The nurse teaches the client with angina about the common expected side effects of nitroglycerin, including:
A. Headache
B. High blood pressure
C. Shortness of breath
D. Stomach cramps
Correct Answer: A. Headache
Because of the widespread vasodilating effects, nitroglycerin often produces such side effects as headache, hypotension, and dizziness. The client should lie or sit down to avoid fainting. Headaches can be severe, throbbing, and persistent and may occur immediately after use. Nitro does not cause shortness of breath or stomach cramps.
Option B: Many of these adverse effects are secondary to the hypotensive effects of nitroglycerin. Patients may report symptoms of orthostatic hypotension which manifest as dizziness, weakness, palpitations, and vertigo. Profound hypotension may occur in patients with preload-dependent conditions.
Option C: Syncope is the most dangerous adverse effect and can result in falls and their resultant injuries. The risk of syncope significantly increases with the concurrent use of a phosphodiesterase-5 (PDE-5) inhibitor. A further discussion is included below under contraindications.
Option D: Some patients can be more sensitive to the hypotension caused by nitrates, which can result in nausea, vomiting, diaphoresis, pallor, and collapse even at therapeutic doses. Vasodilation and venous pooling can increase the amount of blood in the cranial space, resulting in increased intracranial pressures; this can cause persistent, throbbing headaches, along with confusion, fever, vertigo, nausea, vomiting, and visual disturbances.
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