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

A) Discontinue the infusion: While discontinuing the parenteral nutrition infusion may be necessary in severe cases of hypoglycemia, it should not be the initial action unless the client's condition warrants it. Discontinuing the infusion without providing alternative sources of glucose may exacerbate the hypoglycemia and lead to further complications.

B) Obtain arterial blood gases: Arterial blood gases (ABGs) are not typically indicated for evaluating hypoglycemia. While ABGs provide valuable information about acid-base balance and oxygenation status, they do not directly assess blood glucose levels or contribute to the management of hypoglycemia.

C) Warm formula to room temperature: Warming the parenteral nutrition formula to room temperature may improve comfort during administration, but it is not directly related to managing hypoglycemia. Hypoglycemia requires prompt intervention to raise blood sugar levels, and warming the formula would not address the immediate need for glucose supplementation.

D) Administer IV dextrose: Hypoglycemia is a potentially serious complication of parenteral nutrition administration, especially if the infusion rate is too high or if the client's metabolic needs are not adequately met. IV dextrose, a concentrated glucose solution, is the most appropriate intervention for treating hypoglycemia in this situation. It provides a rapid source of glucose to raise blood sugar levels quickly and effectively.

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.