# A nurse is caring for a client receiving patient-controlled analgesia (PCA) with morphine. The client becomes difficult to arouse, with a respiratory rate of 6 breaths/min. After stopping the PCA pump and calling for help, the nurse administers naloxone 0.4 mg IV as prescribed. The client’s respiratory rate increases to 12 breaths/min and they become more alert. Which action should the nurse take next?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=505804&lang=en  
> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

A nurse is caring for a client receiving patient-controlled analgesia (PCA) with morphine. The client becomes difficult to arouse, with a respiratory rate of 6 breaths/min. After stopping the PCA pump and calling for help, the nurse administers naloxone 0.4 mg IV as prescribed. The client’s respiratory rate increases to 12 breaths/min and they become more alert. Which action should the nurse take next?

## Option

1. Administer a second dose of naloxone 0.4 mg IV immediately to prevent recurrence of sedation.
2. Restart the PCA pump at a lower basal rate to maintain pain control while monitoring sedation.
3. Document the event and transfer the client to a medical-surgical unit for routine observation.
4. Continue to monitor the client closely for recurrent sedation and respiratory depression. **✔ Correct answer**

**Correct answer: 4**

## Explanation

After naloxone administration, the client’s respiratory rate and alertness improved, indicating a positive response. However, naloxone has a shorter duration of action than morphine, so the client remains at risk for recurrent opioid-induced respiratory depression. The nurse should continue close monitoring for signs of returning sedation or respiratory compromise. Administering a second dose of naloxone immediately is not indicated because the client is currently stable; naloxone should be titrated only if respiratory depression recurs. Restarting the PCA pump would reintroduce the opioid and could worsen respiratory depression. Transferring the client to a medical-surgical unit for routine observation is inappropriate because the client requires ongoing intensive monitoring after a significant respiratory event.

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