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“Take two tablets at the same time and then call 911.” Taking multiple tablets simultaneously is unsafe and not recommended. Nitroglycerin can cause severe hypotension, syncope, and reflex tachycardia if overdosed. Tablets must be taken one at a time, spaced 5 minutes apart, to allow assessment of response and hemodynamic stability.

“Take a sustained-release nitroglycerin capsule rather than a sublingual tablet and wait 5 more minutes before calling 911.” Sustained-release nitroglycerin is not appropriate for acute anginal attacks due to delayed onset of action. Using this formulation during active chest pain can dangerously delay treatment and emergency evaluation.

“Wait another 5 minutes before taking a second sublingual tablet.” Delaying emergency services places the client at significant risk. Persistent chest pain after the first dose is a medical emergency, and waiting without calling 911 may result in irreversible myocardial damage.

Furosemide is a loop diuretic primarily used to treat fluid overload, heart failure, and hypertension. It does not affect heart rate directly and would not address reflex tachycardia caused by vasodilation. Its use in this scenario would be inappropriate and would not prevent increased myocardial oxygen demand.

Captopril is an ACE inhibitor used to lower blood pressure and improve outcomes in heart failure. While it reduces afterload and preload, it does not directly control reflex tachycardia. Administering captopril in this context would not counteract the tachycardic response to isosorbide mononitrate.

Ranolazine is an antianginal agent that works by inhibiting the late sodium current in cardiac myocytes. It improves myocardial efficiency but does not acutely reduce heart rate. Therefore, it is ineffective for treating nitrate-induced reflex tachycardia.

Keep the patches in the refrigerator. Nitroglycerin patches should be stored at room temperature, away from heat and moisture. Refrigeration is unnecessary and may affect the adhesive properties, potentially reducing drug delivery.

Use the patches only if the chest pain is severe. Transdermal nitroglycerin is intended for prevention of angina, not for acute attacks. Clients should have short-acting forms, such as sublingual tablets, for acute chest pain. Using the patch only during pain undermines its prophylactic purpose.

Apply the patch only to the upper arm or thigh areas. While patches can be applied to various hairless skin areas, they are not limited to the upper arm or thigh. The key is clean, dry, hairless skin with rotation of sites. Limiting to only these areas is unnecessarily restrictive and may reduce flexibility in patch application.