimize ventilation

Answer: (D)

In cardiogenic shock after a myocardial infarction, the heart can’t pump effectively, so tissues rapidly become starved of oxygen. The first priority is to maximize oxygen delivery to those tissues. Providing supplemental oxygen raises the amount of oxygen carried in the blood, helping organs function despite reduced cardiac output. Positioning the patient with the head of the bed elevated supports better chest mechanics and ventilation, making it easier to breathe and improving gas exchange.

Other actions don’t address the immediate need for oxygenation and can even worsen the situation: giving analgesics can lower blood pressure or depress respiration; a large IV fluid bolus can overload a failing heart and worsen pulmonary edema; placing the patient in Trendelenburg increases venous return and can worsen congestion and dyspnea.

So, prioritizing supplemental oxygen and a position that optimizes ventilation directly supports tissue oxygenation and patient stability in this scenario.