NCLEX Question of the Day – Thursday, March 26, 2026

Today’s question targets early recognition of medication-related harm and safe nursing action. That skill matters because many serious changes in patient status start with a subtle finding, not a dramatic crash. A nurse who notices the pattern early can prevent respiratory failure, transfer to ICU, or worse.

Clinical Scenario

You are caring for a 72-year-old client on a medical-surgical unit after an open reduction and internal fixation of a hip fracture earlier today. The client has a history of chronic kidney disease stage 3, hypertension, and osteoarthritis. Postoperative pain has been managed with IV morphine as needed. Two hours ago, the client received morphine 4 mg IV for severe pain.

During your reassessment, the client is difficult to arouse and drifts back to sleep mid-sentence. The respiratory rate is 8/min, oxygen saturation is 89% on 2 L/min by nasal cannula, and pupils are pinpoint. The blood pressure is 102/64 mm Hg and heart rate is 58/min. The surgical dressing is dry and intact.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Increase the oxygen flow rate to 4 L/min by nasal cannula and reassess in 15 minutes
2. B. Administer naloxone as prescribed for opioid-induced respiratory depression
3. C. Obtain a pain rating to determine whether another analgesic should be used
4. D. Place the client in high-Fowler position and encourage deep breathing exercises

Correct Answer

B. Administer naloxone as prescribed for opioid-induced respiratory depression

Detailed Rationale

This client is showing classic signs of opioid toxicity: decreased level of consciousness, respiratory rate of 8/min, low oxygen saturation, and pinpoint pupils after IV morphine. The priority problem is not pain. It is inadequate ventilation. When a client cannot breathe effectively, carbon dioxide rises, oxygen falls, and the condition can worsen quickly.

The first action is to treat the cause of the respiratory depression. Naloxone reverses opioid effects by displacing the opioid from receptor sites. That makes it the most direct and time-sensitive intervention here. Oxygen may help support saturation, but oxygen alone does not reverse opioid-induced hypoventilation. The client needs the medication that addresses the underlying cause.

After giving naloxone, the nurse should stay with the client and reassess closely. Key steps include:

• Assess airway and breathing immediately. Look at respiratory rate, depth, pattern, and effort. Listen for airflow. Check pulse oximetry and mental status.
• Administer naloxone per order or protocol. Give it promptly because the respiratory rate is already dangerously low.
• Support oxygenation. Apply supplemental oxygen and prepare for additional airway support if the client does not improve fast enough.
• Monitor for repeat sedation. Naloxone may wear off before morphine does. That means the client can become sedated again, so repeated doses or continuous monitoring may be needed.
• Reassess pain after stabilization. Reversal can bring pain back suddenly. Pain matters, but only after airway and breathing are secured.
• Notify the provider and follow rapid response policy if needed. A client with significant opioid-induced respiratory depression may need a higher level of monitoring.

The reason this is the best answer comes down to priority. NCLEX questions often test whether you can separate supportive actions from definitive actions. Oxygen and positioning are helpful, but they do not remove the opioid effect causing the problem. Naloxone does.

Why the Other Options Are Wrong

A. Increase the oxygen flow rate to 4 L/min by nasal cannula and reassess in 15 minutes

This is incomplete and too slow for the situation. The client is hypoventilating now. Waiting 15 minutes delays treatment while the opioid continues to suppress respirations. Oxygen can raise saturation temporarily, but it does not fix the low respiratory drive.

C. Obtain a pain rating to determine whether another analgesic should be used

This misses the immediate threat. The client is difficult to arouse and cannot safely participate in a pain assessment right now. Also, the current issue is oversedation, not uncontrolled pain. A pain plan can be reconsidered after the client is stabilized.

D. Place the client in high-Fowler position and encourage deep breathing exercises

Positioning can support breathing in an alert client, but this client is too sedated to reliably follow commands. Deep breathing requires effort and cooperation. It does not reverse the medication effect suppressing the respiratory center.

Key Takeaways

• Pinpoint pupils, decreased alertness, and a low respiratory rate after opioid administration suggest opioid toxicity.
• In opioid-induced respiratory depression, treat the cause. Naloxone is the priority intervention.
• Oxygen is supportive, not definitive, when the main problem is low respiratory drive.
• Older adults and clients with kidney impairment may be more vulnerable to medication effects because drug clearance can be slower.
• After naloxone, keep monitoring. Sedation can return when the reversal agent wears off.

• On-shift mini-checklist: Check sedation level before and after IV opioids
• On-shift mini-checklist: Reassess respiratory rate, oxygen saturation, and mental status
• On-shift mini-checklist: Hold further opioids if the client is overly sedated
• On-shift mini-checklist: Be ready with naloxone and airway support equipment
• On-shift mini-checklist: Document the event, response, and follow-up monitoring

Quick Practice Extension

1. A postoperative client receives IV hydromorphone and is now easy to arouse but has a respiratory rate of 11/min and oxygen saturation of 94% on room air. What assessment finding would help you decide whether to hold the next opioid dose?

2. A client improves after naloxone, then becomes drowsy again 30 minutes later. What should the nurse reassess first, and what risk does this change suggest?

Download