How many nitro tabs before pt should call 911?

[sandyfeet]

I am studying for my final in Med Surg II and am totally confused about nitro. I am doing practice NCLEX questions from an NCLEX book. The question was "Which comment by the client would indicate to the nurse that the client understands how to take his sublingual nitroglycerine?" The first answer was "I will call 911 if the pain does not go away within 5 minutes after taking the medication." Wrong, I thought because I remembered in Pharmacology how my professor emphasized patients can take three tabs before calling 911. Anyways, my answer was wrong and the first answer was correct!

The rationale the book gave was "The EMS should be activated if the client's chest pain is not relieved within 5 minutes of taking the nitroglycerine." I thought that was odd, so I looked in my Med Surg textbook. It also said to call 911 after 5 minutes/one dose. So then I dug out my Pharmacology book. This is exactly what it says under patient education for nitro:

"Explain that if angina is not relieved, up to two more tablets may be taken; one 5 minutes after the first tablet and the other 5 minutes after the second tablet. Instruct the patient to go to the nearest emergency department if angina is not relieved after the above measures are taken."

Am I missing something here? These answers seem to be extremely different. My NCLEX book and Med Surg book are Mosby Elsevier and my Pharm book is Lippincott. Why would there be a discrepancy?

[akulahawkRN, ADN, RN, EMT-P]

This. Take one, not gone, call 911 take second. Better to have EMS in route if 2nd/3rd dose doesnt work and have them there then take 3rd and no relief, then what do you but sit and wait....or take a 4th and let your BP bottom out

Just remind them about taking their NTG after having taken that "little blue pill"...

[tweetRN2009]

[tweetRN2009]

If only they were obviously wrong! :)

"I will put the nitroglycerine between my cheek and gum whenever I begin to have any chest pain." (Wrong because it says in the stem that the drug is sublingual)

"I will take the nitroglycerine when I get up in the morning and whenever I experience chest pain during the day." (Wrong...but some sources say to take nitro as a prophylactic for activities that could cause chest pain...could read too far into this one...)

"I know that nitroglycerine is important to help prevent any further damage to the arteries in my heart." (Um...well it dilates the arteries...too much constriction could cause damage...right?)

It's a credit to my Pharm professor that I remembered her example 2 years after the fact! She made us calculate the exact time with this crazy question, something like "Your patient takes the first tab at 12:00, when do they call". Now I must un-remember.

I take SL nitros and the one about putting it between your cheek and gum may be right bc it's actually still considered SL that way. I know technically that's subbuccal but they say you can take nitro that way too and package insert says you can take them that way. BUT I was taught take 1 if no relief after 5 mins take 2nd and call EMS. If after 5 mins no relief and waiting on EMS take 3rd. That's what package insert says too. Tricky question.

[dionyantigua]

Hello guys. Whenever I am presented with situations like this one I try to think "logic". I believe that both answers, meaning: 1- take 1st dose and call 911 if pain persists after 5 min. then take second dose; and 2- take 3, 5 minutes doses if pain is not relived and call 911 are appropriate answers. The right action here, as I teach my students, depends on the situation. If the nurse is the one assisting the client, for example a home health nurse, the professional can give three doses to the client and evaluate the effectiveness of the intervention and decide to call 911 as soon as he/she understands it is necessary or after the third dose. In the case that the client is alone the situation should be different. The client should call 5 minutes after the first dose if not relieved, to prevent wasting of valuable time to get appropriate treatment in case of myocardial damage.