Level: Clinical
Difficulty: Medium
Subtopic: Opioids and pain medications
NCLEX: A client receiving IV morphine has respiratory rate 10/min, pinpoint pupils, and difficulty arousing. What should…
Pharmacology Pharmacological and Parenteral Therapies
Case Study
A client receiving IV morphine has respiratory rate 10/min, pinpoint pupils, and difficulty arousing. What should the nurse do first?
Question
A. Stop the opioid, assess airway and breathing, and prepare to give naloxone per protocol.
B. Document sedation as an expected effect and continue the infusion.
C. Offer a snack to prevent nausea before assessing respirations.
D. Delegate monitoring to the family and leave the room.
B. Document sedation as an expected effect and continue the infusion.
C. Offer a snack to prevent nausea before assessing respirations.
D. Delegate monitoring to the family and leave the room.
Rationale
Correct answer: A. Stop the opioid, assess airway and breathing, and prepare to give naloxone per protocol.
Rationale: Opioid-induced respiratory depression is life-threatening; stop the opioid and treat per protocol including naloxone when indicated.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Opioid-induced respiratory depression is life-threatening; stop the opioid and treat per protocol including naloxone when indicated.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.