In which condition is leg pain produced upon increased activity and ischemia to tissues, but then the pain is reduced with rest?

The correct answer is Choice D: Headache.

Choice A rationale: Nausea is not a common adverse effect of sublingual nitroglycerin. Nausea may occur in some patients, but it is usually mild and transient.Nausea may be related to the vasodilatory effects of nitroglycerin, which can cause hypotension and reflex tachycardia1. Nausea may also be caused by other factors, such as anxiety, stress, or food intolerance.Nausea is not a specific indicator of nitroglycerin toxicity or overdose2.

Choice B rationale: Bradycardia is not a common adverse effect of sublingual nitroglycerin. Bradycardia is a slow heart rate, usually defined as less than 60 beats per minute.Bradycardia may occur in some patients who take nitroglycerin, especially in combination with other drugs that affect the heart rate, such as beta-blockers, calcium channel blockers, or digoxin3. Bradycardia may also be caused by other factors, such as vagal stimulation, hypothyroidism, or electrolyte imbalance.Bradycardia is not a specific indicator of nitroglycerin toxicity or overdose2.

Choice C rationale: Hypertension is not a common adverse effect of sublingual nitroglycerin. Hypertension is a high blood pressure, usually defined as more than 140/90 mmHg.Hypertension may occur in some patients who take nitroglycerin, especially in those who have a history of hypertension, renal impairment, or volume overload4. Hypertension may also be caused by other factors, such as stress, pain, or caffeine intake.Hypertension is not a specific indicator of nitroglycerin toxicity or overdose2.

Choice D rationale: Headache is a common adverse effect of sublingual nitroglycerin.Headache may occur in up to 80% of patients who take nitroglycerin, especially during the first few days of therapy or after an increase in dose5. Headache may be related to the vasodilatory effects of nitroglycerin, which can cause cerebral vasodilation and increased intracranial pressure. Headache may also be caused by other factors, such as dehydration, sinusitis, or migraine. Headache is usually mild to moderate in intensity and can be relieved by analgesics, such as acetaminophen or aspirin.Headache is not a specific indicator of nitroglycerin toxicity or overdose

This is because nitroglycerin patches can cause tolerance if they are used continuously, which reduces their effectiveness in preventing angina attacks. Removing the patch each evening allows the body to restore its sensitivity to the drug.

Choice A is wrong because nitroglycerin patches should be applied every 24 hours, not every 48 hours.

Applying a new patch every 48 hours would result in inadequate blood levels of the drug and increased risk of angina.

Choice B is wrong because nitroglycerin patches should not be cut in half or altered in any way.

Cutting the patch would compromise the integrity of the drug delivery system and could lead to unpredictable or excessive doses of the drug.

Choice C is wrong because nitroglycerin patches should not be taken off for 30 minutes if a headache occurs.

Headache is a common side effect of nitroglycerin due to its vasodilating action, but it usually subsides with continued use.

Taking off the patch for 30 minutes could increase the risk of angina by interrupting the steady blood levels of the drug.

The nurse should advise the client to take an analgesic such as acetaminophen for headache relief.