A nurse is assessing a client who is receiving a blood transfusion. The nurse notes lung crackles, hypoxia, and distended neck veins. Which of the following actions should the nurse take? (Select all that apply.)

Client is difficult to arouse – This is concerning and may indicate opioid overdose or sedation due to the recent administration of morphine. The nurse should assess the client's level of consciousness closely and consider reversal of the opioid (naloxone) if the client's level of sedation is excessive.

Respiratory rate 10/min – This is below the normal respiratory rate (12–20 breaths/min) and could indicate respiratory depression, a common side effect of opioids like morphine. Close monitoring and possible intervention are required.

Pulse oximetry 88% on room air (95% to 100%) – The oxygen saturation is low, which could indicate hypoxemia. The nurse should administer supplemental oxygen and notify the provider.

Other Findings:

Pupils are 3 mm, equal, and reactive to light – This is a normal finding and not concerning for opioid overdose.

Blood pressure 99/46 mm Hg – This is slightly lower than normal but not critically low, considering the client's condition. Morphine can cause hypotension, especially in older adults or hypovolemic clients.

Heart rate 61/min – This is within a normal range for some postoperative patients, especially in a restful state.

A. A 21-year-old client who had a normal Pap test one year ago. The American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) recommend that cervical cancer screening (Pap test) begin at age 21, regardless of sexual history. Screening should be done every 3 years for individuals aged 21-29, assuming results are normal. Since this client had a Pap test one year ago, they do not need immediate screening but should follow the standard 3-year interval.
B. A 32-year-old client who had a total vaginal hysterectomy last year. A total hysterectomy (removal of the uterus and cervix) for non-cancerous reasons generally means that Pap tests are no longer necessary. However, if the hysterectomy was due to cervical cancer, continued screening might be needed.
C. A 47-year-old client who had a negative combined Pap and HPV test 5 years ago. For clients 30-65 years old, Pap tests can be done every 3 years OR combined Pap and HPV (co-testing) every 5 years. Since this client had a negative co-test 5 years ago, they are due for screening now, but they would not have been referred earlier.
D. A 15-year-old client who recently completed the vaccine series for human papillomavirus (HPV). The HPV vaccine does not replace the need for Pap tests but helps reduce the risk of cervical cancer. Routine Pap testing does NOT begin before age 21, so this client does not yet need screening.