The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement?

Answer: B. Administer a second dose of naloxone. Rationale: A) Prepare to assist with chest tube insertion: Chest tube insertion is not relevant in this situation. A chest tube is typically used for conditions like pneumothorax or pleural effusion, not opioid-induced respiratory depression. The immediate concern here is the opioid overdose and the need for further naloxone administration to reverse the opioid effects, not the placement of a chest tube. B) Administer a second dose of naloxone: Administering a second dose of naloxone is the most appropriate action. Naloxone is a short-acting opioid antagonist, and its effects can wear off before the opioids have fully cleared from the client’s system. Given that the client’s respiratory rate is severely depressed and the oxygen saturation is dangerously low, another dose of naloxone is necessary to reverse the opioid's effects and restore adequate breathing. Immediate action is required to prevent further hypoxia. C) Determine Glasgow Coma Scale score: While assessing the client’s level of consciousness using the Glasgow Coma Scale (GCS) is important, it is not the immediate priority in this situation. The client’s low respiratory rate and oxygen saturation indicate a critical need for immediate treatment to improve ventilation and oxygenation. Administering naloxone should take precedence over neurological assessment. D) Initiate cardiopulmonary resuscitation (CPR): While the client’s respiratory depression is severe, initiating CPR may not yet be necessary if the client still has a pulse. Administering naloxone can potentially reverse the respiratory depression and prevent the need for CPR. If the client's condition continues to decline despite naloxone administration, CPR may become necessary later, but the first step is to administer a second dose of naloxone to restore breathing.