A nurse is caring for a client who has a new prescription for nitroglycerin. The nurse should monitor for which of the following adverse effects of the medication?

The client scenario involves a patient starting a potent vasodilator medication. To identify the appropriate adverse effect, knowledge of cardiovascular pharmacology, smooth muscle relaxation mechanisms, and cranial vascular responses to rapid vasodilation must be properly applied. Choice A rationale Nitroglycerin stimulates cGMP production, causing profound smooth muscle relaxation and systemic vasodilation. This process triggers significant dilation of cerebral and meningeal blood vessels, stimulating intracranial pain receptors and consistently producing a severe throb-like headache. Choice B rationale Nocturia is not an expected adverse effect of nitrates. Nitroglycerin causes systemic venous dilation and venodilatory pooling, which actually reduces venous return to the heart and does not increase nocturnal glomerular filtration or urinary output. Choice C rationale Nitroglycerin induces systemic vasodilation and causes a significant drop in blood pressure. In response to this hypotension, the baroreceptor reflex is activated, which stimulates the sympathetic nervous system, resulting in compensatory reflex tachycardia rather than bradycardia. Choice D rationale Nitroglycerin decreases systemic vascular resistance and blood pressure, but it does not typically cause blurred vision. Blurred vision is more indicative of increased intraocular pressure or anticholinergic toxidromes, not peripheral venous and arterial vasodilation.