# A 64-year-old client with stable angina is being discharged with a prescription for sublingual nitroglycerin 0.4 mg tablets "as needed for chest pain." Which statement by the client demonstrates correct understanding of how to use this medication?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374934&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 64-year-old client with stable angina is being discharged with a prescription for sublingual nitroglycerin 0.4 mg tablets "as needed for chest pain." Which statement by the client demonstrates correct understanding of how to use this medication?

## Option

1. "I will sit or lie down, place one tablet under my tongue, and if my chest pain is not relieved within 5 minutes, I will call 911 and may take a second and third tablet at 5-minute intervals while help is coming." **✔ Correct answer**
2. "If my chest pain is not relieved after one tablet, I will take a second and third dose 5 minutes apart, and if the pain continues, I will continue taking doses until it subsides, without needing to call for help."
3. "If chest pain occurs while I am walking, I will immediately chew the tablet and swallow it with water because chewing it works faster than placing it under the tongue for quick relief."
4. "I will keep the nitroglycerin in my car's center console because if I have chest pain while driving, I can reach it quickly, and I will wrap it in a plastic bag to maintain its potency."

**Correct answer: 1**

## Explanation

Sublingual nitroglycerin (NTG) — patient teaching
NTG dilates predominantly venous vessels (preload reduction) and to a lesser degree coronary arteries, relieving angina. Standard self-administration teaching:
• Sit or lie down before taking — orthostatic hypotension and reflex tachycardia are common.
• Place one tablet (or one spray) under the tongue; let it dissolve. Tingling sensation indicates the tablet is active.
• If chest pain is not relieved in 5 minutes, call 911 immediately; while waiting, take a second tablet, and a third tablet 5 minutes later if needed (max 3 doses in 15 minutes).
• Newer AHA guideline emphasizes calling 911 BEFORE the second/third dose because persistent pain may indicate evolving MI.
• Storage: original dark glass container, away from light/heat/moisture; replace every 3-6 months (efficacy declines with exposure). Do NOT keep in a clear bag, in the car, or in the bathroom.
• Side effects: throbbing headache, flushing, dizziness, hypotension — acetaminophen for headache, hydrate.
• Sildenafil (Viagra), tadalafil, vardenafil within 24-48 hours = absolute contraindication (life-threatening hypotension).
• Prophylactic NTG (one tab) 5-10 minutes before predictable exertion (e.g., stairs, sex) is acceptable for stable angina.

## In-depth explanation

Clinical reasoning summary
Sublingual nitroglycerin (NTG) — patient teaching
NTG dilates predominantly venous vessels (preload reduction) and to a lesser degree coronary arteries, relieving angina. Standard self-administration teaching:
• Sit or lie down before taking — orthostatic hypotension and reflex tachycardia are common.
• Place one tablet (or one spray) under the tongue; let it dissolve. Tingling sensation indicates the tablet is active.
• If chest pain is not relieved in 5 minutes, call 911 immediately; while waiting, take a second tablet, and a third tablet 5 minutes later if needed (max 3 doses in 15 minutes).
• Newer AHA guideline emphasizes calling 911 BEFORE the second/third dose because persistent pain may indicate evolving MI.
• Storage: original dark glass container, away from light/heat/moisture; replace every 3-6 months (efficacy declines with exposure). Do NOT keep in a clear bag, in the car, or in the bathroom.
• Side effects: throbbing headache, flushing, dizziness, hypotension — acetaminophen for headache, hydrate.
• Sildenafil (Viagra), tadalafil, vardenafil within 24-48 hours = absolute contraindication (life-threatening hypotension).
• Prophylactic NTG (one tab) 5-10 minutes before predictable exertion (e.g., stairs, sex) is acceptable for stable angina.

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