A client is scheduled for coronary artery bypass surgery (CABG) tomorrow morning and is currently receiving Nitroglycerin 20 mcg/minute IV. The client reports a new onset of chest pain with a severity of 6 on a 0 to 10 scale. After obtaining a STAT electrocardiogram and vital signs, what action would the nurse anticipate?

A. Discontinue the nitroglycerin drip: Stopping nitroglycerin abruptly can worsen myocardial ischemia by removing vasodilatory support. Discontinuation is not indicated for new-onset chest pain; rather, the infusion is typically adjusted to relieve angina while monitoring hemodynamic status. B. Maintain the nitroglycerin drip at the same rate: Keeping the infusion at the current rate may be insufficient if the client is experiencing new chest pain. The purpose of IV nitroglycerin is to provide continuous antianginal effect, and dose adjustments are often necessary to address breakthrough symptoms. C. Administer sublingual nitroglycerin: Sublingual nitroglycerin provides rapid relief of acute angina; however, for a client already on an IV infusion, the priority action is usually to titrate the IV rate to achieve continuous pain control while maintaining safe blood pressure. Sublingual administration may be considered if the infusion cannot be adjusted promptly. D. Titrate the nitroglycerin drip dose up: Increasing the IV nitroglycerin rate is the appropriate intervention for breakthrough chest pain when vital signs are stable. Titration allows the nurse to optimize coronary vasodilation, reduce myocardial oxygen demand, and relieve angina, while continuously monitoring blood pressure and heart rate to prevent hypotension.