A client is experiencing angina and has just taken one sublingual nitroglycerin tablet. After 5 minutes, the client still reports chest pain. What should the nurse include in their teaching about the next steps? Select all that apply.

Management of acute angina with sublingual Nitroglycerin requires prompt action to restore myocardial oxygen balance and prevent progression to myocardial infarction. Nitroglycerin works by causing vasodilation, which decreases cardiac workload and improves coronary blood flow. Standard teaching includes stopping activity, resting, and taking one tablet at the onset of chest pain. If pain persists after the first dose, emergency intervention and additional doses must follow a specific safe sequence. Rationale: A. Continuing normal activity is inappropriate because physical exertion increases myocardial oxygen demand and can worsen ischemia. The client should immediately stop activity and rest in a sitting or lying position to reduce cardiac workload. Rest enhances the effect of nitroglycerin and helps prevent worsening chest pain or progression to infarction. B. Calling for emergency medical assistance before taking the second tablet is correct because persistent chest pain after the first dose may indicate unstable angina or myocardial infarction. Emergency services should be contacted after 5 minutes if pain is not relieved. Prompt medical evaluation is critical since delayed treatment increases the risk of permanent myocardial damage. C. Taking two more tablets at the same time is unsafe and not recommended. Nitroglycerin should be administered one tablet every 5 minutes, up to a maximum of three doses. Taking multiple tablets simultaneously increases the risk of severe hypotension, dizziness, and syncope without improving safety or effectiveness. D. Stopping all medications is incorrect and potentially dangerous. The client should continue prescribed cardiovascular medications unless specifically instructed otherwise by the provider. Abrupt discontinuation of drugs such as beta blockers, antiplatelets, or antihypertensives can worsen cardiac instability and increase the risk of complications. E. Taking a third sublingual tablet after another 5 minutes is correct if chest pain persists after the second dose. The standard protocol allows one tablet every 5 minutes for a total of three doses while awaiting emergency help. Continued pain after the third dose strongly suggests a serious cardiac event requiring immediate advanced treatment.