What dose (mg) per administration? (Round to the nearest whole number.)
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The nurse is caring for a client on POD 1 after knee arthroplasty. Complete the diagram: choose the condition the client is most likely experiencing, 2 actions to take, and 2 parameters to monitor.
Nurses' Notes, POD 1, 0300
Client, 62 years old, with obstructive sleep apnea, on a hydromorphone PCA. Found difficult to arouse; opens eyes only to sternal rub. RR 8/min, shallow. SpO2 86% on room air. Pupils pinpoint. HR 64/min, BP 108/64 mm Hg. Dressing dry. Capillary glucose 128 mg/dL.
Condition
- Keyed answer. Opioid-induced respiratory depression
- Pulmonary embolism after arthroplasty
- Hypovolemic shock from surgical bleeding
- Hypoglycemia from reduced oral intake
Actions
- Keyed answer. Stop the PCA infusion
- Keyed answer. Give naloxone IV per protocol, titrated to breathing
- Remind the client to press the PCA button less often
- Increase the IV fluid rate to 200 mL/h now
- Place the client in the Trendelenburg position
Monitor
- Keyed answer. Respiratory rate and SpO2
- Keyed answer. Level of sedation
- Surgical dressing drainage
- Pedal pulses in both feet
- Capillary blood glucose before meals
Rationale
Bradypnea, hypoxemia, deep sedation and pinpoint pupils on a PCA mean opioid toxicity: stop the opioid, give naloxone, and watch breathing and sedation for re-sedation.
Study use only · not medical advice or for patient care · verify with current references.
- Source: Naloxone HCl injection label (DailyMed) — postoperative opioid depression: 0.1-0.2 mg IV every 2-3 min; duration may be shorter than the opioid's
- Source: NCSBN NGN scoring FAQ — bow-tie 0/1 scoring
The NCLEX is computer-adaptive and includes Next Generation case studies. Timed practice forms on this site use NCSBN Client Needs weights. Published NGN items are written to the 2026 NCSBN test plan, with cited sources.
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