NCLEX Question of the Day – Friday, March 20, 2026

Today’s question focuses on Med-Surg priority assessment, especially how to recognize early signs of respiratory decline after surgery. This matters in real nursing because patients often worsen before they crash. A nurse who catches subtle changes early can prevent a rapid response, an ICU transfer, or worse.

Clinical Scenario

A 68-year-old man is 8 hours post-op after an open right hemicolectomy for colon cancer. He is on a surgical unit. His history includes obesity, obstructive sleep apnea, hypertension, and chronic kidney disease stage 3. He has a PCA pump with hydromorphone and is receiving 2 L/min oxygen by nasal cannula.

At 1900, the nurse enters the room and finds him drowsy but arousable to voice. He says, “I’m just really tired.” His respirations are 10/min and shallow. Oxygen saturation is 92% on 2 L/min. Lung sounds are diminished at the bases. He has not used the incentive spirometer since arriving from PACU. His blood pressure is 136/78 mm Hg and heart rate is 88/min.

The Question

What is the priority nursing action?

Answer Choices

1. A. Increase the oxygen to 4 L/min and reassess in 30 minutes
2. B. Stop the PCA infusion temporarily, stimulate the patient to take deep breaths, and assess sedation level
3. C. Place the patient flat in bed to reduce abdominal pain and improve rest
4. D. Administer the next scheduled dose of IV ketorolac to improve pain control and reduce splinting

Correct Answer

B. Stop the PCA infusion temporarily, stimulate the patient to take deep breaths, and assess sedation level

Detailed Rationale

This patient is showing early opioid-related respiratory depression. The key clues are drowsiness, shallow respirations, a respiratory rate of 10/min, and low-normal oxygen saturation despite supplemental oxygen. The most important issue is not pain. It is ventilation.

After surgery, several things can lower breathing effort: anesthesia, opioids, pain, obesity, and sleep apnea. This patient has multiple risk factors. The PCA hydromorphone is the biggest concern because opioids suppress the respiratory drive. Sedation often appears before severe hypoxia. That is why the nurse should not wait for a dramatic oxygen drop before acting.

The priority action is to pause the PCA so the patient does not receive more opioid while being assessed. Next, the nurse should try to improve ventilation right away by verbally stimulating the patient, encouraging deep breathing, and positioning him upright if tolerated. At the same time, the nurse should perform a focused assessment: level of consciousness, sedation score, respiratory pattern, depth of breathing, oxygen saturation trend, pain level, and lung sounds.

Then the nurse should continue with immediate safety steps. These include ensuring the airway is open, raising the head of the bed, verifying PCA settings, and notifying the provider or rapid response team if the patient does not improve quickly. Depending on the patient’s response and facility protocol, naloxone may be needed. The nurse should also monitor for rebound pain after stopping opioid delivery, but pain management comes after stabilizing breathing.

This is also a good time to think ahead. The nurse should monitor respiratory rate, sedation, oxygen saturation, and mental status more often. Incentive spirometry is important too, but not as the first action in a sleepy patient with signs of opioid effect. Once the patient is more alert and breathing better, the nurse should reinforce coughing, deep breathing, and early mobilization to reduce atelectasis.

Why the Other Options Are Wrong

A. Increase the oxygen to 4 L/min and reassess in 30 minutes

This treats the number, not the cause. Extra oxygen may raise the saturation temporarily, but it does not fix opioid-induced hypoventilation. A patient can look “better” on the monitor while retaining carbon dioxide and becoming more sedated. Waiting 30 minutes is unsafe when respiratory depression may be developing now.

C. Place the patient flat in bed to reduce abdominal pain and improve rest

This would likely make breathing worse. A flat position reduces lung expansion, especially in a patient with obesity, abdominal surgery, and shallow respirations. Post-op patients at risk for hypoventilation usually need the head of the bed elevated to improve ventilation.

D. Administer the next scheduled dose of IV ketorolac to improve pain control and reduce splinting

Nonopioid pain control can be useful later, but it is not the priority in this moment. The patient’s immediate problem is sedation and slow, shallow breathing. Also, this patient has chronic kidney disease, so ketorolac deserves caution because it can worsen renal function and increase bleeding risk after surgery. Even if ketorolac is ordered, it does not address the current respiratory concern.

Key Takeaways

• In post-op patients, sedation plus slow, shallow breathing should make you think about opioid-related respiratory depression.
• Do not rely on oxygen saturation alone. A patient can hypoventilate before the pulse ox looks severe.
• The priority is to support ventilation and stop the cause, not just increase oxygen.
• Risk factors include older age, obesity, sleep apnea, recent anesthesia, and opioid use.
• Reassess often: respiratory rate, depth, level of consciousness, oxygen saturation, lung sounds, and pain.

• What you’d do on shift: pause PCA, elevate head of bed, stimulate the patient, assess sedation and respirations, verify PCA settings, notify the provider if not improving, and be ready to follow protocol for naloxone if needed.

Quick Practice Extension

1. A post-op patient remains very sleepy after the PCA is paused and now has pinpoint pupils and respirations of 8/min. What nursing action should come next?

2. A different post-op patient has pain 8/10, is awake and alert, respirations are 18/min, and oxygen saturation is 97% on room air. What assessment finding would make opioid administration safer versus more concerning?

Bottom line: When a post-op patient becomes unusually drowsy with slow, shallow breathing, think ventilation first. Nurses save lives by noticing early respiratory depression and acting before it turns into an emergency.

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