A nurse is providing instructions to a client who has a new prescription for sublingual nitroglycerin (Nitrostat) to treat angina pectoris. Which of the following instructions should the nurse include?

A. Using simple language is helpful, but speaking in a childlike manner can be demeaning and may lower the client’s self-esteem. Communication should remain respectful and age-appropriate.

B. Incorporating nonverbal cues such as gestures, facial expressions, pictures, and written words supports understanding. Clients with aphasia often benefit from visual aids and other alternative communication strategies to enhance comprehension.

C. Raising the pitch of the voice does not improve comprehension in aphasia because the issue is related to language processing rather than hearing ability. A normal tone should be maintained unless the client has a hearing impairment.

D. Asking multiple-choice questions can sometimes assist with expressive aphasia; however, relying solely on this method may limit natural communication. The broader and more supportive approach is to incorporate nonverbal communication techniques.

Nitroglycerin is a vasodilator that relaxes smooth muscle in blood vessels and reduces myocardial oxygen demand. It is used to treat and prevent angina atacks. A common side effect of nitroglycerin is headache, which is caused by cerebral vasodilation. The nurse should advise the client to take a mild analgesic, such as acetaminophen, to relieve the headache. The headache usually subsides with continued use of nitroglycerin.

The other options are not correct because:

"Take only one dose of nitroglycerin to reduce the risk of getting a headache." This statement is incorrect because it may compromise the effectiveness of nitroglycerin in relieving angina. The client should follow the prescribed dosage and frequency of nitroglycerin, which is usually one tablet every 5 minutes for up to three doses, as needed for chest pain.

"There's nothing that can be done to relieve the headaches that nitroglycerin causes." This statement is incorrect because it is discouraging and dismissive of the client's concern. The nurse should acknowledge the client's

discomfort and offer suggestions for managing the side effect, such as taking a mild analgesic or lying down in a dark room.

"We will ask the provider to prescribe a different medication for you." This statement is incorrect because it implies that nitroglycerin is not suitable for the client and may cause unnecessary anxiety or confusion. The nurse should explain that nitroglycerin is an effective and safe medication for angina and that the headache is a common and transient side effect that can be managed with simple measures. The nurse should also inform the client that there are other forms of nitroglycerin, such as patches or sprays, that may have less headache-inducing effects. However, changing the medication or the route of administration should be done only after consulting with the provider.