# A 70-year-old client with chronic stable cancer pain who is opioid-tolerant is starting fentanyl transdermal patch 25 mcg/hour every 72 hours. Which client statement indicates correct understanding?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375158&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 70-year-old client with chronic stable cancer pain who is opioid-tolerant is starting fentanyl transdermal patch 25 mcg/hour every 72 hours. Which client statement indicates correct understanding?

## Option

1. I will use a heating pad over the patch when my pain is worse to make it work better.
2. I will cut the patch in half if the dose feels too strong.
3. I will apply two patches at once to control breakthrough pain.
4. I will apply the patch to clean dry intact skin on the upper torso, rotate sites every 72 hours, fold the used patch sticky-side to sticky-side and flush down the toilet, and avoid heat sources because heat increases the dose released. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Fentanyl transdermal patch is reserved for opioid-tolerant patients with chronic stable severe pain. The matrix or reservoir delivers fentanyl continuously over 72 hours. Steady state is reached after 24 hours of the first patch and after dose changes; analgesia is gradual at start and a residual depot persists 12 to 24 hours after removal. Critical teaching: (1) clean, dry, intact, hairless skin on chest, back, flank, or upper arm — clip hair, do not shave; rotate sites every 72 hours and document; press firmly for 30 seconds; (2) heat increases release and can cause overdose — avoid heating pads, electric blankets, hot tubs, saunas, intense exercise, and high fever; report fever; (3) never cut a transdermal patch unless explicitly designed to be cut (the original duragesic patch is matrix and could be sectioned in some products, but practice is to use the lowest available strength rather than cut); (4) used patches contain enough drug to kill a child or pet — fold sticky-to-sticky and dispose by flushing down the toilet (FDA flush list for high-risk opioid patches), never throw whole into trash; (5) breakthrough pain is managed with a short-acting opioid, not by adding patches; (6) confirmed allergy or skin reaction at the site requires removal and report; (7) report increased sedation, confusion, slow breathing, or fall. Heating, cutting, or doubling are unsafe.

## In-depth explanation

Patch is for chronic stable opioid-tolerant pain. The phrase "do not apply heat" is the most-tested fentanyl patch safety. Sticky-to-sticky disposal is the second most-tested.

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