Assessing a patient following IV morphine administration, the nurse notes cold, clammy skin; a pulse of 40 beats/min; respirations of 10 breaths/min; and constricted pupils. Which medication will the patient likely need next?

Transdermal fentanyl patches are a common choice for patients with chronic cancer-related pain because they provide continuous systemic absorption of the drug. This allows for stable plasma concentrations and sustained pain relief, reducing the peaks and troughs that occur with oral or injectable opioids. The patches are not free of adverse effects, but their main advantage is consistent analgesia.

Rationale for correct answer:

A. More constant drug levels for analgesia:
The patch delivers fentanyl steadily over 72 hours, ensuring stable pain control without the fluctuations seen with short-acting opioids. This makes it particularly useful for persistent cancer pain.

Rationale for incorrect answers:

B. Less constipation and minimal dry mouth:
Constipation and dry mouth are common opioid side effects regardless of the route. Fentanyl patches do not eliminate these adverse effects, so laxatives and oral care are still necessary.

C. Less drowsiness than with oral opioids:
Fentanyl can still cause CNS depression and drowsiness. The patch does not prevent this effect—it mainly changes how the drug is delivered.

D. Lower dependency potential and no major adverse effects:
Fentanyl is a potent opioid with the same risks of tolerance, dependence, and adverse effects as other opioids. It must be carefully monitored.

Take-home points:

• Transdermal fentanyl provides stable and continuous analgesia, which is ideal for chronic cancer pain.
• Side effects such as constipation, sedation, and dependency risks remain and require monitoring.
• The main advantage is avoiding peaks and troughs in pain relief, improving patient comfort and quality of life.

Aspirin is a salicylate commonly prescribed for its analgesic, antipyretic, and anti-inflammatory effects in conditions like arthritis. However, it carries a risk of toxicity (salicylism), especially with long-term or high-dose use. One of the earliest warning signs of toxicity is tinnitus, which must be promptly reported to prevent progression to severe complications.

Rationale for correct answer:
A. Tinnitus: Persistent ringing in the ears is a hallmark early symptom of salicylism. Reporting it immediately allows the provider to adjust the dose or discontinue therapy before more serious effects (vertigo, metabolic acidosis, respiratory depression) develop.

Rationale for incorrect answers:
B. Seizures: While seizures may occur in severe salicylate poisoning, they are a late and rare manifestation. The nurse should emphasize earlier warning signs like tinnitus rather than seizures.
C. Sinusitis: This is unrelated to aspirin use and not an expected adverse effect.
D. Palpitations: Aspirin does not typically cause palpitations. Cardiac symptoms are not primary concerns with salicylates.

Take-home points:

• Tinnitus is an early indicator of aspirin toxicity and must be reported promptly.
• Salicylism may progress to more severe CNS and metabolic effects if unrecognized.
• Patient teaching for long-term aspirin use should focus on GI safety (ulcer risk) and early signs of toxicity.