# Clinical context A 68-year-old opioid-naive postoperative client with obstructive sleep apnea and stage 3 CKD is receiving hydromorphone PCA plus scheduled gabapentin and becomes difficult to arouse with shallow respirations of 7/min, SpO2 86% on oxygen, and rising end-tidal carbon dioxide. Highlight the current assessment findings that demonstrate active opioid-induced ventilatory failure. Do not select baseline risk factors or medication exposure alone.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522084&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Clinical context
A 68-year-old opioid-naive postoperative client with obstructive sleep apnea and stage 3 CKD is receiving hydromorphone PCA plus scheduled gabapentin and becomes difficult to arouse with shallow respirations of 7/min, SpO2 86% on oxygen, and rising end-tidal carbon dioxide.

Highlight the current assessment findings that demonstrate active opioid-induced ventilatory failure. Do not select baseline risk factors or medication exposure alone.

Postoperative Record\nA 68-year-old opioid-naive client with obstructive sleep apnea and stage 3 chronic kidney disease is receiving hydromorphone by patient-controlled analgesia and scheduled gabapentin. After therapy begins, the client is difficult to arouse, cannot keep the eyes open, has respirations 7/min and shallow, SpO2 86 percent on 2 L/min oxygen, end-tidal carbon dioxide 58 mm Hg and rising, and pinpoint pupils.

## Explanation

Profound sedation, inability to stay awake, respirations of 7/min, shallow breathing, oxygen saturation of 86 percent despite oxygen, and rising carbon dioxide require immediate rescue.

## In-depth explanation

Quick answer
Recognize sedation plus failing ventilation.

Why this is correct
Opioid overdose can present with severe sleepiness, inability to respond, and slowed or shallow breathing. Carbon dioxide retention can further worsen sedation.

Easy analogy or mental picture
Treat medication safety like airway triage: identify the threat, interrupt exposure, support physiology, and verify a durable response.

Memory hook
Cue, risk, action, response, recurrence check.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving reassessment and escalation.

Why the other choices are wrong
Options that normalize deterioration, add interacting medication, or delay rescue leave the safety loop open.References
1DailyMed: Hydromorphone Hydrochloride InjectionLife-threatening respiratory depression, supportive measures, and opioid reversal
2FDA Drug Safety Communication: Gabapentinoids and Serious Breathing ProblemsAdditive sedation and respiratory depression with opioids and respiratory risk factors
3FDA: Naloxone RecommendationsRecognition of opioid overdose, naloxone administration, emergency response, repeat dosing, and continued observation

## Clinical scenario

Clinical context
A 68-year-old opioid-naive postoperative client with obstructive sleep apnea and stage 3 CKD is receiving hydromorphone PCA plus scheduled gabapentin and becomes difficult to arouse with shallow respirations of 7/min, SpO2 86% on oxygen, and rising end-tidal carbon dioxide.

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