nurse is reviewing a client's medical history before administering a new prescription for atropine. Which of the following client conditions is contraindicated?

A) "Call 911 if pain persists 30 minutes after taking one tablet": This instruction is not accurate and could potentially delay appropriate medical intervention for angina. Nitroglycerin sublingual tablets are rapid-acting vasodilators used to relieve acute angina symptoms. If chest pain persists after taking one tablet, the client should take another tablet after 5 minutes. If the pain persists after a total of three tablets, the client should seek emergency medical assistance.

B) "Place the tablet under the tongue until dissolved": This instruction is correct. Nitroglycerin sublingual tablets should be placed under the tongue and allowed to dissolve completely. Sublingual administration allows for rapid absorption of the medication into the bloodstream, providing quick relief of angina symptoms.

C) "Store the tablets in a refrigerator in a plastic container": This instruction is incorrect. Nitroglycerin sublingual tablets should be stored in their original container at room temperature, away from moisture and heat. Storing them in the refrigerator could alter their effectiveness.

D) "Take a tablet every 10 minutes until the pain subsides": This instruction is incorrect and potentially dangerous. Nitroglycerin sublingual tablets should be taken as directed by the healthcare provider or based on the client's angina management plan. Typically, the client should take one tablet at the onset of angina symptoms and repeat the dose every 5 minutes if the pain persists, up to a maximum of three tablets within 15 minutes. Taking a tablet every 10 minutes without regard to symptom relief or maximum dosage limits could lead to hypotension and other adverse effects.

A) "Reading back the provider's prescription is only necessary for high alert medications": Reading back the provider's prescription is a crucial step in preventing medication errors and should be done for all medications, not just high alert ones. Verbal orders are prone to miscommunication, so repeating the order back to the provider helps ensure accuracy and clarity.

B) "Providers should cosign all verbal prescriptions": This is the correct intervention. Verbal prescriptions are considered high risk for medication errors due to misinterpretation or miscommunication. Having the provider cosign verbal prescriptions adds an extra layer of verification and accountability, reducing the likelihood of errors.

C) "Utilize assistive personnel as a witness to verbal provider prescriptions": While involving another healthcare professional as a witness to verbal prescriptions may provide additional verification, it is not a standard practice and may not be feasible in all situations. Relying solely on assistive personnel for this purpose may not ensure accuracy and could introduce potential communication errors.

D) "Safe abbreviations should only be used by providers": Safe abbreviations should be used by all healthcare team members, not just providers, to prevent medication errors. Standardizing abbreviations reduces the risk of misinterpretation and enhances communication among healthcare providers.