A nurse is monitoring a client who is receiving morphine IV and amitriptyline PO. Which of the following findings indicates an adverse interaction between the prescribed medications?

A. Low-grade fever: A mild fever is not typically associated with the interaction between morphine and amitriptyline. It may indicate an unrelated infection or inflammatory process rather than a medication effect.

B. Urinary retention: Both morphine (an opioid) and amitriptyline (a tricyclic antidepressant) have anticholinergic properties that can decrease bladder tone and inhibit urination. When combined, they increase the risk of urinary retention, making this a significant adverse interaction.

C. Diarrhea: These medications more commonly cause constipation rather than diarrhea because of their combined effects on slowing gastrointestinal motility. Diarrhea would not indicate an interaction between the two drugs.

D. Tachypnea: Morphine typically causes respiratory depression rather than an increased respiratory rate. Tachypnea would not be a sign of interaction but could occur as a compensatory response to pain or anxiety.

A. Return the medications to the pharmacy: Expired medications should be returned to the pharmacy or designated medication disposal area to ensure proper handling and prevent accidental administration. Pharmacies follow regulatory guidelines for safe disposal or destruction.

B. Place the medications back in the medication cart: Returning expired medications to the medication cart is unsafe because it risks administration to clients and violates medication safety protocols.

C. Notify the provider about the expired medications: Providers do not need to be notified about expired medications unless it affects a specific prescription; the responsibility for proper disposal lies with the nurse and pharmacy.

D. Flush the medications down the toilet: Flushing medications is generally discouraged due to environmental contamination risks unless specifically recommended for certain drugs. Safe disposal should follow pharmacy or institutional protocols.