A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider?

Choice A reason: A headache is not likely due to the anxiety about the chest pain, as anxiety usually causes other symptoms, such as palpitations, sweating, or trembling. A headache is more likely related to the vasodilating action of nitroglycerin, which causes increased blood flow to the brain.

Choice B reason: A headache does not indicate tolerance to the medication, as tolerance usually manifests as a reduced effect of the medication on relieving chest pain. A headache is more likely a sign of the medication's potency, as it indicates that the nitroglycerin is reaching the systemic circulation.

Choice C reason: A headache is an expected adverse effect of the medication, as nitroglycerin causes vasodilation of the cerebral vessels, which can result in increased intracranial pressure and pain. A headache is usually mild and transient, and can be relieved by taking analgesics, such as acetaminophen.

Choice D reason: A headache is not an indication of an allergy to the medication, as an allergic reaction usually causes other symptoms, such as rash, itching, swelling, or difficulty breathing. A headache is more likely a pharmacological effect of the medication, rather than an immunological response.

Choice A reason: Taking this medication with 8 ounces of water is not necessary. Sublingual nitroglycerin tablets are designed to dissolve under the tongue and be absorbed quickly into the bloodstream. Drinking water may interfere with the absorption and effectiveness of the medication.

Choice B reason: Taking one tablet at the first indication of chest pain is the correct instruction. Sublingual nitroglycerin tablets are used to relieve anginal pain by dilating the coronary arteries and improving blood flow to the heart. The client should place one tablet under the tongue as soon as chest pain occurs and wait for it to dissolve.

Choice C reason: Taking one tablet every 15 minutes during an acute attack is not the correct instruction. Sublingual nitroglycerin tablets have a short duration of action and may not provide adequate relief for a prolonged anginal attack. The client should follow the rule of three: take one tablet every 5 minutes for up to three doses. If the pain is not relieved after three doses, the client should call 911 or seek emergency medical attention.

Choice D reason: Taking this medication after each meal and at bedtime is not the correct instruction. Sublingual nitroglycerin tablets are not used for the prevention of angina. They are only used for the treatment of acute anginal episodes. Taking this medication regularly may cause tolerance and reduce its effectiveness.