A cancer patient asks the nurse what can be given to alleviate severe, chronic pain of several months’ duration. The patient has been taking oxycodone (OxyContin) and states it is no longer effective. The nurse will suggest discussing which medication with the provider?

Choice A reason: Jaundice indicates liver dysfunction, but ibuprofen rarely causes hepatotoxicity at standard doses. It’s more associated with gastrointestinal issues due to COX-1 inhibition, reducing protective prostaglandins in the stomach lining. While possible with overdose, jaundice is less common than gastrointestinal bleeding, making this choice less likely.

Choice B reason: Ibuprofen, an NSAID, inhibits COX-1, reducing gastric mucosal protection, which can lead to ulcers or gastrointestinal bleeding. Bloody emesis (hematemesis) indicates severe gastrointestinal damage, a well-documented adverse effect requiring immediate intervention, making this the correct choice for a severe ibuprofen-related complication.

Choice C reason: Itching may indicate a mild allergic reaction or skin irritation, not a severe adverse effect of ibuprofen. While possible, it’s less critical than gastrointestinal bleeding, which poses life-threatening risks due to ibuprofen’s impact on gastric mucosa, making this choice less severe and incorrect.

Choice D reason: Dysmenorrhea (painful periods) is a condition ibuprofen treats, not an adverse effect. By inhibiting prostaglandins, ibuprofen reduces uterine contractions and pain. It doesn’t cause dysmenorrhea, making this choice irrelevant as an indicator of a severe adverse effect of ibuprofen therapy.

Choice A reason: NPH insulin is not mixed with insulin glargine, as glargine’s pH and formulation cause precipitation or altered pharmacokinetics when combined. NPH can be mixed with regular insulin, as they are compatible, making this choice incorrect for the patient’s reported practice.

Choice B reason: NPH and regular insulin are compatible and routinely mixed in one syringe to provide both intermediate and short-acting coverage. They don’t react chemically or lose efficacy when combined properly, making this choice incorrect, as mixing is a standard practice in diabetes management.

Choice C reason: Mixing NPH and regular insulin does not increase potency; it combines their pharmacokinetics for basal and prandial glucose control. The mixture delivers the additive effects of each insulin’s profile without enhancing overall potency, making this choice inaccurate for their combined action.

Choice D reason: Mixing NPH (intermediate-acting) and regular insulin (short-acting) is an accepted practice to manage type 1 diabetes with one injection, covering basal and prandial needs. Proper technique (drawing regular insulin first) ensures stability, making this the correct choice for the patient’s reported insulin administration.