# A nurse is assessing a patient who has been receiving morphine sulfate 10 mg IV every 4 hours for severe postoperative pain. Which assessment finding would be the priority concern requiring immediate intervention?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543489  
> language: ko  
> subject: Pharmacology

## 문제

A nurse is assessing a patient who has been receiving morphine sulfate 10 mg IV every 4 hours for severe postoperative pain. Which assessment finding would be the priority concern requiring immediate intervention?

## 보기

1. Patient reports pain level of 7/10 on the numeric rating scale
2. Respiratory rate of 8 breaths per minute with shallow breathing **✔ 정답**
3. Blood pressure decreased from 130/80 to 110/70 mmHg
4. Patient appears drowsy but arouses easily to verbal stimuli

**정답: 2**

## 해설

Respiratory depression is the most serious adverse effect of opioids. A respiratory rate of 8 breaths per minute with shallow breathing indicates life-threatening respiratory depression requiring immediate intervention, such as stopping morphine and administering naloxone. Other findings like pain, hypotension, or drowsiness are less urgent.

## 심화 해설

Priority Concern Identification

The patient is receiving intravenous morphine, a potent opioid agonist, for severe postoperative pain. While effective for analgesia, opioids carry a significant risk of respiratory depression, which is the most life-threatening adverse effect. The nurse must apply the airway, breathing, circulation (ABC) priority-setting framework. Among the listed findings, a respiratory rate of 8 breaths per minute with shallow breathing indicates severe central nervous system depression and impending respiratory failure. This constitutes an immediate threat to oxygenation and ventilation, requiring urgent intervention such as stimulation, naloxone administration, and preparation for possible ventilatory support [1].

Analysis of Other Findings

A pain score of 7/10 indicates inadequate analgesia and requires intervention, but pain itself is not immediately life-threatening. The blood pressure decrease from 130/80 to 110/70 mmHg represents a mild hypotensive effect consistent with opioid-induced vasodilation; while it requires monitoring, it does not signal an acute crisis. Drowsiness with easy arousal to verbal stimuli is an expected, mild sedative effect of opioids and falls within a manageable spectrum on sedation scales, provided the airway and respiratory drive remain intact.

Pathophysiology and Clinical Rationale

Opioids such as morphine exert their effects by binding to mu-opioid receptors in the central nervous system. In the brainstem respiratory centers, activation of these receptors blunts the chemoreceptor response to hypercapnia and hypoxia, directly reducing the respiratory rate and tidal volume. This mechanism explains why bradypnea and shallow breathing are the hallmark signs of opioid toxicity. Clinical practice guidelines for postoperative pain management emphasize that while opioids are a cornerstone of acute pain control, continuous respiratory monitoring is mandatory to detect this dose-limiting toxicity early [2]. The risk is heightened in the postoperative setting where residual anesthetic agents and sleep disruption can potentiate respiratory depression.

Modern perioperative care pathways, such as Enhanced Recovery After Surgery (ERAS) protocols, actively promote opioid-sparing multimodal analgesia to mitigate these exact risks. Research demonstrates that reducing opioid consumption through the use of non-opioid adjuncts can decrease the incidence of adverse effects like respiratory depression, thereby improving patient safety and recovery outcomes . The assessment finding of a depressed respiratory rate is the clinical trigger that directly conflicts with the safety goals of these evidence-based protocols.References (research sources)

- [1]Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.GuidelineOlasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, Chung SP, Considine J, Couper K, Escalante R, Hatanaka T, Hung KKC, Kudenchuk P, Lim SH, Nishiyama C, Ristagno G, Semeraro F, Smith CM, Smyth MA, Vaillancourt C, Nolan JP, Hazinski MF, Morley PT, Adult Basic Life Support Collaborators. (2020) · DOI: 10.1016/j.resuscitation.2020.09.010

- [2]Clinical practice guidelines for postoperative pain management in adults (2024 edition).GuidelineChen X, Chu Q, Peng Y, Chen Y, Kaye AD, Liu H, Yang J, Wang T, Yu W, Pain Group of the Chinese Society of Anesthesiology. (2025) · DOI: 10.1016/j.jatmed.2025.09.001

## 임상 시나리오

Opioid Safety & Respiratory MonitoringResponding to Life-Threatening Respiratory Depression
The ABC framework dictates that a respiratory rate of 8 breaths/min with shallow breathing is the priority. This indicates severe opioid-induced respiratory depression, an immediate threat to ventilation.

Immediate actions include stimulating the patient, administering naloxone as prescribed, and preparing for bag-valve-mask ventilation. Continuous monitoring of end-tidal CO2 and oxygen saturation is critical.

CautionDo not confuse expected mild sedation (drowsy but arousable) with impending respiratory failure. A rate below 10 breaths/min in an adult receiving opioids is a critical red flag requiring immediate intervention.

## 핵심 개념

- **Respiratory Depression** — Respiratory depression. A condition where the respiratory rate decreases abnormally or breathing becomes shallow, resulting in insufficient oxygen supply to the body. The most serious side effect of opioid analgesics.
- **Morphine Sulfate** — Morphine sulfate. A potent opioid analgesic used for managing severe pain. It acts on mu-receptors in the central nervous system to produce analgesic effects, but can cause side effects such as respiratory depression, sedation, and constipation.
- **Naloxone** — Naloxone (brand name Narcan). An opioid antagonist, it is an emergency medication used to rapidly reverse respiratory depression caused by opioids.
- **Bradycardia** — Bradycardia. In adults, this refers to a heart rate of less than 60 beats per minute. Although not directly mentioned in the context of this issue, it is a term related to respiratory depression (bradypnea).
- **Hypoxia** — Hypoxia. A condition where there is insufficient oxygen supply to the body's tissues. It is a major complication that can occur if respiratory depression persists.

## 같은 주제 문제

- [A nurse is assessing a patient who has been receiving morphine sulfate 10 mg IV every 4 ho…](https://mymerci.kr/pages/nclex_q.php?qn_id=543490)
- [A nurse is caring for a patient receiving morphine sulfate via patient-controlled analgesi…](https://mymerci.kr/pages/nclex_q.php?qn_id=543491)
- [A nurse is caring for a patient receiving morphine sulfate via patient-controlled analgesi…](https://mymerci.kr/pages/nclex_q.php?qn_id=543492)
- [A nurse is caring for a patient receiving hydromorphone via continuous intravenous infusio…](https://mymerci.kr/pages/nclex_q.php?qn_id=543493)
- [A nurse is caring for a patient receiving morphine sulfate via patient-controlled analgesi…](https://mymerci.kr/pages/nclex_q.php?qn_id=543494)
- [A nurse is caring for a patient receiving continuous morphine infusion for severe cancer p…](https://mymerci.kr/pages/nclex_q.php?qn_id=543495)
- [A nurse is assessing a patient who has been receiving morphine sulfate 10 mg IV every 4 ho…](https://mymerci.kr/pages/nclex_q.php?qn_id=543524)
- [A nurse is assessing a patient who has been receiving morphine sulfate 10 mg IV every 4 ho…](https://mymerci.kr/pages/nclex_q.php?qn_id=543525)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._