The nurse is discussing home care with a client that has sickle cell anemia. The nurse teaches the client that medical attention should be sought for which of the following?

Choice A reason: Sublingual nitroglycerin is designed for rapid absorption through the highly vascular oral mucosa. Placing the tablet under the tongue and allowing it to dissolve without chewing or swallowing ensures direct systemic entry, bypassing the hepatic first-pass effect, which provides rapid relief of ischemic chest pain.

Choice B reason: Nitroglycerin sublingual tablets are intended for immediate action. If they take 10 minutes to work, the administration technique is likely incorrect. These tablets should provide relief within 1 to 5 minutes; if no relief occurs after one dose, emergency protocols should be initiated.

Choice C reason: Headache is the most common side effect of nitrates due to systemic vasodilation, including dilation of cerebral vessels. It is generally expected and does not necessitate stopping the medication, although the nurse should advise the client that it may occur.

Choice D reason: Taking nitroglycerin prophylactically before physical activity or situations known to trigger angina is a valid clinical recommendation for many clients. Educating the client to take it prior to such events can help prevent the onset of ischemic pain by dilating coronary arteries beforehand.

Choice A reason: Fatigue is a common, chronic symptom associated with the baseline anemia of sickle cell disease due to chronic hemolysis and decreased hemoglobin levels. While concerning if severe or new, it is generally considered a manageable symptom of the underlying condition rather than an acute medical emergency necessitating immediate intervention.

Choice B reason: Vomiting or diarrhea in a patient with sickle cell anemia represents a high risk for rapid dehydration. Dehydration increases blood viscosity and triggers sickling of red blood cells, which can precipitate a vaso-occlusive crisis. This necessitates immediate medical attention to maintain fluid and electrolyte balance and prevent further complications.

Choice C reason: Changes in weight are typically indicators of long-term nutritional status or metabolic shifts. While weight monitoring is important in chronic disease management, it does not represent an acute, life-threatening physiologic emergency requiring immediate medical attention compared to the rapid onset of dehydration from gastrointestinal distress in this population.

Choice D reason: Difficulty eating or sleeping may be indicative of various issues, including pain or psychosocial stressors. While these symptoms require assessment during follow-up visits or routine care, they are generally not acute physiological crises that require immediate emergency medical intervention unless accompanied by signs of severe illness or acute vaso-occlusive pain.