# A nurse is assessing a 65-year-old patient with chronic back pain who has been prescribed opioid analgesics for pain management. Which assessment finding would be the most critical concern requiring immediate nursing intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543501 > language: ko > subject: Pharmacology ## 문제 A nurse is assessing a 65-year-old patient with chronic back pain who has been prescribed opioid analgesics for pain management. Which assessment finding would be the most critical concern requiring immediate nursing intervention? ## 보기 1. Patient reports pain level of 6/10 on numeric rating scale 2. Patient experiences mild constipation for 2 days 3. Patient exhibits confusion and respiratory rate of 8 breaths per minute **✔ 정답** 4. Patient complains of dry mouth and drowsiness **정답: 3** ## 해설 Confusion with bradypnea (8 breaths/min) indicates opioid-induced respiratory depression, a life-threatening emergency requiring immediate intervention. Other options are common but less critical side effects. ## 심화 해설 Clinical Reasoning: Identifying the Priority Assessment Finding When caring for a patient prescribed opioid analgesics, the nurse must continuously weigh assessment data against the hierarchy of physiological needs. Opioids bind to mu-opioid receptors in the central nervous system, producing analgesia but also dose-dependent respiratory depression, sedation, and confusion. The most critical concern is always the risk of life-threatening respiratory compromise. Analysis of Assessment Findings Opioid-induced respiratory depression (OIRD) is the most serious adverse effect of prescribed opioids and the leading cause of opioid-related death. Opioids diminish the brainstem's responsiveness to hypercapnia and hypoxia, directly suppressing the respiratory drive [1]. A respiratory rate of 8 breaths per minute indicates severe central nervous system depression. When this finding is paired with new-onset confusion, it signals cerebral hypoxia and impending respiratory failure. This combination demands immediate intervention, such as withholding the opioid, stimulating the patient, administering oxygen, preparing for naloxone administration, and notifying the prescriber. The remaining options represent expected or less immediately dangerous effects: - Pain level of 6/10 (Option 1) indicates inadequate analgesia and requires follow-up, but pain does not pose an immediate threat to airway, breathing, or circulation. - Mild constipation (Option 2) is a predictable peripheral mu-receptor effect caused by slowed gastrointestinal motility. It is a quality-of-life concern managed with bowel regimens, not a reason for emergency intervention. - Dry mouth and drowsiness (Option 4) are common anticholinergic-like and sedative side effects. While drowsiness warrants monitoring for progression to sedation, it alone does not demand the same urgency as a critically low respiratory rate with altered mental status. The systematic review by Lima et al. confirms that adverse effects of prescribed opioids range from common and manageable (nausea, constipation, pruritus) to severe and potentially fatal (respiratory depression, overdose, dependence). The review emphasizes that respiratory depression remains the most critical harm requiring vigilant monitoring and prompt reversal [1].References (research sources) - [1]Harmful Effects of Prescribed Opioids in Children and Adults: A Systematic Review.Meta-analysis/systematic reviewLima LS, Costa NSD, Galiciolli MEA, Garlet QI, Joaquim JJ, Oliveira CS, Matos C. (2025) · DOI: 10.3390/ph18101429 ## 임상 시나리오 Opioid-Induced Respiratory Depression (OIRD) ResponseImmediate nursing actions for suspected overdose A respiratory rate of ≤8 breaths/min with new-onset confusion or sedation signals severe OIRD and cerebral hypoxia. This is a medical emergency. Immediate steps: Withhold the opioid, administer oxygen, and stimulate the patient. Prepare to administer naloxone per protocol, typically 0.4 mg to 2 mg IV, repeated every 2-3 minutes if needed. CautionNaloxone's half-life is shorter than most opioids; monitor for re-sedation and respiratory depression recurrence. Ensure ABC support remains the priority. ## 핵심 개념 - **Opioid-Induced Respiratory Depression (OIRD)** — Life-threatening suppression of the brainstem's respiratory drive due to opioid binding at mu-receptors, leading to decreased responsiveness to CO2 and hypoxia. - **Naloxone** — An opioid antagonist used as an antidote to reverse severe respiratory and CNS depression caused by opioid overdose. - **ABC Priority Framework** — A nursing assessment model prioritizing Airway, Breathing, and Circulation; respiratory rate of 8 and confusion indicate a critical breathing and cerebral oxygenation issue. - **Mu-opioid Receptors** — Receptors in the central nervous system that mediate both the analgesic effects of opioids and adverse effects like respiratory depression, sedation, and constipation. ## 같은 주제 문제 - [A nurse is assessing a 78-year-old patient with chronic osteoarthritis who has been prescr…](https://mymerci.kr/pages/nclex_q.php?qn_id=543502) - [A nurse is assessing a 65-year-old patient with chronic low back pain who has been taking …](https://mymerci.kr/pages/nclex_q.php?qn_id=543503) - [A nurse is assessing a 72-year-old patient with metastatic bone cancer who has been prescr…](https://mymerci.kr/pages/nclex_q.php?qn_id=543504) - [A nurse is caring for an elderly patient with chronic pain who has been prescribed opioid …](https://mymerci.kr/pages/nclex_q.php?qn_id=543505) - [A nurse is caring for an elderly patient with chronic pain who has been prescribed opioid …](https://mymerci.kr/pages/nclex_q.php?qn_id=543506) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._