A patient with a femur fracture 8 hours ago reports sudden dyspnea and chest pain. The nurse should first:

• A. Admin IV vasopressor
• B. Check Chvostek's sign
• C. Monitor for headache
• D. Provide high flow oxygen

Answer: (D)

When a patient with a recent long-bone fracture develops sudden dyspnea and chest pain, think fat embolism syndrome causing acute hypoxemia. The immediate priority is to improve oxygenation, so providing high-flow oxygen is the best first action. Oxygen therapy helps raise the blood’s oxygen content and supports tissues while the underlying fat droplets in the pulmonary circulation are managed supportively.

Other choices don’t address the most urgent need. An IV vasopressor would be used if there were hypotension or shock, not as the first response to dyspnea with chest pain. Checking a Chvostek’s sign relates to calcium status and isn’t an acute intervention for this presentation. Monitoring for headache may be relevant to neurological assessment, but it doesn’t treat the immediate hypoxemia the patient is experiencing.

In fat embolism syndrome, management is supportive, with oxygen therapy being the cornerstone to stabilize respiration, followed by escalation to more advanced support if needed.