Marie Garcia, age 67, reports that her chronic angina has been recurring even though she has been taking nitroglycerin sublingual tablets as prescribed. She tells the nurse that she used to store the tablets on a table by the window, and when she started to use a new batch of tablets, the problem subsided. What I would explain the ineffectiveness of the tablets?

Explanation:

A. Headache is a common side effect of nitroglycerin due to vasodilation and can often be managed with continued use.

B. Nitroglycerin is known to cause headaches as a common side effect.

C. Taking nitroglycerin with a high-fat meal is not likely to prevent headaches; it may, in fact, delay absorption and onset of action.

D. A headache alone is not indicative of a serious allergic reaction to nitroglycerin; other symptoms would typically be present.

Explanation:

A. This is because lithium levels can be affected by changes in sodium balance and hydration levels in the body. Excessive sweating can lead to dehydration, which can increase lithium levels and potentially lead to toxicity. Therefore, it is important for clients to be aware of the need to maintain hydration and to communicate with their healthcare provider if there are any significant changes in their fluid balance, such as those caused by excessive sweating.

B. Stopping lithium abruptly, especially when moods are stable, can lead to relapse of bipolar disorder symptoms and is not recommended.

C. Regular monitoring of blood levels of lithium is essential to ensure therapeutic levels and prevent toxicity; therefore, the statement indicating the client no longer needs blood checks is incorrect.

D. Restricting salt intake lowers the sodium levels which can decrease lithium elimination, hence increasing the risk of toxicity.