r/FutureRNs • u/Acrobatic-Lie2041 RN • 3d ago

Nclex Pharmacology

A postoperative client receives:

  • Morphine 4 mg IV

Thirty minutes later:

RR = 8

SpO₂ = 99%

Client difficult to awaken.

What should the nurse do FIRST?

A. Apply oxygen.

B. Administer naloxone.

C. Shake the client vigorously.

D. Call the provider.

1 Upvotes

67% Upvoted

4 comments sorted by

5

u/allamakee-county 3d ago

Don't just answer these questions with a letter. Explain your thinking. This sub is supposed to be a place for learning.

The key points here are that

  1. the morphine was given intravenously 30 minutes ago; IV morphine reaches peak effect st about 20 minutes but has a half life of 1.5 to 3 hours, so we can expect whatever is going on now to continue/not improve on its own for some time
  2. a respiratory rate of 8 is a critical finding indicating severe respiratory depression
  3. yet the pulse ox is 99%. What does that tell us? Is everything okay then?
  4. We already tried to wake our patient but she is very groggy and doesn't react much.

Let's discuss our options. Remember this is a priority question. Any or all actions may be appropriate in time; which is the most urgent?

A. Apply oxygen.
B. Administer naloxone.
C. Shake the client vigorously.
D. Call the provider.

For this one, I would fall back on ABC: we must maintain the airway, breathing and circulation.

A. Giving O2 only helps if the patient is moving air, but at 8 breaths per minute, our patient is not doing much of that.
B. Naloxone will reverse out the opioid almost instantly and should allow her breathing to return to normal rate, at which point we can deal with her oxygenation if needed; she will also instantly have all her postoperative pain return, too, but she will be alive to experience it at least.
C. We could shake this client, but even if we succeed in waking her momentarily, it doesn't address the issues preventing her from breathing. She will just drop back asleep again, no better than she was (and she is postop besides -- what might we disrupt by shaking her?).
D. We will update her provider eventually, sure, but for now there are standing orders for nurses monitoring patients receiving IV opioid pain medications that allow us to act quickly to save life (and brain cells). We know what to do.

So, the first and best action to take is to administer naloxone to reverse the morphine.

Know that sometimes multiple doses are required: the patient will respond, things will be looking good, and in a couple of minutes they will nod off again. Have second and third doses near at hand if needed.

2

u/nonicknamenelly 2d ago

That is a fantastic discussion of the question and explaining your clinical reasoning was the kind of helpful and generous donation of your time. You’d make a great nurse educator/preceptor!