NCLEX Question of the Day – Tuesday, April 14, 2026

Today’s question targets early recognition of a medication-related complication and the nurse’s first priority action. This matters in real nursing because subtle changes can turn serious fast, especially when a common drug affects breathing. The skill here is not just knowing a side effect. It is noticing the pattern, connecting it to the medication, and acting in the right order.

Clinical Scenario

You are caring for a 72-year-old client on a medical-surgical unit who had an open cholecystectomy earlier today. The client has a history of obstructive sleep apnea, obesity, and hypertension. Two hours ago, the client received IV hydromorphone for severe incisional pain. The client is now difficult to arouse and drifts back to sleep during your assessment. Respirations are 8/min and shallow. Oxygen saturation is 89% on 2 L/min by nasal cannula. Pupils are pinpoint. The surgical dressing is dry, and the blood pressure is 104/62 mm Hg.

The Question

Which action should the nurse take first?

Answer Choices

1. Increase the oxygen flow rate from 2 L/min to 4 L/min by nasal cannula
2. Administer naloxone as prescribed for suspected opioid-induced respiratory depression
3. Obtain a full set of vital signs and reassess pain level in 15 minutes
4. Place the client in a flat supine position to improve comfort and reduce movement

Correct Answer

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

Detailed Rationale

This client is showing classic signs of opioid-induced respiratory depression: decreased level of consciousness, slow shallow respirations, low oxygen saturation, and pinpoint pupils after receiving IV hydromorphone. The biggest immediate threat is not pain or blood pressure. It is inadequate ventilation.

On the NCLEX, when a client is not breathing well, airway and breathing come first. Oxygen saturation matters, but the deeper problem here is hypoventilation. If the client is not moving enough air, simply adding more oxygen may not fix the problem. The opioid effect needs to be reversed.

Naloxone is an opioid antagonist. It competes with opioids at receptor sites and can quickly improve respiratory effort. Because this client is difficult to arouse and breathing only 8 times per minute, the nurse should act right away according to the prescription or protocol.

The nurse should also do several things at the same time or immediately after giving naloxone:

• Stimulate the client and call for assistance
• Support the airway and apply oxygen as needed
• Monitor respiratory rate, oxygen saturation, level of consciousness, and blood pressure closely
• Be ready for repeat naloxone dosing if ordered, because naloxone may wear off before the opioid does
• Reassess pain after the client stabilizes, since reversing the opioid may bring pain back suddenly

A good nurse also thinks about why this client was at higher risk. Older age, obstructive sleep apnea, obesity, recent surgery, and IV opioid use all increase the chance of oversedation and breathing problems. That risk should shape how often the nurse reassesses sedation and respirations after medication.

One more practical point: a low respiratory rate is important, but sedation level often changes before oxygen saturation falls. That is why a client who is hard to wake up after an opioid deserves immediate attention, even before the pulse oximeter gets worse.

Why the Other Options Are Wrong

A. Increase the oxygen flow rate from 2 L/min to 4 L/min by nasal cannula

This may be helpful as a supportive step, but it is not the first priority by itself. The main problem is opioid suppression of breathing. More oxygen does not reverse the cause. A client can still retain carbon dioxide and continue to deteriorate even if extra oxygen raises the saturation briefly.

C. Obtain a full set of vital signs and reassess pain level in 15 minutes

This delays treatment. The client already has enough assessment data to show a dangerous change. Waiting 15 minutes could allow respiratory arrest. Pain reassessment is important later, but not before treating the breathing problem.

D. Place the client in a flat supine position to improve comfort and reduce movement

This would likely make ventilation worse. A flat position can reduce chest expansion and increase airway obstruction risk, especially in a client with obesity and sleep apnea. If positioning is needed, elevating the head of the bed is more helpful for breathing.

Key Takeaways

• After an opioid, decreased alertness plus slow shallow breathing is an emergency warning sign.
• Pinpoint pupils support opioid effect, but the priority is still airway and breathing.
• Naloxone treats the cause of opioid-induced respiratory depression. Oxygen alone does not.
• High-risk clients include older adults and those with sleep apnea, obesity, or recent IV opioid use.
• Naloxone can wear off before the opioid does, so continued monitoring matters.

• What you’d do on shift: wake and stimulate the client, call for help, support airway, give naloxone if prescribed, apply oxygen, raise the head of the bed, and monitor respirations and mental status closely.
• Then: document the event, notify the provider per policy, and reassess pain and safety after the client stabilizes.

Quick Practice Extension

1. A client receives oral oxycodone and is now very sleepy but still answers questions. What assessment finding would make you most concerned that the client is progressing from sedation to respiratory compromise?
2. After naloxone improves a client’s breathing, what follow-up assessments should the nurse prioritize during the next 30 to 60 minutes?

Category used today: Pharmacology

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