DHS 2018 shift 1st
Pharmacology
Easy
The client admitted with angina is given a prescription for nitroglycerine. The client should be instructed to?
Appeared in: DHS 2018 shift 1st
Explanation
- Nitroglycerin is highly sensitive to light, heat, and moisture, which can degrade its chemical structure and reduce its effectiveness.
- To maintain potency, it must be stored in its original dark-colored (amber), airtight glass container with a metal lid.
- This specific packaging protects the medication from environmental factors, ensuring it is effective when used for an acute angina attack.
Why Other Options Were Wrong
- Option A: The standard recommendation for replacing sublingual nitroglycerin is every 3 to 6 months after opening, not strictly every 3 months. While important, proper storage is a more fundamental instruction.
- Option B: The correct protocol for acute angina is to take one tablet every 5 minutes, for a maximum of 3 doses. Waiting 15 minutes between doses would dangerously delay treatment.
- Option D: Sublingual nitroglycerin must be dissolved under the tongue for rapid absorption into the bloodstream. Crushing and swallowing it would cause the drug to be metabolized by the liver (first-pass effect), rendering it ineffective.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Patient education for sublingual nitroglycerin administration and storage as background academic context rather than a clinical decision trigger.
- Proper patient education on nitroglycerin is a critical nursing responsibility to ensure patient safety and effective self-management of angina.
- Nurses must verify the patient's understanding of the administration protocol, storage requirements, and when to seek emergency help to prevent complications like an evolving myocardial infarction.
- A common side effect of nitroglycerin is a headache due to vasodilation; patients can be advised to manage this with acetaminophen if not contraindicated.
How to Approach the Question
- First, identify the core subject of the question, which is the correct patient instruction for using nitroglycerin.
- Next, analyze each option by recalling the key pharmacological principles of nitroglycerin: its instability, route of administration, and dosing protocol for acute angina.
- Evaluate the storage instruction: Nitroglycerin is known to be sensitive to light, so keeping it in a brown bottle is a valid and critical instruction.
- Evaluate the dosing interval: The standard is every 5 minutes, not 15, so this option is incorrect.
- Evaluate the supply replenishment: The standard is typically 3-6 months, making this option less precise and less critical than proper storage.
- Evaluate the administration method: Nitroglycerin is sublingual for rapid effect, so crushing and swallowing is incorrect.
Concept Tested & Keywords
- Concept Tested: Patient education for sublingual nitroglycerin administration and storage.
- Stem keywords: angina, nitroglycerine, instructed
- Lead-in keywords: instructed to
- Negative lead-in flag: false
Question ID
QDMWSpPbt9wr3KzTCfriGq
Reference Book
E6 Pharmacology Nursing Lilley 11e Part 2 pp. 64-66, 62-64
Practise the full DHS 2018 shift 1st
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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