# 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. Place the emergency actions in the safest sequence.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522088&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.

Place the emergency actions in the safest sequence.

Reassess respiratory rate, depth, arousal, oxygenation, and ventilation repeatedly and give further authorized reversal if needed.

After stabilization, revise the analgesic plan and monitoring level before any opioid is resumed.

Administer the authorized opioid reversal agent while resuscitation support remains available.

Open the airway and provide oxygen and assisted ventilation according to the response.

Stop opioid delivery, attempt to arouse the client, and activate emergency assistance.

## Explanation

The sequence interrupts exposure, supports ventilation, reverses opioid effect, checks for recurrence, and prevents another unsafe analgesic cycle.

## In-depth explanation

Quick answer
Sequence interrupt, ventilate, reverse, reassess, redesign.

Why this is correct
Airway and ventilatory support are not delayed while reversal is prepared, and a brief response does not justify immediate return to the prior regimen.

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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