A client with chest pain received sublingual nitroglycerin and then reports taking sildenafil 12 hours ago. The blood pressure is 76/44 mm Hg, and the client feels dizzy. Which action should the nurse take first?
1Withhold further nitrates, place the client supine, begin an ordered isotonic fluid bolus, monitor continuously, and notify the provider.✓ Correct answer
2Give another nitroglycerin dose, place the client upright, apply oxygen, and reassess the pain and blood pressure in 5 minutes.
3Start a vasopressor immediately, restrict intravenous fluids, insert a urinary catheter, and obtain an echocardiogram before notifying the provider.
4Give morphine for pain, obtain an electrocardiogram and troponin level, and delay treatment of the hypotension until results return.
Explanation
Sildenafil potentiates nitrate-induced vasodilation and can cause profound hypotension. Because sildenafil was taken within 24 hours and the client is unstable, the nurse should withhold further nitrates, support circulation with supine positioning and an ordered isotonic fluid bolus, monitor continuously, and notify the provider. Repeating nitroglycerin can worsen hypotension. A vasopressor may be needed if fluids are insufficient, but it is not the first independent action before initial stabilization and provider direction. Diagnostic testing and pain treatment must not delay correction of severe hypotension.
Clinical reasoning summary Sildenafil and nitrates both increase vasodilation and can produce life-threatening hypotension. Withhold all further nitrates, place the client supine, begin ordered isotonic fluid resuscitation, monitor cardiac rhythm and blood pressure continuously, and notify the provider.