A patient with cancer is admitted to the hospital. The nurse ...

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A patient with cancer is admitted to the hospital. The nurse obtains an admission history and learns that the patient has been taking oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year.
 
  The patient reports a recent increase in the intensity of pain, along with a new pain described as burning and shooting. The nurse anticipates that the prescriber will order:
  a. a combination opioid/NSAID and an adjunctive analgesic.
  b. a fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic.
  c. an increase in the oxycodone and NSAID doses.
  d. intramuscular morphine sulfate and acetaminophen.

Question 2

A patient newly diagnosed with cancer is admitted to the hospital, and the provider orders oxycodone (OxyContin) every 4 to 6 hours PRN pain.
 
  The patient requests pain medication whenever he reports pain as a 7 or 8 on a scale of 1 to 10 (10 being the worst pain), but he tells the nurse the medication is not working well. The nurse will contact the provider to discuss:
  a. a fixed dosing schedule for the oxycodone.
  b. intramuscular meperidine (Demerol).
  c. intravenous morphine sulfate.
  d. transdermal fentanyl.

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Answer to Question 1

ANS: B
As pain increases in severity, more powerful opioids should be used. This patient has been taking oxycodone, which is a moderate-strength opioid; fentanyl is stronger. Because the pain is chronic and is now severe and because the patient has opioid tolerance, a transdermal patch may be used. Long-term use of NSAIDs is not recommended because of the risk of thrombotic events. The patient also is describing neuropathic pain, which can be treated with an adjuvant analgesic. Fixed-dose combination drugs are not recommended for increasing pain. NSAIDs are not recommended long term. Intramuscular medications are not recommended because of the pain associated with administration.

Answer to Question 2

ANS: A
Dosing should be done on a fixed schedule to prevent opioid levels from becoming subtherapeutic once patients begin to have more severe pain. IM and IV dosing are more invasive and should not be used unless other methods have failed. Transdermal fentanyl is used for chronic, severe pain in patients tolerant to opioids.

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