# A client taking oral naltrexone is admitted after a traumatic fracture and reports severe pain. Place the nursing actions in the appropriate order.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513818&lang=en  
> language: en  
> subject: Pharmacological Pain Management  
> category: PPT

## Question

A client taking oral naltrexone is admitted after a traumatic fracture and reports severe pain. Place the nursing actions in the appropriate order.

Assess airway, breathing, circulation, pain, and current respiratory status.

Notify the prescriber, anesthesia team, and pharmacist that opioid blockade may be present.

Verify the time of the last naltrexone dose and the complete medication history.

If opioid analgesia is required, administer it only in a closely monitored, resuscitation-capable setting and reassess continuously.

Implement prescribed regional or nonopioid analgesia when clinically appropriate.

## Explanation

Stabilizing assessment comes first, followed by verification of naltrexone exposure, coordinated planning, use of prescribed nonopioid or regional options, and intensive monitoring if an opioid is required.

## In-depth explanation

Quick answer
Assess first, verify naltrexone exposure, alert the team, use prescribed nonopioid or regional strategies, and provide intensive monitoring if an opioid is necessary.

Why this is correct
Naltrexone blocks opioid effects. The label recommends regional analgesia, sedation, nonopioid analgesics, or general anesthesia in emergencies; if opioid analgesia is required, respiratory depression may be deeper and more prolonged and close monitoring with resuscitation capability is necessary.

Easy analogy or mental picture
Naltrexone is a locked receptor gate. First check the client and the lock, then bring the right team and tools before attempting to manage pain through or around the blockade.

Memory hook
Assess, verify, coordinate, use alternatives, monitor any required opioid.

NCLEX decision rule
Immediate threats and current respiratory status take priority. Medication timing then informs a coordinated analgesia plan; never attempt to overcome opioid blockade by escalating doses in an unmonitored setting.

Why the other choices are wrong
Starting with an opioid before assessment and team notification risks ineffective analgesia followed by delayed, prolonged respiratory depression. Skipping medication verification hides the cause of the altered response.References
1DailyMed: Naltrexone HydrochlorideEmergency pain management during opioid blockade

## Clinical scenario

Pain-safety sequence
Assess immediate stability, identify opioid-antagonist exposure, coordinate the analgesia plan, and match monitoring intensity to the selected therapy.

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