Naloxone administration and monitoring

Question

An adult client who received intravenous morphine develops profound sedation and bradypnea with a respiratory rate of 6 breaths/min. The nurse administers prescribed intravenous naloxone, and within two minutes the client becomes alert with a respiratory rate of 16 breaths/min. Which action should the nurse prioritize next?

1. AContinue frequent respiratory assessments because naloxone's duration of action is shorter than that of morphine✓ Correct

   Naloxone wears off more quickly than most opioids; as its receptor blockade wanes, respiratory depression can recur, requiring repeated dosing.

2. BDischarge the client from observation since the respiratory rate has normalized✗ Incorrect

   Discharging the client is unsafe because sedation and hypoventilation often return once naloxone is metabolized.

3. CAdminister an immediate oral dose of morphine to treat the return of surgical pain✗ Incorrect

   Giving additional opioids immediately after acute overdose reversal risks precipitating secondary respiratory collapse.

4. DPlace the client in a prone position to maintain an open airway✗ Incorrect

   A prone position impairs airway visualization and chest expansion in a recovering client.

Answer

A. Continue frequent respiratory assessments because naloxone's duration of action is shorter than that of morphine

Rationale

Naloxone works by competing for and displacing opioids from neural receptors. However, naloxone has a significantly shorter circulating half-life than morphine and most other opioids. Once the antagonist clears, uneliminated opioid molecules can rebind to receptors, plunging the client back into life-threatening hypoventilation. The nurse must continue diligent respiratory and sedation monitoring.