A nurse is caring for a postoperative patient receiving opioid analgesics for pain management. Which assessment would alert the nurse to contact the provider?

Choice A reason: Nuchal rigidity, or neck stiffness, is a hallmark of bacterial meningitis due to meningeal inflammation irritating the spinal nerves and muscles. This causes resistance to neck flexion, often accompanied by fever, headache, and photophobia. It reflects the inflammatory response to bacterial invasion of the meninges, a critical diagnostic sign.

Choice B reason: Hypoactive deep tendon reflexes are not typical in bacterial meningitis. The condition causes central nervous system irritation, often leading to hyperactive reflexes due to meningeal inflammation. Hypoactive reflexes may occur in peripheral neuropathies or late-stage neurological diseases, not in acute meningitis, where irritability and hyperreflexia are more common.

Choice C reason: Bradycardia is not expected in bacterial meningitis. The systemic inflammatory response and fever typically cause tachycardia as the body compensates for infection and increased metabolic demand. Bradycardia may occur in late stages with increased intracranial pressure, but it is not a primary or early finding in meningitis.

Choice D reason: Increased appetite is not associated with bacterial meningitis. The condition causes systemic symptoms like fever, headache, and nausea, often leading to anorexia due to inflammation and discomfort. Increased metabolic demand exists, but patients typically experience reduced appetite, making this an unlikely finding in acute bacterial meningitis.

A. A single IV line allows simultaneous administration of multiple drugs, but compatibility must be confirmed. Morphine and ketorolac are generally compatible for IV administration, but a dedicated line is preferred to avoid potential precipitation or chemical interactions that could reduce efficacy or cause harm. A dedicated line ensures each drug is delivered without interference, aligning with safe administration practices for this patient’s pain management.

B. A Y-site IV configuration allows drugs to mix at the infusion site, which could lead to incompatibility. Morphine, an opioid, and ketorolac, an NSAID, have different chemical properties, and while no major incompatibility is documented, using a Y-site risks minor interactions or reduced efficacy, making it less ideal than a dedicated line for this patient.

C. Flushing the IV line ensures patency but does not address drug compatibility. Morphine and ketorolac administration through the same line without a dedicated setup could lead to precipitation or reduced effectiveness, especially if not flushed properly between doses. This option is insufficient for ensuring safe delivery in this context.

D. Ketorolac, an NSAID, can cause gastrointestinal or renal side effects but does not directly interfere with morphine’s action. However, simultaneous administration through the same IV line could risk chemical incompatibility, such as precipitation, which could obstruct the line or reduce drug efficacy, making this a critical consideration for the patient’s IV setup.

E. Morphine, an opioid, provides analgesia but does not inherently interfere with ketorolac’s action. The concern lies in their co-administration through the same IV line, where potential chemical interactions could occur, supporting the need for a dedicated line to ensure both drugs are delivered effectively for the patient’s pain control.

F. Heparin, an anticoagulant, is not mentioned in the provider’s orders. Interference with heparin is irrelevant here, as the focus is on morphine and ketorolac compatibility. This option is incorrect, as it does not address the patient’s medication regimen or IV administration concerns.

G. Saline is used for flushing IV lines to maintain patency, not as a primary drug. It does not interfere with morphine or ketorolac but is irrelevant to the question of drug interference, making this option incorrect for the patient’s pain management context.

H. Precipitation occurs when incompatible drugs mix, forming insoluble particles that can clog the IV line or reduce drug efficacy. Morphine and ketorolac have a low risk of precipitation, but a dedicated line minimizes this risk, ensuring safe and effective delivery, making this a correct consideration for the patient’s IV setup.

I. Flushing between drug administrations prevents mixing but does not eliminate the need for a dedicated line. While flushing reduces interaction risks, it is less reliable than a dedicated line for ensuring morphine and ketorolac are administered without interference, making this option less optimal for the patient’s needs.