After administering naloxone (Narcan), an opioid antagonist, Nurse Ronald should monitor female client carefully for which of following?

Correct Answer: A. Respiratory depression

After administering naloxone (Narcan) the nurse should monitor the client’s respiratory status carefully because the drug is short-acting & respiratory depression may recur after its effects wear off. Once the pharmacological effects of naloxone have worn off, there is a possibility that respiratory depression may recur, and without monitoring, this could spell real trouble for the patient.

• Option B: Naloxone has few side effects. The most common are those of acute withdrawal from opioids, such as anxiety, aggression, nausea, vomiting, diarrhea, abdominal pain, and rhinorrhea. In rare cases, the use of naloxone can precipitate noncardiogenic pulmonary edema. The incidence of naloxone-induced noncardiogenic pulmonary edema is estimated to be between 0.2% and 3.6% of patients who have received naloxone and are transported to the emergency department.
• Option C: In chronic opioid users, naloxone requires slow administration to individuals who are dependent on opioids. All patients who have responded to naloxone should be continuously monitored for at least six to 12 hours since some opioids (methadone, fentanyl, buprenorphine) have a much longer half-life than naloxone. The half-life of naloxone in adults varies from 30 to 80 minutes. The patient should have vital signs, including pulse oximetry, monitored until obtaining a full recovery.
• Option D: Symptoms include persistent hypoxia, despite the resolution of respiratory depression secondary to acute overdose. Patients may also have a cough productive of the classic “pink, frothy sputum” indicative of pulmonary edema. Chest radiography will be consistent with the findings of pulmonary edema. It bears mention that the onset of noncardiogenic pulmonary edema occurs within 4 hours in most patients. However, there have been case reports of delayed onset of up to 8 hours after naloxone administration.