一位穩定型心絞痛病人處方了舌下化學甘油（Nitroglycerin）。護理師在出院衛教時應強調哪項重點？
A client is prescribed sublingual nitroglycerin for stable angina. Which instruction should the nurse emphasize during discharge teaching?
- ASwallow the tablet with a full glass of water用一杯水吞服藥片
- BStore the medication in a clear plastic container for easy access將藥物存放在透明塑膠容器中以便取用
- CDiscard the tablets 12 months after opening the bottle開瓶後 12 個月丟棄藥片
- DTake a dose every 5 minutes for up to 3 doses if chest pain persists✓ 正解若胸痛持續，每 5 分鐘服用一劑，最多三次
穩定型心絞痛的藥物教育核心在於 Nitroglycerin（NTG）的正確使用時機與保存。NTG 透過擴張冠狀動脈與全身靜脈來降低心臟負荷。正確指導為：心絞痛發作時立即舌下含服一錠，若 5 分鐘後症狀未緩解，可含第二錠，最多三錠。若含完第一錠症狀未改善甚至加劇，美國心臟學會（AHA）建議應立即撥打 911（台灣為 119）。此題重點在於劑量極限與時間間隔。選項 B 錯誤是因為 NTG 具高度揮發性且畏光，必須儲存在深色原裝玻璃瓶中；選項 A 錯誤是因為舌下吸收可避開首渡效應（first-pass effect），吞服會失效；選項 C 錯誤是因為開瓶後藥效僅維持 3-6 個月，而非一年。
The core of medication education for stable angina is the correct timing of use and storage of nitroglycerin (NTG). NTG reduces cardiac workload by dilating coronary arteries and systemic veins. Correct instructions are: at the onset of an angina attack, immediately place one tablet under the tongue; if symptoms do not improve after 5 minutes, a second tablet may be taken, up to a maximum of three tablets. If symptoms do not improve, or even worsen, after the first tablet, the American Heart Association (AHA) recommends calling 911 immediately (119 in Taiwan). The focus of this question is on the dose limit and the time interval. Option B is incorrect because NTG is highly volatile and light-sensitive and must be stored in its dark original glass bottle; option A is incorrect because sublingual absorption bypasses first-pass effect, and swallowing the tablet renders it ineffective; option C is incorrect because once the bottle is opened, the drug retains potency for only 3-6 months, not one year.
美國 NCLEX 強調 5 分鐘含一次、最多三次的標準流程，且強調若第一劑無效就應叫救護車。台灣臨床衛教有時會簡化為『含三次無效再去醫院』，但現代觀念已與美國趨同，強調早期啟動緊急醫療系統（EMS）以預防心肌永久受損。