Pharmacology Nitro / Angina #6

Question

The nurse is providing discharge instructions for a patient who experienced a myocardial infarction. The discharge instruction includes administration of nitroglycerin for chest pain. Which statement by the patient indicates understanding of instructions on taking nitroglycerin?

Answers

  1. "I will take 2 nitroglycerin tablets 15 minutes apart, and if I do not have any relief I will contact my health provider."
    • Rationale:

      This answer is not correct because the proper way to take nitroglycerin sublingual is to place one pill under the tongue every 5 minutes for up to 3 times. If there is no relief, emergency care should be sought immediately. It is incorrect to take 2 nitroglycerin tablets 15 minutes apart, then, if no relief to contact the health care provider.

  2. "I will place 1 tablet under my tongue 5 minutes apart for up to 3 times, and if I do not have any relief I will seek emergency care immediately.
    • Rationale:

      This answer is correct because patients with a history of MI should be taught the proper way to take sublingual nitroglycerin. The proper way to take nitroglycerin sublingual is to place one pill under the tongue every 5 minutes for up to 3 times. If there is no relief, emergency care should be sought immediately.

  3. "I will take 3-4 nitroglycerin tablets every 5 minutes until the chest pain subsides."
    • Rationale:

      This answer is not correct because taking 3-4 nitroglycerin tablets every 5 minutes until the chest pain subsides is not the correct way to take nitroglycerin. The proper way to take nitroglycerin sublingual is to place one pill under the tongue every 5 minutes for up to 3 times. If there is no relief, emergency care should be sought immediately.

  4. "I will take 1 tablet and lay down for an hour."
    • Rationale:

      This answer is not correct because taking 1 tablet then laying down is not the proper way to take sublingual nitroglycerin for chest pain. The proper way to take nitroglycerin sublingual is to place one pill under the tongue every 5 minutes for up to 3 times. If there is no relief, emergency care should be sought immediately.

Overview

The nurse should teach a patient who has experienced a myocardial infarction (MI) how to take sublingual nitroglycerin. The proper way to take nitroglycerin sublingual is to place one pill under the tongue every 5 minutes for up to 3 times. If there is no relief, emergency care should be sought immediately.

Explanation

Answer is B. Clients with MI may be instructed to call 9-1-1 if no relief after taking 1-3 NTG SL tabs. The health provider will designate for specialized teaching, since some conditions may require calling emergency services after only 1 tab SL if no relief of chest pain, especially for most acute coronary syndromes (per American College of Cardiology). Still others may instruct on 2 tablets. No more than 3 tabs should be administered without calling 9-1-1. Since the answer is in a range of 1-3, it is the best answer for the question. Please note: the question refers to a client who already had an MI. The question is NOT only for a client with angina. No instructions should be given for every 15 minutes, and while 3 NTG (answer C) may be correct, it also lists a 4th dose, and the question indicates an MI has already taken place. (Note that other questions may only state 3 doses. If 3 doses only are indicated, the answer would still be incorrect for post MI. Taking one and laying down is incorrect (answer D).

Learning Outcomes

Nitroglycerin sublingual is a vasodilator medication given in emergency situations when chest pain is involved, such as with myocardial infarction (MI). Patients with a history of MI should be taught the proper way to take sublingual nitroglycerin. The proper way to take nitroglycerin sublingual is to place one pill under the tongue every 5 minutes for up to 3 times. If there is no relief, emergency care should be sought immediately. 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, “3xs 5 to stay alive” when trying to remember how to take nitroglycerin.

Video Rationale