A client with aplastic anemia is transitioning to take control of their care. The nurse notes the client's need for immunosuppressive medication and emphasizes the importance of understanding this medication and potential complications. What statement by the client indicates a need for further teaching about the medication?

Choice A reason: Sublingual nitroglycerin is designed for rapid absorption through the highly vascular oral mucosa. Placing the tablet under the tongue and allowing it to dissolve without chewing or swallowing ensures direct systemic entry, bypassing the hepatic first-pass effect, which provides rapid relief of ischemic chest pain.

Choice B reason: Nitroglycerin sublingual tablets are intended for immediate action. If they take 10 minutes to work, the administration technique is likely incorrect. These tablets should provide relief within 1 to 5 minutes; if no relief occurs after one dose, emergency protocols should be initiated.

Choice C reason: Headache is the most common side effect of nitrates due to systemic vasodilation, including dilation of cerebral vessels. It is generally expected and does not necessitate stopping the medication, although the nurse should advise the client that it may occur.

Choice D reason: Taking nitroglycerin prophylactically before physical activity or situations known to trigger angina is a valid clinical recommendation for many clients. Educating the client to take it prior to such events can help prevent the onset of ischemic pain by dilating coronary arteries beforehand.

Choice A reason: Weight gain is not expected in severe ulcerative colitis. Instead, these clients typically experience significant weight loss due to malnutrition, decreased oral intake secondary to abdominal pain, and the malabsorptive nature of chronic intestinal inflammation.

Choice B reason: While dehydration can occur due to diarrhea, extreme thirst is not a specific diagnostic manifestation of ulcerative colitis. Dehydration is usually addressed by monitoring for fluid volume deficit rather than identifying extreme thirst as a defining symptom of this disease.

Choice C reason: Esophageal ulcers are not associated with ulcerative colitis. Ulcerative colitis is a disease process specifically limited to the mucosa and submucosa of the colon and rectum, whereas Crohn's disease can affect any part of the gastrointestinal tract, including the esophagus.

Choice D reason: Perianal fistulas are a hallmark complication of Crohn's disease, not ulcerative colitis. In ulcerative colitis, inflammation is continuous and superficial, primarily affecting the mucosal layer, and does not typically result in the deep, transmural fistulizing processes seen in Crohn's disease.

Choice E reason: Rectal bleeding is a classic sign of ulcerative colitis. The inflammation and ulceration of the colonic and rectal mucosa lead to friable tissue that bleeds easily. The presence of bright red blood per rectum is a common and expected clinical finding during an acute exacerbation of the disease.

Choice F reason: Bloody diarrhea is a primary clinical manifestation of ulcerative colitis. The inflammatory process causes the mucosal lining of the colon to slough off, leading to frequent, liquid stools that contain blood, mucus, and pus. This is a direct consequence of the extensive mucosal ulceration.

Choice G reason: Constipation is not an expected finding. The underlying pathophysiology involves hypermotility and inflammation, which produces diarrhea rather than slowing transit time.