護理師正衛教一位新開立舌下硝化甘油（nitroglycerin）治療穩定型心絞痛的病人。護理師應包含哪些指導內容？（選所有適合的）
A nurse is teaching a client who has been newly prescribed sublingual nitroglycerin for stable angina. Which instructions should the nurse include? (Select all that apply.)
- AStore the tablets in their original dark glass bottle✓ 正解將錠劑存放在原廠深色玻璃瓶中
- BIf chest pain occurs, stop activity and sit down✓ 正解若發生胸痛，停止活動並坐下
- CTake one tablet every 5 minutes for up to 3 doses if pain persists✓ 正解若疼痛持續，每 5 分鐘服用一錠，最多三錠
- DCall 911 if the pain is not relieved 5 minutes after the first dose✓ 正解若第一劑服用 5 分鐘後疼痛未緩解，請撥打 911
- EThe tablets should be swallowed with a full glass of water錠劑應與一杯滿的水一起吞服
舌下硝化甘油的衛教包含儲存、正確使用及急救啟動。首先，藥物具光敏感性且易揮發，必須存在原始深色玻璃瓶內（A）。發作時應先休息並坐下（B），以減少心臟氧耗並預防藥物引起的姿勢性低血壓。用藥邏輯是：每 5 分鐘一錠，最多三錠（C）。但最重要的安全觀念是：若第一劑 5 分鐘後症狀未緩解或惡化，應立即打 911（D），而非等到三劑吃完才求救。選項 E 是明確錯誤，舌下給藥不可吞服，否則會因肝臟首過效應（First-pass effect）而失效。這題整合了藥理學、病人安全及急救處置。護理師必須確保病人能準確執行這些救命步驟。
Teaching about sublingual nitroglycerin covers storage, correct use, and activation of emergency services. First, the medication is sensitive to light and volatile and must be stored in its original dark glass bottle (A). When chest pain occurs, the client should rest and sit down (B) to reduce cardiac oxygen demand and to prevent orthostatic hypotension caused by the medication. The usual dosing schedule is: one tablet every 5 minutes for up to three doses (C). However, the most important safety concept is: if the pain is not relieved 5 minutes after the first dose, or if it worsens, the client should call 911 immediately (D), rather than waiting until all three doses have been taken to seek help. Option E is clearly wrong, as sublingual medication must not be swallowed, otherwise the hepatic first-pass effect will inactivate it. This question integrates pharmacology, patient safety, and emergency response. The nurse must ensure the client can accurately perform these lifesaving steps.
美國 AHA 指引強調第一劑無效後即打 911。台灣部分衛教仍停留在『吃三劑再就醫』，但在 NCLEX 考試中，『第一劑無效即啟動急救系統』是較新且正確的安全優先概念。