A client with a history of angina reports the onset of chest pain. The nurse determines that the heart rate is 104 beats/minute and the blood pressure is 138/86 mm Hg. A transdermal nitroglycerin patch was applied 30 minutes ago to the right upper chest. Which action should the nurse take?

A. Reassure the client that the patch will begin to take effect within a few minutes: Transdermal nitroglycerin provides a slow, continuous release of medication and is not designed to treat acute chest pain. Relying on the patch alone could delay urgently needed relief for ischemic pain. B. Withhold further doses of nitroglycerin until contacting the healthcare provider: Sublingual nitroglycerin is prescribed specifically for immediate relief of anginal pain. Waiting for provider instructions before addressing active chest pain would not follow standard angina protocols and could endanger the client. C. Leave the patch in place and administer a PRN dose of sublingual nitroglycerin: In cases of acute chest pain, it is appropriate to maintain the transdermal patch for background therapy and give sublingual nitroglycerin for immediate relief. Sublingual forms act rapidly by dilating coronary arteries and improving blood flow to relieve ischemia. D. Obtain another transdermal patch and position it on the client's left upper chest: Applying an additional transdermal patch is inappropriate and could result in overdose, severe hypotension and will not provide immediate relief. The onset of action for transdermal nitroglycerin is too slow to address acute chest pain. The focus should be on a rapid-acting form of nitroglycerin.