A patient is administered sublingual nitroglycerin (NTG). Which of the following adverse effects should the nurse expect? .

Appeared in: NORCET 7 Prelims -2024

Explanation

Nitroglycerin is a potent vasodilator that relaxes vascular smooth muscles throughout the body.
This vasodilation leads to a drop in systemic blood pressure, causing dizziness and lightheadedness (orthostatic hypotension).
Dilation of cerebral blood vessels is also a direct effect, which commonly results in a throbbing headache.
These two effects, dizziness and headache, are the most frequently reported adverse reactions to nitroglycerin therapy.

Option A: Diplopia (double vision) is not a known or common adverse effect of nitroglycerin.
Option C: Constipation is not associated with nitroglycerin. NTG's primary effects are on the vascular system, not the gastrointestinal motility in this manner.
Option D: Hyperglycemia (elevated blood sugar) is not an adverse effect of nitroglycerin.

Visual 1: Diagram - Illustrating the mechanism of action of nitroglycerin, showing vasodilation of coronary arteries and peripheral veins and arteries.
Visual 2: Infographic - A patient-friendly guide on how to correctly take sublingual nitroglycerin for angina, including the '3 doses in 15 minutes' rule and when to call emergency services.

Clinical Relevance

Nursing practice connection: Use the key finding related to Adverse effects of Nitroglycerin (NTG) to guide bedside assessment, documentation, and the next nursing action.
Patient safety is paramount. The risk of falls due to NTG-induced dizziness and hypotension is significant. Nurses must instruct patients to sit or lie down before and after taking the medication.
Monitoring vital signs, especially blood pressure, is a critical nursing responsibility before and after NTG administration. A systolic BP below 90 mmHg is a common contraindication for administration.
What if the patient is also taking a phosphodiesterase inhibitor like sildenafil (Viagra)? This combination is absolutely contraindicated as it can cause a profound, life-threatening drop in blood pressure. The vasodilatory effects are dangerously potentiated.

How to Approach the Question

First, identify the drug mentioned in the question: sublingual nitroglycerin (NTG).
Recall the drug class and its primary mechanism of action. NTG is a nitrate, which acts as a potent vasodilator.
Think through the physiological consequences of widespread vasodilation. Widening blood vessels will cause blood pressure to drop and affect blood flow to the brain.
Connect these physiological effects to potential adverse effects. A drop in blood pressure leads to dizziness and lightheadedness. Increased blood flow in the cerebral vessels leads to headaches.
Evaluate the given options based on this understanding. 'Dizziness & headache' directly aligns with the known mechanism of action.
Eliminate the other options by recalling their lack of association with NTG and their association with other drug classes or conditions.

Concept Tested & Keywords

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Practise the full NORCET 7 Prelims -2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.