A nurse is collecting data from a client who reports nausea and has vomited clear emesis. Which of the following medications should the nurse administer?

A. "If my pain is not relieved in 20 minutes, I will take a second tablet." Sublingual nitroglycerin should be taken at 5-minute intervals, up to a maximum of three doses within 15 minutes. If chest pain persists after three doses, emergency medical assistance is necessary, as this may indicate a myocardial infarction. Delaying a second dose for 20 minutes may lead to worsening of the condition and delay appropriate treatment.

B. "I will keep my tablets on a shelf in the bathroom." Nitroglycerin is highly sensitive to heat, light, and moisture, which can cause it to lose potency. Storing it in the bathroom, where temperature and humidity fluctuate, can degrade the medication. It should be kept in its original dark glass container with the lid tightly closed and stored in a cool, dry place away from moisture and heat sources.

C. "I should be sure to swallow the tablet whole." Sublingual nitroglycerin is designed to dissolve under the tongue for rapid absorption into the bloodstream. Swallowing it whole delays its effect because it would need to pass through the digestive system before being absorbed, reducing its ability to quickly relieve angina. Clients should be instructed to place the tablet under the tongue and allow it to dissolve completely without chewing or swallowing.

D. “If my mouth is dry, I will take a sip of water before I take the tablet.” A dry mouth can slow the dissolution of the sublingual tablet, delaying its absorption and effectiveness. Taking a sip of water before administration ensures the tablet dissolves properly under the tongue, allowing for rapid relief of angina symptoms. However, clients should avoid drinking excessive amounts of water that might wash the tablet down before it dissolves.

A. Aspirate before injecting the medication. Aspirating before injecting heparin is not recommended because it can cause tissue trauma and increase the risk of hematoma formation. Heparin is administered into the subcutaneous tissue, which has fewer blood vessels than intramuscular tissue, making aspiration unnecessary. Aspiration can also lead to bruising and discomfort, which should be minimized when administering anticoagulants.

B. Use a 25-gauge, 1/2-inch needle to administer the medication. Heparin should be administered using a small-gauge (25- to 27-gauge) needle with a length of 1/2 to 5/8 inch to reduce tissue trauma and minimize the risk of bleeding. The small needle size helps ensure that the medication is delivered into the subcutaneous tissue rather than deeper layers. Proper needle selection is important to prevent bruising and irritation, which are common concerns when administering anticoagulants.

C. Administer the medication within 2 cm (1 in) of the umbilicus. Heparin should not be injected near the umbilicus because this area has a higher density of blood vessels and an increased risk of bruising. The preferred injection sites are the abdomen (at least 5 cm or 2 inches away from the umbilicus), the upper outer thigh, or the outer upper arm. Injecting in these areas ensures proper absorption while minimizing complications such as hematoma formation.

D. Massage the site after injecting the medication. Massaging the injection site after administering heparin is contraindicated because it can lead to increased bruising, tissue irritation, and the potential for excessive bleeding. Instead of massaging, gentle pressure can be applied with a gauze pad if necessary to control minor bleeding. Clients should be advised to avoid rubbing or applying unnecessary pressure to the injection site to reduce the risk of local complications.