A client has been instructed in how to take her nitroglycerin tablets. The nurse giving her instructions knows the client understands the information…

The standard protocol for using sublingual nitroglycerin for acute anginal pain is to take one dose and wait five minutes. If the pain is not relieved, a second dose can be taken, and if it persists after another five minutes, a third dose. If chest pain is not relieved after three doses over 15 minutes, it is considered a medical emergency, potentially a myocardial infarction. The client must seek immediate medical help by calling 911 or their physician. This client's statement correctly reflects an understanding of this critical emergency protocol.

A. Headache is a common, expected side effect of nitroglycerin due to vasodilation and does not typically require physician notification unless severe or persistent.

B. Nitroglycerin tablets are sensitive to heat, light, and moisture and should be kept in their original dark glass container at room temperature, not refrigerated.

D. Sublingual tablets are placed under the tongue to dissolve for rapid absorption into the bloodstream; they should not be swallowed with water or any other liquid.

1. Adams, M. P., Holland, L. N., & Urban, C. Q. (2020). Pharmacology for Nurses: A Pathophysiologic Approach (6th ed.). Pearson. In Chapter 23, "Drugs for Angina Pectoris and Myocardial Infarction," the patient education section for nitrates specifies that if chest pain does not respond after 10 to 15 minutes after two or three doses, the patient should seek immediate medical attention. It also lists headache as a common side effect and details proper storage.

2. Vallerand, A. H., & Sanoski, C. A. (2021). Davis's Drug Guide for Nurses (17th ed.). F.A. Davis Company. In the monograph for Nitroglycerin, under "Patient/Family Teaching," it instructs patients to call for emergency help if anginal pain is not relieved by 3 tablets in 15 minutes. It also specifies storage at room temperature and notes that headache is a common side effect.

3. Johns Hopkins Medicine. (n.d.). Nitroglycerin (Sublingual Route, Oral Route). In the "Proper Use" section, it is stated: "If the pain is not relieved after a total of 3 tablets in a 15-minute period, call your doctor or go to a hospital emergency room right away." The "Precautions" section lists headache as a known side effect, and the "Storage" section advises against refrigeration.