NCLEX-RNPhysiological AdaptationHard
A client is found unresponsive with a respiratory rate of 6/min and pinpoint pupils after a suspected opioid overdose. Arterial blood gas results show pH 7.22, PaCO2 68 mmHg, HCO3 24 mEq/L, and PaO2 58 mmHg. Which action should the nurse take first?
- AAdminister intravenous sodium bicarbonate
- BProvide bag-valve-mask ventilation with supplemental oxygen
- CPrepare for endotracheal intubation
- DAdminister intravenous naloxone
Show answer & explanationAnswer & explanation
Correct answer: B. Provide bag-valve-mask ventilation with supplemental oxygen
The ABG shows uncompensated acute respiratory acidosis with hypoxemia from opioid-induced respiratory depression. The immediate priority is to restore ventilation and oxygenation via bag-valve-mask before naloxone takes effect, since airway and breathing take precedence over reversal agents.
Why the other options are wrong
- A. Sodium bicarbonate does not treat the underlying hypoventilation and is not indicated for acute respiratory acidosis.
- C. Intubation may ultimately be needed but is not the fastest first step; manual ventilation should begin immediately.
- D. Naloxone is essential but takes a few minutes to act; ventilation must be supported immediately to prevent hypoxic injury.
Opioid-Induced Respiratory Acidosis
CNS depression from opioids reduces respiratory rate and depth, causing CO2 retention and acute respiratory acidosis with hypoxemia.
- ABG pattern: low pH, high PaCO2, normal HCO3 (acute, uncompensated)
- Airway/breathing support precedes naloxone administration
- Naloxone reverses opioid effect but ventilation must be supported first
Memory trick: Breathe for them before you reverse the drug