一位患有穩定型心絞痛病史的 60 歲男性，正在接受關於正確使用其新處方之『舌下硝酸甘油 (NTG) 藥片』的出院護理指導。個案的哪些陳述表示了對此關鍵藥物指示有著深切且危險的誤解，並需要護理師立刻介入並重新衛教？（多選題）
A 60-year-old male with a history of Stable Angina is receiving discharge instruction concerning the proper use of his newly prescribed sublingual Nitroglycerin (NTG) tablets. Which statements by the client indicate a profound and dangerous misunderstanding of the critical medication instructions, requiring the nurse to intervene and re-educate the client immediately? (Select all that apply.)
- A“If my chest pain isn't completely entirely gone 5 minutes after placing the very first pill under my tongue, I will immediately call 911 and take a second pill while waiting.”「如果我將第一顆藥片放在舌下 5 分鐘後，胸痛沒有完全消失，我會立即撥打 911 並在等待期間服用第二顆藥。」
- B“To ensure I never lose them during my mountain hikes, I bought a very nice clear, transparent glass vial necklace so the pills can brightly catch the sunlight.”✓ 正解「為了確保我在登山時不會弄丟它們，我買了一個漂亮的透明玻璃瓶項鍊，讓藥片能明亮地反射陽光。」
- C“Because I know this medicine will instantly drop my blood pressure, I must sit down securely before placing the pill under my tongue to prevent fainting.”「因為我知道這種藥會瞬間降低我的血壓，我必須在將藥片放在舌下之前穩穩坐下，以防止暈倒。」
- D“I will confidently swallow the entire pill rapidly with a large glass of water to speed up how fast it reaches my stomach and my heart.”✓ 正解「我會自信地將整顆藥片快速吞下，並搭配一大杯水，以加快它到達胃部和我心臟的速度。」
- E“If I have taken all 3 pills over 15 minutes, but the pressure in my chest is only 'a little bit better,' I shouldn't bother the ambulance; I should just wait and rest.”✓ 正解「如果我已經在 15 分鐘內服用了所有 3 顆藥片，但胸部的壓力只是『好一點點』，我不應該麻煩救護車；我應該只是等待並休息。」
本題以逆向思考測驗心血管急救藥物硝酸甘油（Nitroglycerin, NTG）的「錯誤、需被糾正的認知」。選項A與C是完全正確、能救命的認知（5分鐘沒全好就要叫救護車、擴張血管會導致嚴重姿勢性低血壓必須坐下才能吃藥）。但請注意！題目問的是『哪些陳述代表危險誤解並需要糾正』。因此錯誤認知才是答案：選項B：NTG 的化學結構遇到熱與光線會極速降解失效！它『絕對必須』裝在原本就發配的深棕色（不透光）玻璃瓶裡，裝進透明瓶子且暴露於陽光下會使藥物徹底報廢（需糾正）。選項D：這藥物叫做『舌下含服（Sublingual）』，黏膜的大血管能在一分鐘內吸收避開肝臟門脈循環；若伴隨開水直接『吞入胃中』，它會被胃酸與肝臟首渡效應徹底摧毀，導致藥效為零（需糾正）。選項E：這犯了急救大忌！NTG 的極限為『每5分鐘 1 顆，最多 3 顆』。如果在吃第一顆後胸痛沒有『完全清除至 0 分』，這就是心肌梗塞，必須在等救護車（已經叫了）的當下把三顆吃完。以為「好一點點就可以不用叫救護車」將導致倒地猝死（需糾正）。故答案為 BDE。
Storing nitroglycerin in clear glass exposes it to light and heat, causing rapid degradation and loss of efficacy; it must be kept in its original dark container. Swallowing the tablet instead of placing it sublingually results in first-pass metabolism, rendering the drug ineffective. Additionally, assuming slight pain improvement means emergency care is unnecessary is dangerous, as persistent angina may indicate a myocardial infarction requiring immediate intervention.
世界兩大心血管鐵律。「NTG 必須裝在避光棕色瓶」且「每 5 分鐘一顆，第一顆吃完胸痛沒『全好』就必須馬上撥打台美專線(119/911)叫救護車，最多吃三顆」。全球心臟科護理師必考題。