Chest pain is a common complaint among adult patients. Chest pain may be a signal of an impending life-threatening event. The accurate assessment of chest pain is difficult. The responsibility of identifying a potentially life-threatening condition accompanied by chest pain presents the nurse with an incredible challenge. Chest pain may be caused by a variety of cardiac, respiratory, gastrointestinal and musculoskeletal illnesses. A complete, thorough history that includes family history and risk factors is the most important part of the assessment. The history is followed by the physical assessment. This phase of the assessment process may include important tests such as a chest X ray, 12-lead electrocardiograph and cardiac isoenzymes. A perceptive and observant nurse with astute assessment skills will set the tone for optimal patient treatment leading to a more positive outcome for the patient.