A nurse is providing teaching to a client who wants to stop smoking and has purchased a transdermal smoking patch. Which of the following information should the nurse provide?

Choice A Reason:
Apply the patch to a hairless area of the skin is correct. Nitroglycerin patches should be applied to a clean, hairless area of the skin to ensure proper absorption of the medication. Hair can interfere with the patch's adherence and the absorption of nitroglycerin into the bloodstream. The site chosen should be rotated to prevent skin irritation or tolerance development. Commonly used areas include the chest, upper arms, or torso, but it's important to follow specific instructions provided by the healthcare provider.
Choice B Reason:
Apply a 4x4 dressing over the patch is incorrect. Covering the nitroglycerin patch with a dressing may interfere with its absorption and effectiveness. These patches are designed to be applied directly to the skin without covering.
Choice C Reason:
Apply the patch to the same site every 24 hr is incorrect. Repeatedly applying the patch to the same site increases the risk of skin irritation or tolerance to the medication. It's crucial to rotate patch sites to avoid these issues.
Choice D Reason:
Apply the patch to a bony prominence on the chest is incorrect. Nitroglycerin patches should not be placed on bony prominences because these areas can be uncomfortable and may not provide optimal absorption. Instead, they are typically applied to relatively flat, hairless areas of the skin.

Choice A Reason:
BUN 15 mg/dL (blood urea nitrogen) is incorrect. An elevated BUN level can indicate kidney dysfunction or dehydration, but it's not typically associated with azathioprine's adverse effects. Azathioprine is known to affect bone marrow, leading to decreased blood cell counts, rather than directly impacting kidney function.
Choice B Reason:
WBC 3,000/mm³ (low white blood cell count) is correct. Azathioprine is an immunosuppressive medication used to treat various conditions, including rheumatoid arthritis. One of its known adverse effects is bone marrow suppression, which can lead to decreased production of blood cells, including white blood cells (WBCs). A low WBC count (leukopenia) can increase the risk of infections due to compromised immune function, making it an important adverse effect to monitor in individuals taking azathioprine.
Choice C Reason:
Hct 45% (hematocrit) is incorrect. A hematocrit of 45% is within the normal range for both men and women. Azathioprine adverse effects usually manifest as blood cell-related issues (such as leukopenia) rather than directly impacting hematocrit levels.
Choice D Reason:
Platelets 250,000/mm³: Platelets within the range of 150,000 to 400,000/mm³ are considered normal. Azathioprine typically affects white blood cells more prominently than platelet counts.