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Hypotension. Although nitroglycerin can cause systemic vasodilation and a drop in blood pressure, a significant hypotensive event is less common with a single sublingual dose in otherwise stable clients. Nurses should still monitor blood pressure, but hypotension is not the most likely adverse reaction.

Dizziness. Dizziness may occur secondary to hypotension or orthostatic changes, but it is generally less frequent and less pronounced than the headache. Monitoring and assisting the client to sit or lie down can prevent injury if dizziness develops.

GI distress. Gastrointestinal upset is not a typical adverse effect of nitroglycerin. The medication acts primarily on vascular smooth muscle rather than the gastrointestinal tract, so nausea or abdominal discomfort is uncommon.

“Cut each patch in half if angina attacks are under control.” Nitroglycerin patches are not designed to be cut, except for specific formulations labeled for safe division. Cutting can lead to inaccurate dosing, loss of adhesive integrity, and uneven absorption, potentially causing either subtherapeutic effect or overdose.

“Take off the nitroglycerin patch temporarily for 30 min if a headache occurs.” Headaches from nitroglycerin may occur due to cerebral vasodilation, but removing the patch for brief intervals is not recommended because it disrupts the therapeutic effect. Headaches should be managed with analgesics and careful titration rather than temporary removal.

“Change the patch every 48 hr right after the first meal of the day.” Transdermal nitroglycerin is typically changed every 24 hours, not 48 hours, to maintain effective drug delivery. Changing it at inconsistent intervals risks breakthrough angina or subtherapeutic dosing. Timing with meals is unnecessary as food does not significantly affect transdermal absorption.

“Rub the ointment directly into your skin until it is no longer visible.” Rubbing nitroglycerin into the skin is contraindicated, as it can lead to rapid, unpredictable absorption, causing severe hypotension, dizziness, or reflex tachycardia. The ointment is designed to stay on the skin surface to provide controlled transdermal absorption over time.

“Cover the applied ointment with a clean gauze pad.” Covering nitroglycerin ointment with an occlusive dressing is not recommended, as it can increase systemic absorption and risk toxicity. The ointment should be lightly covered with a non-occlusive wrap only if necessary to prevent clothing contamination, not to enhance absorption.

“Apply the ointment to the same skin area each time.” Repeated application to the same site increases the risk of skin irritation, redness, and dermatitis. Sites should be rotated daily to prevent localized skin damage while maintaining effective nitrate therapy.

Nausea and vomiting. While gastrointestinal upset can occur, it is not a typical immediate response to nitrates. Persistent nausea may indicate other causes or a drug interaction, rather than a predictable pharmacologic effect of nitrate therapy.

Stomach cramps. Abdominal cramping is not commonly associated with nitrate use. It is not a reliable indicator of the drug’s pharmacologic action or an expected initial side effect.

Irregular pulse rate. Nitrates may slightly lower blood pressure and reflexively increase heart rate (reflex tachycardia), but an irregular pulse is not a standard expected effect. An irregular pulse may indicate a cardiac conduction abnormality or other pathology, requiring further assessment.