NCLEX: A 68-year-old client on a medical-surgical unit is being evaluated for opioid analgesia after surgery. Assessment…

Pharmacology Pharmacological and Parenteral Therapies

Case Study

A 68-year-old client on a medical-surgical unit is being evaluated for opioid analgesia after surgery. Assessment data include INR 4.6 without active bleeding but with dark tarry stools. Using ABCs and Maslow, which need should the nurse address first?

Question

A. Airway, breathing, and circulation problems before comfort or psychosocial needs.
B. Pain relief before checking airway and breathing.
C. Visitor concerns before physiologic stability.
D. Long-term teaching before treating acute physiologic risk.

Rationale

Correct answer: A. Airway, breathing, and circulation problems before comfort or psychosocial needs.

Rationale: Physiologic stability and ABCs take priority over comfort, teaching, or psychosocial needs when the client is unstable.

Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.

Level: Clinical

Difficulty: Medium

Subtopic: Opioids and pain medications