Pharmacology Nitro / Angina #7

Question

The nurse is caring for a patient admitted to the hospital for chest pain. Nitroglycerin sublingual is given one time without relief. The blood pressure drops from 142/94 to 120/72. Which action should the nurse perform next?

Answers

  1. Administer another dose of NTG sublingually.
    • Rationale:

      This answer is correct because the proper chest pain protocol is taking nitroglycerin sublingual (under the tongue) every 5 minutes for up to 3 times. Since the medication is a vasodilator, the blood pressure can decrease substantially. If the systolic blood pressure remains above 100 mm/Hg, it is safe to give. If the blood pressure falls below that, the health care provider should be contacted and a fluid bolus may be prescribed to raise the blood pressure to a safe level.

  2. Administer oxygen at 3L/min per nasal cannula.
    • Rationale:

      This answer is not correct because although oxygen therapy is part of the chest pain protocol, another nitroglycerin tablet is warranted at this time then, oxygen can be placed. There is no indication of oxygen saturation but there is indication of chest pain. The priority is administration of nitroglycerin.

  3. Notify the health care provider.
    • Rationale:

      This answer is not correct because it is not necessary to contact the health care provider at this time. The blood pressure is adequate enough to give the nitroglycerin per protocol. If the systolic blood pressure remains above 100 mm/Hg, it is safe to give. If the blood pressure falls below that, the health care provider should be contacted and a fluid bolus may be prescribed to raise the blood pressure to a safe level.

  4. Lay the patient supine.
    • Rationale:

      This answer is not correct because the patient’s blood pressure is high enough, lying them supine is not as important as giving the next dose of nitroglycerin. The patient can experience orthostatic hypotension with nitroglycerin therapy and should be lying in the bed but lying flat is not necessary at this time.

Overview

Nitroglycerin sublingual will lower the blood pressure of the patient taking it. Up to three doses can be taken, if the blood pressure stays at a safe level.

Explanation

The correct answer is A since another dose of NTG is warranted for unrelieved chest pain, five minutes apart. Follow institutional policies on how many doses may be given. Many have policies for NTG every 5 minutes up to three times, then activate the cardiac protocols. Some may have policies for 2 doses. While it is important to maintain oxygenation, administering the NTG comes first, since the pain may ease (selection B—incorrect). Likewise, the healthcare provider does not need notification for the first NTG dose unless other symptoms are present. Selection D is incorrect. Lying supine does not help the chest pain.

Learning Outcomes

Nitroglycerin sublingual is a vasodilator medication given in emergency situations when chest pain is involved. The proper chest pain protocol is taking nitroglycerin sublingual (under the tongue) every 5 minutes for up to 3 times. Since the medication is a vasodilator, the blood pressure can decrease substantially. If the systolic blood pressure remains above 100 mm/Hg, it is safe to give. If the blood pressure falls below that, the health care provider should be contacted and a fluid bolus may be prescribed to raise the blood pressure to a safe level.

Test Taking Tip

Remember, nitrOglycerin can make the patient hypOtensive, so carefully monitor the blood pressure before and during administration.

Video Rationale