A nurse is preparing to administer nitroglycerine 15 mcg/min by continuous IV infusion. Available is nitroglycerin 25 mg in 250 mL of dextrose 5% in water (D5W). The nurse should set the IV pump to deliver how many mL/hr? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.

A) Bradycardia
Bradycardia (a slow heart rate) is not the most common response to nitroglycerin (NTG). While NTG can affect heart rate in some individuals, its primary action is related to blood vessels, and it typically leads to vasodilation, which more commonly results in reflex tachycardia (an increased heart rate), rather than bradycardia.

B) Tachycardia
Tachycardia (an increased heart rate) can occur as a compensatory mechanism when nitroglycerin causes vasodilation and a decrease in blood pressure. However, this is more of a secondary effect. The primary action of nitroglycerin is to lower blood pressure (by dilating blood vessels), and in response to the lowered blood pressure, the body may try to compensate by increasing the heart rate.

C) Hypotension
The most common and primary response to nitroglycerin (NTG) administration is hypotension. Nitroglycerin works by relaxing smooth muscle in blood vessels, leading to vasodilation (widening of blood vessels). This reduces the amount of work the heart has to do and lowers the overall blood pressure. Hypotension is expected as part of the therapeutic effect of NTG, especially with a larger dose or rapid administration (e.g., sublingual NTG).

D) Dry mouth
While many medications can cause dry mouth (especially anticholinergic drugs), nitroglycerin is not typically associated with this issue. Its primary action is vasodilation, and while it can cause other symptoms like headaches, dizziness, and hypotension, dry mouth is not considered a common or significant effect.

A) Esophagus
Enteric-coated tablets are designed to not dissolve or disintegrate in the esophagus. They are coated with a protective layer that prevents the tablet from breaking down in the acidic environment of the stomach. This is to ensure that the medication is released in the part of the digestive tract where it is most needed, typically beyond the stomach.

B) Duodenum
Enteric-coated tablets are designed to disintegrate in the duodenum, which is the first part of the small intestine. The coating protects the tablet from stomach acid, allowing it to pass intact through the stomach and into the small intestine, where the pH is higher and the coating dissolves, releasing the medication for absorption.

C) Stomach
Enteric-coated tablets are specifically designed not to disintegrate in the stomach because the stomach's acidic environment could either damage the drug or cause premature release. The coating ensures that the drug is protected until it reaches the more neutral pH of the duodenum.

D) Colon
The colon is too far along in the digestive tract for enteric-coated tablets to typically disintegrate. The design of enteric coatings is intended to protect the drug until it reaches the duodenum, where absorption is most efficient. Enteric coatings are not meant to disintegrate in the colon.