A patient who has had abdominal surgery has been receiving morphine sulfate via patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated, and that the patient is drowsy and lethargic. The patient's heart rate is 84 beats/minute, the respiratory rate is 10s breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do?
Note the effectiveness of the analgesia in the patient's chart
Discuss possible opiate dependence with the patient's provider
Encourage the patient to run over and cough and take deep breaths
Prepare to administer naloxone and possibly ventilatory support
The Correct Answer is D
Postoperative patients receiving patient-controlled analgesia (PCA) with opioids such as Morphine sulfate are at risk for opioid-induced respiratory depression and central nervous system suppression. Over-sedation, bradypnea, hypotension, and altered mental status are warning signs of opioid toxicity. Pupillary changes, lethargy, and reduced respiratory rate indicate a potentially life-threatening overdose. Immediate intervention focuses on airway protection, reversal of opioid effects, and hemodynamic stabilization.
Rationale:
A. Noting the effectiveness of analgesia is inappropriate because the patient shows signs of opioid toxicity rather than therapeutic pain control. Drowsiness, respiratory depression, hypotension, and altered mental status indicate overdose rather than adequate analgesia. Documenting effectiveness at this stage would delay urgent intervention and compromise patient safety.
B. Discussing possible opioid dependence is not the priority in an acute clinical deterioration. The immediate concern is respiratory depression and cardiovascular instability, which require urgent reversal and supportive care. Dependence assessment is a long-term consideration and does not address the current life-threatening condition.
C. Encouraging the patient to turn, cough, and take deep breaths may be useful in mild sedation but is unsafe in this scenario. The patient has a respiratory rate of 10 breaths per minute and signs of significant CNS depression, indicating opioid overdose. Stimulation alone is insufficient and delays definitive treatment.
D. The findings are consistent with opioid-induced respiratory depression requiring emergency reversal with an opioid antagonist such as Naloxone. Naloxone rapidly displaces opioids from receptors, restoring respiratory drive. The nurse should also prepare for ventilatory support because rebound sedation may occur, and airway protection may be necessary to stabilize oxygenation and circulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Antipsychotic medications, including low-potency agents, require adequate time to demonstrate full therapeutic effects on psychotic symptoms. Antipsychotics work primarily by modulating dopamine pathways, but clinical improvement, especially in hallucinations, delusions, and thought disturbances, may take several weeks. Early treatment response is often gradual, with some symptoms improving before others. Evaluation of effectiveness should consider duration of therapy, adherence, and expected pharmacologic onset.
Rationale:
A. It is too early to see a full therapeutic response because antipsychotic medications typically require 2–6 weeks or longer to show significant improvement in psychotic symptoms. Early partial response may be subtle, especially in negative symptoms or cognitive changes. At only 2 weeks, continued therapeutic effect is still expected as dopamine receptor adaptation continues over time.
B. Refractory illness refers to treatment-resistant psychosis, which is diagnosed only after adequate trials of multiple antipsychotics at therapeutic doses and durations. A 2-week trial is insufficient to determine treatment failure. Labeling the illness as refractory at this stage would be premature and clinically inaccurate.
C. Nonadherence cannot be assumed without evidence such as missed doses, inconsistent serum levels, or patient report. While noncompliance is a common issue in psychiatric treatment, the question provides no indication of medication refusal or poor adherence. Clinical evaluation should first consider expected drug response timelines.
D. Increasing to a stronger medication is not indicated at this stage because therapeutic response has not yet had adequate time to develop. Premature medication escalation may increase side effects without improving outcomes. Standard practice is to allow sufficient trial duration before changing antipsychotic potency or class.
Correct Answer is D
Explanation
Tricyclic antidepressants (TCAs) work by inhibiting the reuptake of norepinephrine and serotonin in the central nervous system. In addition to treating depression, certain TCAs are widely used at lower doses for chronic pain conditions such as neuropathic pain and back pain. Their sedative properties make them beneficial for patients with sleep disturbances. However, abrupt discontinuation can lead to withdrawal symptoms due to their effects on neurotransmitter balance.
Rationale:
A. Selegiline is a monoamine oxidase inhibitor (MAOI) primarily used in the management of Parkinson’s disease and sometimes depression. It works by inhibiting the breakdown of dopamine rather than affecting serotonin and norepinephrine reuptake. It is not classified as a tricyclic antidepressant and is not used for chronic pain management or bedtime sedation.
B. Bupropion is an atypical antidepressant that primarily inhibits the reuptake of norepinephrine and dopamine. It is commonly used for depression and smoking cessation but lacks the sedative properties seen in tricyclic antidepressants. It is not effective for neuropathic pain and is usually taken in the morning due to its stimulating effects.
C. Citalopram is a selective serotonin reuptake inhibitor (SSRI) used mainly for depression and anxiety disorders. It does not have significant analgesic properties for neuropathic pain and is not classified as a tricyclic antidepressant. Its side effect profile and mechanism differ significantly from TCAs.
D. Amitriptyline is a tricyclic antidepressant that is frequently used at low doses for neuropathic pain and chronic back pain. It has strong antihistaminic effects that cause sedation, making bedtime administration appropriate. Abrupt discontinuation can result in withdrawal symptoms such as nausea, headache, and malaise due to sudden neurotransmitter imbalance.
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