護理師指導病人使用舌下硝化甘油 (Nitroglycerin) 治療心絞痛。應包含哪些衛教？（選所有適合的）
A nurse is teaching a client about the use of sublingual nitroglycerin for angina. Which instructions should the nurse include? (Select all that apply.)
- ATake one tablet every 5 minutes for up to 3 doses✓ 正解每 5 分鐘服用一片，最多服用三次
- BCall 911 if pain is not relieved after the first dose✓ 正解若服用第一劑後疼痛未緩解，請撥打 911
- CKeep the tablets in the original light-resistant container✓ 正解將藥片保存在原裝避光容器中
- DExpect a tingling sensation under the tongue✓ 正解預期舌下有刺痛感
- ESwallow the tablet immediately with water立即用水吞服藥片
此題評估對舌下硝化甘油（Sublingual Nitroglycerin）治療心絞痛（Angina）的衛教知識。核心概念是了解其作用機轉、正確用法、儲存方式及預期反應，以確保用藥安全與療效。 正確答案 A, B, C, D 涵蓋了舌下硝化甘油的關鍵衛教內容。A 指出標準的急救劑量與頻率：每次舌下含服一粒，若五分鐘後疼痛未緩解，可再服用一粒，總共最多三次。B 強調了緊急情況下的應對：若連續含服三粒後胸痛仍未緩解，表示可能為更嚴重的病況（如不穩定型心絞痛或心肌梗塞），必須立即撥打 911（急救電話）尋求醫療協助。C 說明了藥物保存的重要性：硝化甘油對光和熱敏感，易分解失效，因此應保存在原裝的、避光的容器中，並置於陰涼乾燥處。D 提及了藥物的預期副作用或反應：舌下含服時，病人可能感受到舌下或口腔黏膜有灼熱感或刺麻感（tingling sensation），這是藥物被黏膜吸收的正常現象，也代表藥物有效。 選項 E 錯誤，因為舌下硝化甘油的吸收途徑是透過口腔黏膜，直接進入體循環，以快速作用於冠狀動脈。若用水吞服，藥物會進入腸胃道，經肝臟首渡代謝（first-pass metabolism），導致藥效顯著降低，無法達到及時緩解心絞痛的目的。此外，舌下含服時不應配水，以免沖淡藥物或影響吸收。
This item assesses teaching about sublingual nitroglycerin for angina. The core concepts are understanding its mechanism of action, correct use, storage, and expected reactions, in order to ensure medication safety and efficacy. The correct answers A, B, C, and D cover the key teaching points for sublingual nitroglycerin. A specifies the standard emergency dose and frequency: place one tablet sublingually; if pain is not relieved after 5 minutes, take another tablet, up to three doses total. B emphasizes the emergency response: if chest pain is still not relieved after three consecutive doses, this may indicate a more serious condition (such as unstable angina or myocardial infarction), and 911 (emergency services) must be called immediately. C addresses the importance of medication storage: nitroglycerin is sensitive to light and heat and can degrade and lose potency, so it should be stored in its original light-resistant container in a cool, dry place. D addresses an expected side effect or reaction: when placed sublingually, the client may feel a burning or tingling sensation under the tongue or on the oral mucosa, which is a normal indication that the medication is being absorbed and is effective. Option E is incorrect, because sublingual nitroglycerin is absorbed through the oral mucosa directly into the systemic circulation in order to act rapidly on the coronary arteries. If swallowed with water, the medication enters the gastrointestinal tract and undergoes first-pass metabolism in the liver, markedly reducing efficacy and failing to relieve angina promptly. In addition, the tablet should not be taken with water when used sublingually, in order to avoid diluting the medication or interfering with absorption.