NCLEX-RNPharmacological and Parenteral TherapiesHard
A client using patient-controlled analgesia (PCA) with morphine has a respiratory rate of 8 breaths/min and is difficult to arouse. Which action should the nurse take first?
- AStop the PCA infusion and prepare to administer naloxone
- BIncrease the basal rate to manage breakthrough pain
- CReposition the client and reassess in 30 minutes
- DEncourage the client to use the PCA button more frequently
Show answer & explanationAnswer & explanation
Correct answer: A. Stop the PCA infusion and prepare to administer naloxone
A respiratory rate of 8 with difficulty arousing indicates opioid-induced respiratory depression, a medical emergency. The nurse must stop the PCA immediately and prepare to administer naloxone, the opioid antagonist, while ensuring airway and oxygenation support.
Why the other options are wrong
- B. Increasing opioid dosing would worsen respiratory depression and could be fatal.
- C. Waiting 30 minutes delays treatment of a life-threatening respiratory emergency.
- D. Encouraging more opioid use would further depress respirations.
Opioid-Induced Respiratory Depression
A dangerous adverse effect of opioids in which respiratory rate falls (often <10-12/min) with sedation, requiring immediate intervention and naloxone reversal.
- Naloxone is the opioid antagonist antidote
- Assess sedation level and RR before each PCA dose
- Stop opioid infusion first, then administer naloxone per protocol
Memory trick: 'RR under 10, stop and give Narcan'