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

A) Morphine 2 mg IV: Morphine is a potent opioid analgesic commonly used to manage moderate to severe pain. However, in this scenario, the client reports pain as 5 on a scale of 0 to 10, which indicates moderate pain. Morphine 2 mg IV may be excessive for this level of pain and could result in unnecessary sedation, respiratory depression, or other opioid-related adverse effects. Therefore, it is not the most appropriate choice for managing the client's pain.

B) Amitriptyline 25 mg PO: Amitriptyline is a tricyclic antidepressant with analgesic properties, but it is not typically used as a first-line treatment for acute postoperative pain. Additionally, it is administered orally and may not provide rapid pain relief in the immediate postoperative period. Therefore, it is not the most suitable option for managing the client's pain after a total knee replacement surgery.

C) Ketorolac 15 mg IV: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that provides potent analgesic and anti-inflammatory effects. It is commonly used for the management of moderate to severe pain, including postoperative pain. In this scenario, the client reports moderate pain after total knee replacement surgery, making ketorolac an appropriate choice for pain management. Administering ketorolac 15 mg IV can provide effective pain relief without the sedative effects of opioids, making it the most suitable PRN medication for the client's pain level.

D) Acetaminophen 650 mg PO: Acetaminophen is a non-opioid analgesic commonly used for mild to moderate pain relief. While acetaminophen is generally safe and effective, it may not provide sufficient pain relief for a client who reports pain as 5 on a scale of 0 to 10 after total knee replacement surgery. Additionally, oral administration may result in delayed onset of action compared to IV medications. Therefore, acetaminophen 650 mg PO may not be the most optimal choice for managing the client's pain in this situation.

Lansoprazole: Lansoprazole is a proton pump inhibitor commonly used to reduce stomach acid production and treat conditions like gastroesophageal reflux disease (GERD) and ulcers. There are no significant contraindications or interactions between lansoprazole and nitroglycerin. Therefore, it is not contraindicated for use with nitroglycerin.

B) Diazepam: Diazepam is a benzodiazepine medication used to treat anxiety, muscle spasms, and certain seizure disorders. While caution may be necessary when using diazepam concurrently with nitroglycerin due to the potential for additive hypotensive effects, it is not typically contraindicated. However, close monitoring of blood pressure and signs of hypotension is prudent when these medications are used together.

C) Sildenafil: Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor used to treat erectile dysfunction and pulmonary arterial hypertension. Concomitant use of sildenafil with nitroglycerin is contraindicated due to the risk of profound hypotension, which can result in cardiovascular collapse. Both medications have vasodilatory effects, and their combination can lead to severe hypotension, syncope, and even myocardial infarction. Therefore, sildenafil is contraindicated for use with nitroglycerin.

D) Gemfibrozil: Gemfibrozil is a lipid-lowering medication used to reduce triglyceride levels in individuals with hypertriglyceridemia. There are no significant contraindications or interactions between gemfibrozil and nitroglycerin. Therefore, it is not contraindicated for use with nitroglycerin.