A new nitroglycerin transdermal patch is scheduled, and the nurse finds the previous patch still attached to the client. Which action should the nurse take?
1Apply the new patch beside the old patch and document both patches for the next nurse
2Cut the new patch in half and place both halves over the patch that is already attached
3Leave the old patch in place until the next scheduled patch-free interval begins
4Remove the old patch, clean the skin, and place the new patch on a different site✓ Correct answer
Explanation
The previous transdermal system is removed before the scheduled replacement, and the new system is applied to a different clean, dry site. Leaving both patches on can deliver unintended medication and increase hypotension or other adverse effects.
Quick answer Remove the previous patch before applying the scheduled replacement to a different clean, dry site.
Why this is correct A transdermal patch continues releasing medication while attached. Removing the prior system prevents unintended overlapping delivery, while site rotation reduces local skin irritation and keeps administration consistent with the prescribed schedule.
Easy analogy or mental picture A patch is like a slow medication tap that stays open while attached; adding another tap increases flow. The comparison explains overlap, but the exact on-off schedule must still follow the prescription and product label.
NCLEX decision rule Before applying a scheduled transdermal medication, inspect for and remove the previous system, verify the ordered schedule, rotate the site, and document removal and application. Never alter or stack patches without an explicit order.
Why the other choices are wrong Stacking patches risks excess drug delivery. Cutting a system can alter delivery, and postponing removal beyond the ordered schedule leaves medication active longer than intended.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
Nitroglycerin Transdermal System Prescribing InformationDailyMed, U.S. National Library of Medicine
Clinical Practice GuideFor Insulin glargine mixing question, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.
CautionDo not choose an action from one isolated cue when the full scenario changes priority or safety.
Insulin Glargine — A long-acting basal insulin used for background glucose control.
Rapid-Acting Insulin — Insulin used around meals or corrections with a faster onset.
Medication Safety — Practices that reduce medication errors and adverse effects.