A client receiving IV hydromorphone after surgery was found difficult to arouse with a respiratory rate of 7/min. After naloxone 0.04 mg IV was given and repeated twice as prescribed, the client is arousable and the respiratory rate is 14/min. Which action is most important for the nurse to take next?
- AResume the previous hydromorphone dose, because the respiratory rate is now normal.
- BGive an additional 0.4 mg dose of naloxone to prevent the sedation from returning.
- CMonitor sedation level and respiratory rate closely for recurrence.
- DAssess the client's pain and request a non-opioid analgesic.
Show answer and explanations
Answer
C
A: Restarting the prior opioid without reassessment can reproduce respiratory depression. B: Automatic prophylactic redosing is not a substitute for assessed protocol-based treatment. C: Naloxone's duration can be shorter than hydromorphone's, so sedation and respiratory depression can recur and must be monitored. D: Pain needs reassessment after reversal, but the priority is close monitoring because naloxone can wear off before hydromorphone and respiratory depression can recur.
A
Restarting the prior opioid without reassessment can reproduce respiratory depression.
B
Automatic prophylactic redosing is not a substitute for assessed protocol-based treatment.
C
Naloxone's duration can be shorter than hydromorphone's, so sedation and respiratory depression can recur and must be monitored.
D
Pain needs reassessment after reversal, but the priority is close monitoring because naloxone can wear off before hydromorphone and respiratory depression can recur.