A patient is taking hydrocodone and ibuprofen for cancer pain and ...

[Kikoku]

A patient is taking hydrocodone and ibuprofen for cancer pain and is admitted to the hospital for chemotherapy. The nurse anticipates that the prescriber will _____ ibuprofen.
 
  a. reduce the dose of
  b. discontinue the
  c. increase the dose of
  d. order aspirin (ASA) instead of

Question 2

A patient who has had cancer for 1 year uses a fentanyl transdermal patch for pain relief. The patient reports having three or four episodes of pain (which she rates as 8 or 9 on a scale of 1 to 10) each day, and each episode lasts 15 to 30 minutes.
 
  The nurse will contact the provider to:
  a. discuss the use of an adjuvant analgesic.
  b. request an order for an NSAID.
  c. request a strong, short-acting opioid PRN.
  d. suggest increasing the dose of fentanyl.

[missalyssa26]

Answer to Question 1

ANS: B
NSAIDs are contraindicated in patients undergoing chemotherapy because of decreased platelet production caused by bone marrow suppression. Any NSAID further increases the risk of bruising and bleeding. ASA is especially dangerous, because it causes irreversible inhibition of platelet aggregation. Ibuprofen should be discontinued, not reduced or increased.

Answer to Question 2

ANS: C
Breakthrough pain can occur in patients who otherwise have well-controlled pain, and it should be managed with extra doses of short-acting, strong opioids. This pain is moderate to severe and is not neuropathic, so adjuvant analgesics or NSAIDs are not useful. Increasing the dose of the long-acting opioid would not alleviate breakthrough pain.

[Kikoku]

TYSM

Gracias!