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Cardiac - Priority Sheet
Nitroglycerin Nursing Considerations NCLEX Priority Sheet
Nitroglycerin questions test chest pain priority, blood pressure before dosing, headache, orthostatic hypotension, PDE-5 inhibitor contraindication, and patch safety.
Study aid - not medical advice. Not a clinical decision tool. For NCLEX pharmacology review only.
Priority 1
What to do first
1. Assess chest pain, vital signs, oxygenation, and blood pressure.
2. Have the patient sit or lie down because hypotension and dizziness can occur.
3. Follow chest-pain/emergency protocol if pain is new, severe, or not relieved promptly.
Safety
Hold If
Notify the provider and hold per protocol for hypotension, severe dizziness/syncope, suspected right ventricular infarct context, or recent PDE-5 inhibitor use such as sildenafil, tadalafil, or vardenafil.
Do not treat ongoing chest pain as routine. Escalate per emergency protocol.
Monitoring
Labs to Watch
Nitroglycerin monitoring is mainly assessment: BP, HR, chest pain rating, ECG changes, oxygenation, and headache/dizziness.
Cardiac markers and ECG are ordered based on chest-pain protocol, not because nitroglycerin has a routine therapeutic lab level.
Review Details
NCLEX Review Notes
Key Effects
Expected: headache, flushing, dizziness, orthostatic hypotension.
Danger: severe hypotension, syncope, persistent chest pain, or PDE-5 inhibitor interaction.
NCLEX Trap
Trap: a patient took sildenafil earlier and now asks for nitroglycerin for chest pain.
Safer answer: hold nitroglycerin per protocol, notify the provider, and manage chest pain through emergency protocol because profound hypotension can occur.
Patch Pattern
Transdermal nitroglycerin: remove the old patch before applying a new one, rotate sites, and avoid cutting patches unless product instructions specifically allow it.
Nitrate-free interval: may be ordered to reduce tolerance.
Mini Quiz
Question: A patient has chest pain and BP 82/48 after one nitroglycerin dose. What should the nurse do?
Answer: hold further nitroglycerin per protocol, assess perfusion and chest pain, notify the provider, and escalate per emergency/chest-pain protocol.
References
Saunders Comprehensive Review for the NCLEX-RN Examination; Davis's Drug Guide for Nurses; DailyMed nitroglycerin labeling; AHA chest pain emergency guidance.
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