A nurse is caring for a client who is postoperative following orthopedic surgery and is receiving IV ketorolac.
Which of the following findings should the nurse identify as the priority to report to the provider?

Choice A rationale

Naloxone is an opioid antagonist used to reverse opioid-induced respiratory and central nervous system depression. Midazolam is a benzodiazepine, not an opioid. Therefore, naloxone would not be effective in reversing the adverse effects of midazolam. Its mechanism of action specifically targets opioid receptors.

Choice B rationale

Flumazenil is a benzodiazepine receptor antagonist. It specifically binds to benzodiazepine receptors, competitively inhibiting the effects of benzodiazepines like midazolam. In cases of benzodiazepine overdose or excessive sedation leading to adverse effects such as hypotension, flumazenil can rapidly reverse these central nervous system depressant effects.

Choice C rationale

Moxifloxacin is a fluoroquinolone antibiotic. It is used to treat bacterial infections and has no pharmacological action that would counteract the effects of benzodiazepines or specifically address drug-induced hypotension during a procedure like a colonoscopy. Administering an antibiotic in this scenario would be inappropriate.

Choice D rationale

Fludrocortisone is a mineralocorticoid used primarily for its effects on electrolyte and fluid balance, often in conditions like Addison's disease or orthostatic hypotension. It would not be an appropriate choice for rapidly reversing acute drug-induced hypotension caused by midazolam during a medical procedure. Its action is not immediate.

Choice A rationale: Persistent coughing with mucopurulent sputum suggests an ongoing respiratory infection or inflammation. Mucopurulent sputum indicates the presence of neutrophils and bacteria, often seen in bacterial pneumonia or tuberculosis. While significant, coughing alone is not an immediate life-threatening finding but rather a symptom requiring monitoring and further diagnostic follow-up to confirm the cause.

Choice B rationale: Joint pain in a patient receiving infliximab for rheumatoid arthritis may reflect an autoimmune flare or side effects of immunosuppression. Although uncomfortable and significant for quality of life, joint pain does not usually require immediate intervention compared to respiratory or infectious signs that may threaten life or transmission risk.

Choice C rationale: Anorexia, or decreased appetite, is a common systemic symptom in chronic infections like tuberculosis. It reflects the body’s inflammatory response and catabolic state but is a nonspecific finding. It requires addressing nutritional support but is not immediately life-threatening or requiring urgent intervention compared to active infectious disease signs.

Choice D rationale: Night sweats are a classic systemic symptom of tuberculosis caused by cytokine-mediated thermoregulatory dysfunction during infection. Although important in clinical suspicion, night sweats themselves do not necessitate immediate intervention but support the need for further diagnostic workup and infection control precautions.

Choice E rationale: An 11 mm induration on the purified protein derivative (PPD) test is considered positive in this patient due to immunosuppression with infliximab, which increases TB risk. The normal cutoff varies by risk factors, but 5 mm or greater is positive in immunosuppressed patients. This finding requires urgent follow-up to initiate treatment and prevent active disease and transmission, making it the most critical.