NCLEX Question of the Day – Saturday, April 25, 2026

Today’s question focuses on Pharmacology, specifically safe opioid administration after surgery. This matters because nurses often catch early signs of medication-related harm before anyone else does. A patient can go from uncomfortable to unstable very quickly if sedation and breathing changes are missed.

Clinical Scenario

A 68-year-old client is 6 hours post-op after an open colon resection on a surgical unit. The client has a history of obstructive sleep apnea, obesity, and hypertension. Pain has been treated with IV morphine as needed. During the start-of-shift assessment, the nurse finds the client lying still in bed with eyes closed. The client wakes to loud verbal stimulation, answers one question, then drifts back to sleep. Respiratory rate is 8/min, oxygen saturation is 91% on 2 L/min by nasal cannula, and pupils are small. The client’s dressing is dry, blood pressure is 118/70 mm Hg, and heart rate is 74/min. The previous nurse documented morphine given 30 minutes ago for severe abdominal pain.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Increase the oxygen flow rate to 4 L/min and reassess in 15 minutes
2. B. Administer the prescribed PRN naloxone and continue close monitoring
3. C. Wake the client and ask the client to take deep breaths every few minutes
4. D. Hold the next opioid dose and notify the health care provider about uncontrolled pain

Correct Answer

B. Administer the prescribed PRN naloxone and continue close monitoring

Detailed Rationale

This client is showing opioid-induced respiratory depression. The key clues are the recent IV morphine dose, difficult arousal, respiratory rate of 8/min, low oxygen saturation despite supplemental oxygen, and pinpoint pupils. The biggest immediate threat is not pain. It is inadequate ventilation.

The nurse’s first job is to recognize that this is more than simple sleepiness. Post-op clients often feel tired, but a client who only wakes to loud stimulation and quickly falls back asleep is showing a dangerous level of sedation. In opioid toxicity, sedation usually appears before full respiratory arrest. That is why sedation assessment matters so much.

The first priority is to reverse the opioid effect enough to improve breathing. If naloxone is available by PRN order, the nurse should give it promptly and monitor the response. The nurse should also support airway and breathing, stimulate the client, and be prepared to escalate care if the response is incomplete. In real practice, this means staying at the bedside, reassessing respiratory rate, depth, oxygen saturation, level of consciousness, and pain, and calling for additional help as needed.

After naloxone, the nurse should closely monitor for two important issues. First, naloxone may wear off before the opioid does, so respiratory depression can return. Second, the client may develop a sudden increase in pain as the opioid effect is partially reversed. That does not change the priority. Breathing comes first.

The nurse should also assess why this client was at higher risk. This client has obstructive sleep apnea, obesity, recent surgery, and recent IV opioid use. Those factors increase the chance of hypoventilation. On shift, the nurse would review the timing and total amount of opioids given, trend sedation scores, and check whether other sedating drugs were also administered.

In short, the nurse should assess airway and breathing, give naloxone per order, stay with the client, monitor continuously, and notify the provider or rapid response team if the client does not improve quickly.

Why the Other Options Are Wrong

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

Oxygen can improve the saturation number, but it does not fix the underlying problem of poor ventilation caused by opioid effect. A client with a respiratory rate of 8/min and significant sedation needs immediate intervention, not delayed reassessment. Relying on oxygen alone can hide worsening respiratory failure.

C. Wake the client and ask the client to take deep breaths every few minutes

Stimulation may briefly improve breathing, and the nurse should stimulate the client while intervening. But this is not enough as the first and main action in a client with clear opioid toxicity signs. The client is too sedated to maintain safe breathing without more definitive treatment.

D. Hold the next opioid dose and notify the health care provider about uncontrolled pain

Holding future opioids is reasonable later, but it does nothing for the client’s current respiratory depression. Also, the stem is not about uncontrolled pain. It is about a current medication complication that requires urgent action now.

Key Takeaways

• Excessive sedation after opioid administration is an early warning sign of respiratory depression.
• A respiratory rate less than 12/min in a heavily sedated post-op client should get immediate attention.
• Pinpoint pupils, recent opioid use, low oxygen saturation, and hard-to-arouse behavior support opioid toxicity.
• Oxygen helps saturation, but it does not reverse opioid-induced hypoventilation.
• Naloxone is used to reverse opioid effects, but the nurse must watch for return of respiratory depression.

• What you’d do on shift: stop and assess airway, breathing, sedation level, and opioid timing
• Stimulate the client and stay at the bedside
• Give naloxone if ordered and monitor the response closely
• Reassess respiratory rate, oxygen saturation, level of consciousness, and pain frequently
• Escalate care quickly if breathing does not improve

Quick Practice Extension

1. A post-op client receiving IV hydromorphone is alert but has a respiratory rate of 10/min and is difficult to keep awake. What assessment finding would make the situation more urgent?

2. After naloxone improves a client’s breathing, which ongoing assessments are most important during the next hour?

NCLEX Question of the Day – Saturday, April 25, 2026

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