A patient’s chest pain is currently 7 out of 10. The patient is diaphoretic and reports mild nausea. The nurse should anticipate administration of which of these?

• A. Oxygen by mask
• B. Aspirin 325 mg chewable
• C. Morphine 2 mg IV
• D. Nitroglycerin sublingual

Answer: (C)

In acute chest pain suggestive of myocardial ischemia, the immediate goal is to relieve pain and reduce the heart’s oxygen demand so the myocardium can recover. Morphine given intravenously provides rapid, potent analgesia that also helps calm the patient, which lowers sympathetic stimulation and decreases preload and myocardial workload. This combination can quickly improve comfort, reduce heart rate and blood pressure stress, and lessen oxygen demand on the heart when the pain is severe and not easily controlled by other measures. A typical IV dose is small and titratable, such as 2 mg, with careful monitoring for respiratory depression, hypotension, or excessive sedation.

Oxygen by mask is reserved for patients who are hypoxic or in respiratory distress, which isn’t stated here, so it’s not the immediate call based solely on the symptoms described. Nitroglycerin sublingual is also a key ACS therapy to relieve ischemia, but it’s dependent on blood pressure and other factors and is often used after relieving pain or alongside analgesia. Aspirin chewable is a critical antiplatelet treatment to start early, but in the moment of significant pain and distress, providing rapid analgesia with morphine addresses the most urgent symptom—the severe chest pain that’s driving the sympathetic surge.