NCLEX Question of the Day – Thursday, February 19, 2026

Today’s question targets safe opioid administration and rapid recognition of respiratory depression. This matters because post-op patients often get potent analgesics. If you miss early signs of over-sedation, hypoventilation can progress quickly to arrest. The nurse’s first action can save a life.

Clinical Scenario

A 54-year-old man is on the surgical unit, postoperative day 1 after a right hemicolectomy. He has a hydromorphone PCA with a basal rate of 0.2 mg/hr and demand dose of 0.2 mg with a 10-minute lockout. History includes obstructive sleep apnea (uses CPAP at home) and hypertension. Over the last hour, the nurse notes the following: he is difficult to arouse, sedation score 3 (frequently drowsy, drifts off during conversation), respiratory rate 8/min, shallow breathing, oxygen saturation 88% on 2 L/min nasal cannula, and pinpoint pupils. Lungs are clear. Blood pressure 118/70 mm Hg, heart rate 56/min.

The Question

Which action is the nurse’s priority?

Answer Choices

1. A. Increase oxygen to 4 L/min by nasal cannula and reassess in 15 minutes.
2. B. Stop the PCA, stimulate the patient, and administer naloxone per protocol.
3. C. Obtain a prescription for diphenhydramine to treat pruritus.
4. D. Educate the family not to push the PCA button and reinforce that only the patient should press it.

Correct Answer

B. Stop the PCA, stimulate the patient, and administer naloxone per protocol.

Detailed Rationale

This patient shows classic signs of opioid-induced respiratory depression: low respiratory rate with shallow effort, decreased oxygen saturation, marked sedation, miosis, and bradycardia. He also has a known risk factor—obstructive sleep apnea—that increases sensitivity to opioids and the chance of hypoventilation during sleep.

Use airway-breathing-circulation priorities. The biggest threat is inadequate ventilation, not pain or itching. The nurse should immediately stop ongoing opioid delivery (turn off the basal rate and pause the PCA), provide physical stimulation and verbal cues to improve respiratory drive, and give naloxone per protocol to reverse the opioid effect. Titrated doses of naloxone help restore adequate ventilation while avoiding abrupt, severe pain or acute withdrawal.

After the first dose, support oxygenation and ventilation as needed: elevate the head of bed, deliver supplemental oxygen, and be ready to assist with a bag-valve-mask if respirations remain poor. Place the patient on continuous pulse oximetry and, if available, capnography for end-tidal CO2. Call for help early (rapid response) if the patient does not improve promptly or if bag-mask ventilation is needed. Notify the provider after the immediate rescue steps.

Continue close monitoring because naloxone’s duration is shorter than many opioids. Re-sedation can occur when naloxone wears off. Repeat naloxone as ordered if respiratory depression returns. Reassess pain and collaborate on a safer analgesic plan: remove basal infusion, lower PCA demand dose, increase monitoring, consider non-opioid adjuncts, and avoid other sedatives.

Why the Other Options Are Wrong

• A. Increasing oxygen without reversing the opioid effect does not fix hypoventilation. Oxygen can improve saturation while CO2 rises, masking deterioration. Waiting 15 minutes delays definitive treatment and increases risk of respiratory arrest.
• C. Diphenhydramine treats itching. Pruritus is not the problem here. Giving a sedating antihistamine could worsen central nervous system depression and further impair breathing.
• D. Family education about PCA use is appropriate, but it does not address the current emergency. Many facilities prohibit anyone but the patient from pressing the PCA, but stopping the drug and reversing toxicity must come first.

Key Takeaways

• Opioid toxicity presents with depressed respirations, pinpoint pupils, and excessive sedation before arrest.
• Prioritize airway and breathing: stop the opioid, stimulate, and give naloxone promptly.
• Supplemental oxygen does not correct hypoventilation; treat the cause and support ventilation.
• Patients with sleep apnea are at higher risk; avoid basal PCA rates and use continuous monitoring.
• Naloxone may wear off before the opioid; watch for re-sedation and repeat as ordered.

• On-shift mini-checklist:
  • Assess pain, sedation level, and respiratory rate before and after opioid doses.
  • If RR ≤ 10/min or patient is hard to arouse: stop opioid, call for help, stimulate, give naloxone per protocol.
  • Apply continuous oximetry (and capnography if available), elevate HOB, provide oxygen, prepare for bag-mask ventilation.
  • Notify provider after initial stabilization; anticipate orders to remove basal PCA, adjust dosing, and add non-opioid analgesics.
  • Reassess frequently for re-sedation and pain control; document findings and actions.

Quick Practice Extension

• A patient receives naloxone for hydromorphone-induced respiratory depression and wakes up in severe pain with RR 14/min. What is your next best action to manage pain safely?
• A post-op patient on a PCA also received a benzodiazepine for anxiety. Two hours later, RR is 10/min and end-tidal CO2 is 55 mm Hg. What targeted assessments and orders do you anticipate to address combined sedative effects?

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com