Doing some homework :/ HELP!!!

[LoveER01]

A client is admitted to the intensive care unit after overdosing on meperidine. What is the nurse's first priority?

1. Maintain continuous cardiac monitoring.

2. Administer naloxone hydrochloride 0.4 mg IV every 2-3 minutes prn.

3. Provide alprazolam 0.25 mg PO PRN.

4. Initiate intravenous fluid resuscitation with lactated ringers at 125 mL/hr.

Ok, I need help with this one. I figure if the patient is going to ICU, the ER would have given the patient Naloxone. I have eliminated 3 because that is for benzo OD. Now I am stuck

[203bravo, MSN, APRN]

1st rule about test questions is NEVER assume anything. The question says nothing about coming in through the ER and nothing about having received any narcan.

Narcan is normally given 0.4mg q 2-3 min until respirations and LOC improve. Strictly going by the information provided and knowing that airway and decreased respirations are the biggest concern with a opioid overdose --- I would lean more toward 2.

[LoveER01]

Ohhhh, you are right. I will keep that advice about never assuming. Thank you :)

[JustBeachyNurse, LPN]

Alpralzolam IS a benzodiazepine it is not a treatment for benzodiazepine overdose. Romazicon (flumazinal) is the treatment for a known benzodiazepine OD

Treatment of benzodiazepine overdose with flumazenil. The Flumazenil in Benzodiazepine Intoxication Multicenter Study Group. - PubMed - NCBI

[LoveER01]

Ahhhh, thank you. I feel silly now lol!

[JustBeachyNurse, LPN]

Use your drug reference book. It has most of the information you need for this question including treatment for meperidine overdose and the class and indication for all the others listed.

[NICU Guy, BSN, RN]

What is going to stabilize a patient that OD'd on an Opiate the quickest?

1. Maintain (not initiate) continuous cardiac monitoring. (Do nothing but monitor patient)

2. Administer Narcan

3. Provide an anti-depressant

4. Initiate intravenous fluid resuscitation

[NICUmiiki, DNP, NP]

Now that others have chimed in, I'll give my thoughts too.

Like a PP, never assume anything. When picking an answer, think of it as the ONE and ONLY thing you can do. All patients are trying to die. You also have a prescription for every option. Never do nothing.

Cardiac monitoring will not stabilize/change anything. You will do nothing and monitor the patient's death.

The patient is already OD (depressed respirations and mental status) on an opiate. Do not also give them another depressant. You will kill them quicker.

Since their main problem is the whole not breathing thing.. Giving them more fluid will not help them with that. You will give fluid as they die.

That leaves administering Narcan (which is an action). Look up Narcan. Good stuff.

[JustBeachyNurse, LPN]

What is going to stabilize a patient that OD'd on an Opiate the quickest?

1. Maintain (not initiate) continuous cardiac monitoring. (Do nothing but monitor patient)

2. Administer Narcan

3. Provide an anti-depressant

4. Initiate intravenous fluid resuscitation

But meperidine does not cause fluid volume loss. The patient is not in need of fluid or blood volume replacement.

Respiratory depression caused by opiate overdose will kill you. Narcan can help prevent that.

Xanax is not an antidepressant, it's a sedative/hypnotic anti-anxiety drug. Still inappropriate in this case since benzodiazepines can further suppress respiratory drive..in other words will kill the patient quicker.