the nurse practitioner (np) is working at a health clinic in a homeless shelter during the early evening. a 48-year-old african american man approaches the practitioner and asks to have his blood pressure taken, saying that he has not had it checked "in a while". the man appears to be in some type of distress and experiencing pain. the man walks slowly, using a guarded manner, and he appears diaphoretic. his mucous membranes also appear pale. the patient’s blood pressure is 210/98. the patient reports that he has not been diagnosed with hypertension previously. the patient reveals that he has severe abdominal pain that is radiating to his back. the nurse finds a heart rate of 110, respirations 30 with shallow inspirations, and temperature 102.2°f. the patient’s skin is cool and clammy.