NCLEX Question of the Day – Tuesday, May 05, 2026

Today’s question targets early recognition and first-line nursing action in a worsening clinical situation. That skill matters because nurses are often the first to notice subtle changes before a patient crashes. In real practice, knowing what to do first can protect oxygenation, prevent complications, and help the team act fast for the right reason.

Clinical Scenario

A 68-year-old man is on a medical-surgical unit 10 hours after an open right hemicolectomy for colon cancer. His history includes chronic obstructive pulmonary disease, hypertension, and a 40-pack-year smoking history. He has a patient-controlled analgesia pump with morphine and is receiving 2 L/min oxygen by nasal cannula. During the start-of-shift assessment, the nurse finds him drowsy but arousable. His respiratory rate is 8/min, oxygen saturation is 89%, and he has shallow respirations. His blood pressure is 104/62 mm Hg, heart rate is 58/min, and pupils are pinpoint. 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 from 2 L/min to 4 L/min by nasal cannula
2. B. Stop the morphine PCA infusion and stimulate the patient to take deep breaths
3. C. Notify the surgeon that the patient may have a postoperative complication
4. D. Place the patient in high-Fowler position and reassess in 15 minutes

Correct Answer

B. Stop the morphine PCA infusion and stimulate the patient to take deep breaths

Detailed Rationale

This patient shows signs of opioid-induced respiratory depression. The clues matter because they fit together: drowsiness, respiratory rate of 8/min, shallow breathing, low oxygen saturation, and pinpoint pupils. After surgery, opioid pain control is common, but opioids can suppress the respiratory drive. The biggest immediate threat here is inadequate ventilation.

The nurse should act on airway and breathing first. Stopping the PCA removes the likely cause of the respiratory suppression. Stimulating the patient and encouraging deep breaths can improve ventilation right away while the nurse prepares for the next steps. In practice, the nurse would also stay with the patient, raise the head of the bed, apply oxygen as needed, and call for rapid assistance or notify the provider per facility protocol. If the patient does not improve quickly, naloxone may be needed. But the first action is to stop the source of the problem.

The nurse should then assess whether the patient is protecting the airway, how responsive the patient is, and whether breathing improves after stimulation. The nurse should monitor respiratory rate, depth, oxygen saturation, level of consciousness, and pain level. Because naloxone can reverse analgesia and may wear off before the opioid does, continued monitoring is important. The patient may become more alert, but respiratory depression can return, so repeated assessment is not optional.

It also matters that the dressing is dry and intact and the blood pressure is not severely low. Those details make major hemorrhage less likely as the cause of the drowsiness. The key assessment detail is the breathing pattern and opioid effect, not the incision.

Why the Other Options Are Wrong

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

Oxygen may be needed, but it does not treat the main problem: hypoventilation from opioid effect. A patient can have a normal or improved oxygen saturation for a short time and still retain carbon dioxide if ventilation stays poor. If the nurse only increases oxygen and does not stop the opioid, the patient can continue to worsen. Oxygen is supportive, not the first priority over removing the cause.

C. Notify the surgeon that the patient may have a postoperative complication

Notification is appropriate after immediate safety actions are started. But calling first delays treatment. NCLEX asks what the nurse should do first. This patient needs prompt bedside intervention before communication. Also, the likely issue is opioid-related respiratory depression, not a surgical incision problem that only the surgeon can address.

D. Place the patient in high-Fowler position and reassess in 15 minutes

Positioning can help chest expansion, but waiting 15 minutes is unsafe. A respiratory rate of 8/min with shallow respirations is already an urgent change. Reassessment is important, but not after a delay and not as the only action. The nurse must intervene now.

Key Takeaways

• Opioid-induced respiratory depression often presents with sedation, slow respirations, shallow breathing, and pinpoint pupils.
• When breathing is impaired, think airway and breathing before routine reporting.
• Stopping the opioid source is a priority when the medication is likely causing the problem.
• Oxygen supports oxygenation, but it does not fix poor ventilation by itself.
• Naloxone may be needed, but close follow-up is essential because its effect may wear off before the opioid does.

• On-shift mini-checklist:
• Check respiratory rate, depth, oxygen saturation, and level of consciousness.
• Pause or stop opioid delivery per protocol if respiratory depression is suspected.
• Stimulate the patient, elevate the head of the bed, and support breathing.
• Call for help, notify the provider, and prepare for naloxone if ordered or allowed by protocol.
• Continue frequent reassessment after intervention.

Quick Practice Extension

1. A postoperative patient receives naloxone for opioid-induced respiratory depression and becomes alert with severe pain 20 minutes later. What should the nurse assess and anticipate next?

2. A patient on IV opioids is sleeping and has an oxygen saturation of 95%, but the respiratory rate has fallen from 16/min to 9/min. Why is the respiratory rate trend more concerning than the oxygen saturation alone?

Category: Med-Surg

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