A nurse is planning care for an older adult client who has dementia and a nutritional deficit.
Which of the following actions should the nurse plan to take?

Choice A rationale

Storing transdermal scopolamine patches in the refrigerator is incorrect. Scopolamine patches are designed to be stored at controlled room temperature, typically between 20 to 25 degrees Celsius, to maintain the integrity of the adhesive and the stability of the medication. Refrigeration can compromise the patch's adhesive properties, potentially causing it to fall off, and may also affect the rate of drug delivery.

Choice B rationale

Replacing a dislodged patch onto the same location is incorrect. The skin's absorption capabilities at the initial site may be reduced due to the previous application, leading to a diminished therapeutic effect. Applying a new or dislodged patch to a new, clean, and dry site, typically behind the ear, ensures optimal drug absorption and efficacy, which is a crucial aspect of patient education.

Choice C rationale

Applying the patch prior to traveling is correct. Transdermal scopolamine requires a significant onset time to achieve therapeutic blood levels to effectively prevent the symptoms of motion sickness. The recommendation is to apply the patch at least four hours before the anticipated travel to allow for sufficient absorption and systemic distribution of the medication to the central nervous system.

Choice D rationale

Placing the patch on the upper arm is incorrect. The recommended application site for transdermal scopolamine is the postauricular area, which is the hairless skin behind the ear. This location offers a thin epidermis and a rich capillary network, facilitating consistent and effective absorption of the medication into the systemic circulation, which is essential for its prophylactic antiemetic effect. *.

Choice A rationale: A protective environment is typically indicated for immunocompromised clients, such as those with neutropenia or undergoing chemotherapy, not for uncomplicated anemia. The toddler’s white blood cell count is within the normal range of 5,000 to 10,000/mm³, and no evidence of infection risk or severe immunodeficiency is present. Pallor and low hemoglobin are consistent with iron deficiency anemia, which does not require isolation precautions unless additional hematologic compromise is identified.

Choice B rationale: Blood transfusions are reserved for cases of severe anemia with hemodynamic instability, cardiac compromise, or hemoglobin levels below 7 g/dL. This toddler’s hemoglobin is 8.1 g/dL, which while low, does not meet transfusion threshold in a stable, asymptomatic pediatric patient. Transfusion carries risks like iron overload and alloimmunization, making it inappropriate for mild to moderate anemia. Instead, correction through dietary modification and iron supplementation is preferred for age-related iron-deficiency anemia.

Choice C rationale: Iron supplementation is the standard therapy for iron deficiency anemia, especially in toddlers consuming excessive cow’s milk, which lacks iron and can cause occult intestinal blood loss. Hemoglobin of 8.1 g/dL is below the normal pediatric range of 9.5 to 14 g/dL, confirming anemia. Iron replenishment stimulates erythropoiesis by enabling hemoglobin synthesis. Supplementation corrects deficiency over time and should be paired with dietary education to limit milk to <24 oz/day and include iron-rich foods.

Choice D rationale: Continuing antibiotics is unnecessary unless there is ongoing infection. The toddler has recently completed antibiotic therapy for otitis media, and current symptoms do not suggest infection recurrence. Vital signs are stable and the white blood cell count is within normal limits (5,000–10,000/mm³), indicating no acute bacterial process. Antibiotic overuse may disrupt gut flora, impair iron absorption, and contribute to resistant bacterial strains, which is contraindicated in this clinical scenario.