A nurse is talking with a client who is about to start taking nitroglycerin oral, sustained-release capsules. Which of the following instructions should the nurse include?

A) Shave excess hair from skin before applying a nitroglycerin patch:
Shaving excess hair is not necessary for applying a nitroglycerin patch. The patch should be applied to a clean, dry, and hairless area of skin to ensure proper adhesion and absorption of medication.

B) Keep a nitroglycerin patch in place 24 hr. per day:
Nitroglycerin patches are typically worn for a specified period (usually 12 to 14 hours) and then removed for a "patch-free" interval to prevent tolerance development. Continuous use can lead to tolerance, reducing the effectiveness of the medication.

C) Put a second patch in place if angina pain occurs:
Applying a second nitroglycerin patch is not recommended without consulting a healthcare provider. Increasing the dosage of nitroglycerin without proper medical advice can lead to hypotension and other adverse effects. The client should follow the prescribed regimen and seek medical assistance if angina pain is not relieved.

D) Fold used patch with medication area to the inside and discard in a closed receptacle:
This is the correct instruction. Used nitroglycerin patches should be folded with the adhesive side together (medication area inside) to prevent accidental exposure and disposed of in a closed receptacle. This helps ensure safe disposal and prevents unintentional contact with the medication by others.

Calculating IV Drip Rate for Manual Infusion

Here's how to calculate the drip rate for the manual IV infusion:

Identify total volume and infusion time:

Total volume of saline solution (NS) to infuse: 100 mL

Infusion time: 4 hours

Convert infusion time to minutes:

4 hours x 60 minutes/hour = 240 minutes

Determine the drip factor:

Drip factor: 60 gtt/mL (indicates the number of drops delivered per milliliter of solution by the IV tubing)

Calculate the desired flow rate (mL/min):

We want to know how many milliliters the nurse needs to infuse per minute.However, the question asks for the rate in gtt/min. We'll calculate the mL/min rate first and then convert it to gtt/min.

Flow rate (mL/min) = Total volume (mL) / Infusion time (minutes)

Flow rate (mL/min) = 100 mL / 240 minutes

Flow rate (mL/min) = 0.4167 mL/min (round to four decimal places for accurate conversion)

Convert mL/min to gtt/min:

Flow rate (gtt/min) = Flow rate (mL/min) x Drip factor (gtt/mL)

Flow rate (gtt/min) = 0.4167 mL/min x 60 gtt/mL

Flow rate (gtt/min) = 25 gtt/min (round to nearest whole number)

Therefore, the nurse should set the manual IV infusion to deliver approximately 25 gtt/min.