Question

The client was given 15 mg of morphine IM for postsurgical pain. When the nurse checks the client for pain relief 1 hour later, the client is sleeping and has a respiratory rate of 10 breaths/min. What is the nurse's first action?

A. Administering oxygen by nasal cannula
B. Documenting the findings and continuing to monitor
C. Arousing the client by calling his or her name
D. Administering naloxone (Narcan) IV push

Answer 1

The nurse's first action should be to administer oxygen by nasal cannula to alleviate respiratory depression caused by the morphine naloxone is an opiate antagonist used to reverse the effects of narcotic overdose. Documenting the findings and continuing to monitor is necessary, but not the immediate first action.

Step-by-step explanation:

The nurse's first action should be to administer oxygen by nasal cannula. This is because the client is sleeping and has a respiratory rate of 10 breaths/min, which indicates respiratory depression as a side effect of the morphine. Administering oxygen can help improve the client's oxygenation levels and alleviate the respiratory depression.

Arousing the client by calling their name may not be effective in this situation as the client is in a deep sleep due to the respiratory depression caused by the morphine. Administering naloxone (Narcan) IV push is not the nurse's first action, as naloxone is an opiate antagonist used to reverse the effects of narcotic overdose. Documenting the findings and continuing to monitor is necessary, but not the immediate first action.