When teaching about nitrate administration, the nurse should instruct the client to:
A. Change position slowly.
B. Take a pulse daily.
C. Reduce salt intake.
D. Chew the sustained-release tablets.
Correct Answer: A. Change position slowly.
Clients taking nitrates should change position slowly to avoid orthostatic hypotension. Poor right ventricular contractility causes the patients to be pre-load sensitive, and nitrates may cause severe hypotension. Decreased left ventricular volume from decreased preload will worsen the outflow tract obstruction.
Option B: It is not necessary to take the pulse before taking this drug. Generally, nitrate use does not necessitate monitoring. However, if the patient is on diuretic therapy or has low systolic blood pressure, blood pressure, and heart rate requires monitoring.
Option C: It is also not necessary to change the diet while taking this drug. Multiple health care professionals such as general practitioners (GP), home care workers, pharmacists, and dieticians can work together to improve patients’ quality of life and prevent exacerbation of the disease.
Option D: It is contraindicated to chew sustained-release tablets. Other forms of commonly used nitrates include isosorbide dinitrate, isosorbide mononitrate, and isosorbide mononitrate sustained-release (SR). These forms are taken orally and have a longer duration of action. However, due to hepatic metabolism, the oral forms require relatively larger doses.