A nurse is caring for a client in an outpatient clinic who has received a new prescription for a medication to be taken sublingually. The nurse must provide education on the correct administration of this medication. The client expresses concern about possible side effects and when to take the medication. Which of the following nursing actions are appropriate to include as anticipated or contraindicated instructions?

Sublingual nitroglycerin is the prototypical sublingual medication used for anginal episodes, and correct administration technique is essential for therapeutic effectiveness and safety. Instructing the client to sit or lie down when experiencing chest pain before taking the medication is anticipated (appropriate) because nitroglycerin causes vasodilation and can precipitate orthostatic hypotension and dizziness, making falls a real risk if the patient is standing. Encouraging the client to place the tablet under the tongue and allow it to dissolve completely is also anticipated; this is the correct technique that allows rapid absorption through the sublingual mucosa into systemic circulation. Recommending more than three sublingual tablets for persistent chest pain is contraindicated; the standard guideline is to take one tablet, wait five minutes, and if pain persists repeat up to a total of three tablets, then call emergency services — taking additional tablets beyond three increases the risk of severe hypotension without additional benefit and delays seeking emergency care for a possible myocardial infarction. Advising the client to swallow the tablet immediately is contraindicated because swallowing bypasses the sublingual mucosa, subjects the drug to first-pass hepatic metabolism, dramatically reduces bioavailability, and prevents the rapid onset of action that makes sublingual administration effective.