A client who has chronic pain due to cancer is prescribed fentanyl patches for pain management. The nurse should instruct the client to follow which of the following guidelines when using this controlled substance? (Select all that apply.)

Correct answer: d) Schedule IV

Rationale: Diazepam is a benzodiazepine that acts as a central nervous system depressant. It belongs to Schedule IV of controlled substances, which have a low potential for abuse and dependence compared to Schedule I, II, or III substances.

Incorrect choices:
a) Schedule I: Schedule I substances have no accepted medical use and a high potential for abuse and dependence. Examples include heroin, LSD, and ecstasy.
b) Schedule II: Schedule II substances have a high potential for abuse and dependence but have some accepted medical uses with severe restrictions. Examples include morphine, oxycodone, and cocaine.
c) Schedule III: Schedule III substances have a moderate potential for abuse and dependence but have accepted medical uses. Examples include codeine, ketamine, and anabolic steroids.

Correct answer: A, D, E

Rationale: Fentanyl patches are transdermal delivery systems that provide continuous opioid analgesia for up to 72 hours. The nurse should instruct the client to apply the patch to a dry, hairless area of intact skin; avoid exposing the patch to heat sources that can increase absorption and cause overdose; and report any signs of opioid toxicity such as confusion, drowsiness, or difficulty breathing.

Incorrect choices:
b) Change the patch every 24 hours or as needed for pain relief.: This is incorrect as changing the patch more frequently than every 72 hours can cause overdose and dependence.

c) Dispose of the used patch by flushing it down the toilet.: This is incorrect as flushing the patch down the toilet can contaminate the water supply and pose a risk of accidental ingestion by children or pets. The nurse should instruct the client to fold the patch in half with the sticky sides together and dispose of it in a secure trash container.