A nurse is planning care for a client who is experiencing opioid toxicity. Which of the following medications should the nurse anticipate administering?

) Glaucoma: Atropine is contraindicated in clients with glaucoma due to its potential to exacerbate intraocular pressure. Glaucoma is a condition characterized by increased intraocular pressure, which can lead to optic nerve damage and vision loss if left untreated or if pressure is further increased. Atropine, as an anticholinergic medication, works by dilating the pupil and inhibiting accommodation, thereby increasing intraocular pressure. Administering atropine to a client with glaucoma can worsen their condition and potentially cause acute angle-closure glaucoma, which is a medical emergency. Therefore, it is essential to avoid using atropine in clients with glaucoma to prevent irreversible vision loss and other serious complications.

B) Bronchospasms: Atropine can be used to treat bronchospasms by dilating the bronchi and bronchioles, making it easier to breathe. While it may not be the first-line treatment for bronchospasms, it is not contraindicated in this condition. The bronchodilatory effects of atropine help relieve airway constriction and improve airflow, which can be beneficial in managing bronchospasms associated with conditions such as asthma or chronic obstructive pulmonary disease (COPD). Therefore, atropine can be considered as part of the treatment regimen for bronchospasms when indicated.

C) Diverticulitis: Atropine does not have any specific contraindications related to diverticulitis. However, caution should be exercised in clients with pre-existing gastrointestinal conditions due to potential anticholinergic effects, such as decreased gastrointestinal motility. While atropine can inhibit gastrointestinal motility and secretions, which may exacerbate symptoms in some individuals with diverticulitis, it is not considered a contraindication. The decision to use atropine in clients with diverticulitis should be based on the overall assessment of the client's condition and the potential benefits versus risks of treatment.

D) Diarrhea: Atropine can be used to treat diarrhea by reducing gastrointestinal motility and secretions. Therefore, it is not contraindicated in clients with diarrhea. By slowing down gastrointestinal motility and reducing secretions, atropine can help alleviate diarrhea and promote better bowel control. While other treatment options may be considered depending on the underlying cause of diarrhea, atropine can be effective in managing diarrhea associated with certain conditions or as part of a treatment regimen for specific gastrointestinal disorders.

B) Nalbuphine: Nalbuphine is an opioid analgesic that acts on the central nervous system to relieve pain. When administered concurrently with morphine, there is a risk of additive respiratory depression and other opioid-related side effects, such as sedation and hypotension. Therefore, the nurse should clarify the prescription for nalbuphine with the provider to ensure that the combination of opioid medications is appropriate for the client's pain management. Additionally, nalbuphine has mixed agonist-antagonist properties and can precipitate withdrawal symptoms in clients who are physically dependent on full opioid agonists like morphine. Due to these potential interactions and safety concerns, it is essential for the nurse to obtain clarification from the provider before administering nalbuphine to the client receiving morphine via a PCA pump.

A) Ondansetron: Ondansetron is an antiemetic medication commonly prescribed to manage nausea and vomiting, which can be side effects of opioid analgesics like morphine. There are no significant contraindications or interactions between ondansetron and morphine, making it a suitable choice for adjunctive therapy in clients receiving PCA morphine for cancer pain.

C) Insulin glargine: Insulin glargine is a long-acting insulin analog used to control blood glucose levels in clients with diabetes mellitus. While clients with cancer may have comorbidities such as diabetes, the prescription for insulin glargine is unlikely to require clarification in the context of concurrent morphine use. However, the nurse should verify the client's current blood glucose levels and adjust the insulin dosage as needed based on the client's glycemic control.

D) Acetaminophen: Acetaminophen is a non-opioid analgesic commonly used to manage mild to moderate pain. When used in combination with opioids like morphine, acetaminophen can provide additive pain relief and may reduce the total opioid dosage required. There are no significant contraindications or interactions between acetaminophen and morphine, making it a suitable choice for adjunctive pain management in clients receiving PCA morphine for cancer pain.