護理師正指導病人如何使用舌下硝酸甘油片（Nitroglycerin）治療穩定型心絞痛。應包含哪項指導？
A nurse is teaching a client how to use a Nitroglycerin sublingual tablet for stable angina. Which instruction should the nurse include?
- ATake one tablet every 5 minutes for up to 3 doses; call 911 if pain persists after the first dose✓ 正解每 5 分鐘服用一片，最多三片；若第一劑後疼痛持續，請撥打 911
- BSwallow the tablet with a full glass of water用一杯水吞服藥片
- CTake the tablet only when the pain becomes severe僅在疼痛變嚴重時服用藥片
- DStore the tablets in a clear plastic container for easy access將藥片存放在透明塑膠容器中以便取用
舌下硝酸甘油（NTG）的衛教是心血管藥物的核心考點。重點一：給藥方式。必須舌下含服（Sublingual），不可吞服（B），因為吞服會經肝臟首渡效應而失效。重點二：給藥流程。心絞痛發作時立即含服一顆，若 5 分鐘後症狀未緩解，應立即撥打急救電話（911/119）並含服第二顆，最多三顆。這是為了防止心肌梗塞延誤就醫。重點三：保存。NTG 極易受熱、受光、受潮分解，必須保存在原裝深色玻璃瓶內（D 錯）。重點四：副作用。常見頭痛、低血壓，應坐下含服以防跌倒。此題 A 選項反映了最新的安全標準，即「第一劑無效就報警」，而非等三劑含完才報警。
Teaching on sublingual nitroglycerin (NTG) is a core cardiovascular medication topic. Point 1: Route. The tablet must be administered sublingually, not swallowed (B), because swallowing produces a first-pass effect through the liver and renders the drug ineffective. Point 2: Dosing sequence. At the onset of angina, the client takes one tablet immediately; if symptoms do not resolve after 5 minutes, the client should call emergency services (911/119) immediately and take a second tablet, up to a maximum of three tablets. This prevents delayed treatment of a myocardial infarction. Point 3: Storage. NTG is easily degraded by heat, light, and moisture and must be kept in its original dark glass bottle (D incorrect). Point 4: Side effects. Common effects are headache and hypotension; the client should sit down when taking the tablet to prevent falls. Option A reflects the current safety standard—"call emergency services if the first dose is ineffective"—rather than waiting for all three doses to be used.
美國 NCLEX 已經全面採用「第一劑無效即打 911」的指引；台灣部分早期教材可能還寫著「含完三劑再送醫」，但臨床實務與考試已趨向早期介入，護理師衛教時應與國際指引同步。