The nurse is caring for a patient with a hydromorphone (Dilaudid) PCA set at a basal rate of 0.1 mg per hour, with a 0.1 mg bolus every 10 minutes. The nurse is concerned for opioid toxicity when she notes which of the following findings?

Decreased alertness
The patient is difficult to arouse


•Symptoms of opioid toxicity include decreased level of consciousness, difficulty arousing, lowered respiratory rate and depth, and at times, bradycardia.

•Anxiety is not a sign of opioid toxicity but can occur with withdrawal from the drug. Wheezing is not a symptom of opioid toxicity and is associated with asthma and COPD. Fever is not a symptom.

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