A nurse is caring for a client and preparing to complete a medication reconciliation. Which of the following actions should the nurse complete first?

A) Return the remaining medication to the facility's pharmacy: Returning the remaining medication to the pharmacy is not appropriate in this situation because the medication has been removed from its original packaging and administered to the patient. Once medication has been removed from its original packaging and administered, it cannot be returned to the pharmacy for reuse or storage due to contamination risks and potential medication errors.

B) Dispose of the remaining medication while another nurse observes: This is the correct action. Since the prescribed dose is only half of the tablet, the nurse should dispose of the remaining half of the tablet while another nurse observes, ensuring proper disposal and adherence to medication administration policies and procedures. This prevents errors in subsequent doses and ensures accurate medication administration.

C) Store the remaining half of the pill in the automated medication dispensing system: Storing the remaining half of the pill in the automated medication dispensing system is not appropriate because the medication has already been removed from its original packaging and administered to the patient. Storing half tablets in the automated dispensing system could lead to medication errors and confusion during future administrations.

D) Place the remaining half of the pill in the unit-dose package: Placing the remaining half of the pill in the unit-dose package is not appropriate because the medication has already been removed from its original packaging and administered to the patient. Placing half tablets back into the unit-dose package could lead to medication errors and confusion during future administrations.

A. “Take a tablet every 10 minutes until the pain subsides.”: This is not correct. Nitroglycerin tablets are typically taken at the first sign of an angina attack. If the pain is not relieved within 5 minutes, a second tablet may be taken. If the pain still persists after another 5 minutes, a third tablet may be taken. However, if the pain continues after a total of 3 tablets in 15 minutes, emergency medical help should be sought.

B. “Place the tablet under the tongue until dissolved.”: This is the correct answer. Nitroglycerin sublingual tablets should be placed under the tongue and allowed to dissolve. This allows for rapid absorption of the medication into the bloodstream through the mucous membranes of the mouth.

C. “Store the tablets in a refrigerator in a plastic container.”: This is not correct. Nitroglycerin tablets should be stored at room temperature, away from light and moisture. They should not be stored in a refrigerator or a plastic container as this can cause the tablets to lose their effectiveness.

D. “Call 911 if pain persists 30 minutes after taking one tablet.”: This is not correct. If chest pain is not relieved within 5 minutes after taking a nitroglycerin tablet, a second tablet should be taken. If the pain still persists after another 5 minutes, a third tablet may be taken. However, if the pain continues after a total of 3 tablets in 15 minutes, emergency medical help should be sought. Waiting 30 minutes could delay necessary medical treatment.