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

Administering diclofenac at bedtime does not specifically mitigate its gastrointestinal side effects. NSAIDs like diclofenac can cause gastric irritation and ulceration by inhibiting cyclooxygenase-1 (COX-1), which produces prostaglandins essential for gastric mucosal protection. Time of administration is less critical than co-administration with food or protective agents.

Choice B rationale

Antacids can interfere with the absorption of some medications, but specifically for diclofenac, avoiding concomitant administration is not a standard recommendation to mitigate adverse effects. In fact, antacids can sometimes be used to alleviate gastric distress associated with NSAIDs, although they do not prevent direct mucosal damage.

Choice C rationale

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the gastric mucosa, potentially causing dyspepsia, nausea, and ulceration. Administering the medication with food or milk helps to buffer the gastric acid and physically protect the stomach lining, thereby reducing the direct irritant effect on the gastrointestinal tract and enhancing tolerability.

Choice D rationale

Diclofenac is typically formulated as an enteric-coated tablet or delayed-release capsule to protect the stomach from irritation and ensure targeted drug release in the small intestine. Crushing the medication would destroy this protective coating, leading to premature drug release in the stomach, increasing gastric irritation, and potentially reducing therapeutic efficacy.

Choice A rationale

Aspartate aminotransferase (AST) is an enzyme primarily found in the liver, heart, and muscle. Elevated levels can indicate hepatocellular damage or cardiac muscle injury. While some medications can affect liver function, AST is not a primary monitoring parameter for methylprednisolone, which is a corticosteroid, unless specific hepatotoxicity is suspected or pre-existing liver conditions exist. Normal AST levels are typically 10-40 U/L.

Choice B rationale

Fibrin split products (FSPs) are indicators of fibrinolysis, the breakdown of fibrin clots. Elevated FSPs suggest active clotting and subsequent clot degradation, often seen in disseminated intravascular coagulation (DIC). Methylprednisolone, a corticosteroid, does not directly impact fibrinolysis or coagulation to warrant routine monitoring of FSPs as a primary concern. This test is not routinely indicated.

Choice C rationale

Blood urea nitrogen (BUN) measures the amount of nitrogen in the blood that comes from the waste product urea. Elevated BUN can indicate kidney dysfunction or dehydration. While corticosteroids can influence fluid balance, BUN is not a specific or primary laboratory value monitored for the direct effects of methylprednisolone therapy unless a pre-existing renal impairment is present. Normal BUN levels are typically 7-20 mg/dL.

Choice D rationale

Methylprednisolone, a glucocorticoid, significantly impacts carbohydrate metabolism by promoting gluconeogenesis and glycogenolysis, leading to increased blood glucose levels. This can induce hyperglycemia and even steroid-induced diabetes, particularly in predisposed individuals. Therefore, close monitoring of blood glucose is crucial to prevent and manage this common adverse effect. Normal fasting glucose is typically 70-99 mg/dL.