Stop the pump and report a respiratory rate under 12, rising sedation, or oxygen saturation under 92 percent.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client has a patient-controlled analgesia (PCA) pump with morphine after surgery. Which teaching point is correct?
Answer: A. With patient-controlled analgesia, only the client should press the demand button so that excessive dosing and oversedation are prevented. The lockout interval limits how often a dose can be delivered. Family members must not press the button for the client.
Question 2 of 5
A nurse withdraws medication from a single-dose vial and has more than the ordered dose in the syringe. What should the nurse do with the excess?
Answer: A. Excess controlled substance is wasted and witnessed by a second authorized nurse, with both documenting the waste. For non-controlled drugs the excess is simply discarded; controlled substances always require a witnessed waste to maintain the chain of accountability.
Question 3 of 5
A client is receiving morphine through a patient-controlled analgesia (PCA) pump after surgery. Which instruction is essential for the nurse to give the client and family?
Answer: A. For safety, only the client should press the PCA button; family or visitors pressing it ('PCA by proxy') can cause overdose because a sedated client cannot self-dose. Telling family to press it, pressing it on a schedule regardless of pain, or doubling doses for severe pain all bypass the built-in safety design.
Question 4 of 5
A client uses a patient-controlled analgesia (PCA) pump for postoperative pain. The nurse teaches that:
Answer: B. Only the CLIENT should press the PCA button (not family) — built-in lockouts prevent overdose. Monitor respiratory rate and sedation; the dose limit protects the client.
Question 5 of 5
A medication label states the safe range is 2 to 4 mg/kg/dose. A patient weighs 70 kg and the order is for 200 mg per dose. How should the nurse respond?
Answer: A. The safe range is 70 x 2 to 70 x 4, or 140 to 280 mg per dose. The ordered 200 mg falls within that range, so the nurse may safely administer the dose. Recalculating against the patient's weight is the safeguard.
Keep the streak going with more questions like these, each with a full rationale.
What is patient-controlled analgesia?
A lockout interval prevents overdose by limiting how often a dose can be delivered. Only the patient should press the button, which is the built-in safety feature.
Key points to remember
- The pump is programmed with a demand dose, a lockout interval, and often a maximum hourly limit.
- A basal (continuous) rate increases the risk of respiratory depression and is used cautiously.
- Common PCA opioids are morphine, hydromorphone, and fentanyl.
- Two-nurse independent verification of drug, concentration, and pump settings is required at setup and shift change.
- PCA-by-proxy, where family or staff press the button, removes the key safety mechanism and is prohibited.
- Naloxone and a resuscitation setup must be readily available whenever a PCA opioid is infusing.
Nursing priorities
- Verify pump settings with a second nurse against the order, and document delivered versus attempted doses.
- Monitor respiratory rate, sedation level, and oxygen saturation per protocol, especially in the first 24 hours.
- Use a sedation scale; rising sedation precedes respiratory depression.
- Teach the patient that only they may press the button and that the lockout protects them.
- Keep naloxone and an oxygen source at the bedside.
Patient teaching
- Press the button when you start to feel pain; the pump will not let you give too much.
- Only you should press the button, never a family member or visitor.
- Tell the nurse if your pain is not controlled or if you feel very drowsy or nauseated.
Red flags: report now
- Stop the pump and report a respiratory rate under 12, rising sedation, or oxygen saturation under 92 percent.
- Never let family members press the PCA button for the patient.
- Excessive attempts relative to delivered doses signal inadequate analgesia and need a provider review.
References
Clinical references for this topic
