I agree with #1, not with #2. There are 2 occassions where a nurse should question a doctor's orders: 1) when its unsafe; 2) when its an obvious oversight or duplicate order. The scenario described by the OP fits neither of those scenarios. Its not like the resident ordered a heparin drip for musculoskeletal chest pain. THAT is an unsafe order and needs to be questioned. Doing stat troponins, CXR, EKG DOES NOT HARM THE PATIENT AND IS A VALUABLE DIAGNOSTIC WORKUP, therefore it should have been done, as ordered.
You are ABSOLUTELY wrong here, and it illustrates the trouble that nurses have when they think they can replace the thinking of doctors. While its true that chest pain should be evaluated in person by a doctor, there are studies showing that musculoskeletal chest pain vs ischemic chest pain in post-op patients cant be distinguished very well by most patients. Therefore they deserve a basic workup. As for troponins being "worthless" in OHS cases, again you are absolutely WRONG on this point. Of course they are going to have elevated troponins, but the TREND in troponin rise is critical. Lets say you have a pre-op heart patient with troponin of 200. Post-op, it rises to 500 due to myocardial injury from the procedure. Then, it will commonly start to drop off slowly, maybe 2 days post-op its down to 250. Then the patient c/o chest pain on POD #3 and the troponin level is back up to 400. Are you honestly going to sit there and ignore the troponin level because you say its "useless" in OHS cases? Thats absolutely wrong logic, if post-op troponins rise at hte same time the pt is c/o chest pain, then you have to assume that they are having an ischemic event post-op that needs to be managed. Again, to say that troponins serve no role in the post-op care of OHS patients is ridiculous. Thats something that DOCTORS, not NURSES, are trained to address and you are wrong for thinking you have the knowledge base to make that decision.
Thats no justification for ignoring the order. If you are getting swamped by critically ill patients and cant keep up with them all, then its your responsibility to notify the charge nurse and have somebody else help you out. You cant in good conscience say "I'm too busy with my other patients to deal with this patient who could be having a life-changing ischemic event."