A postoperative client that recently returned from surgery has a morphine PCA pump. The basal rate is ordered to be 1 mg/hour and the patient can have a 1-mg bolus every 15 minutes. When the nurse assesses the client, the nurse finds the client stuporous, hard to arouse, with a respiratory rate of 6 breaths/minute. After successfully treating the client, which action by the nurse takes priority? The nurse should
A) ask the physician to discontinue the PCA pump and revert to prn opioids for pain.
B) check the IV pump to ensure the basal rate is set correctly.
C) question the client about how he/she has been using the button on the pump.
D) request the physician order different basal and bolus rates.

Question

Quizplus · Accepted Answer

The patient exhibited manifestations of opioid toxicity. The ordered dose was well within a safe range for a postoperative client. On a PCA pump, the demand feature has a lock-out device limiting the amount of opioid the client can administer. This could have been set incorrectly, allowing the client to overdose him/herself; however, a sleepy postoperative client often cannot use the demand feature without reminders. This leaves the basal rate as the most likely source of error and the nurse should check to see that it was set correctly. Giving prn pain medications often results in undertreatment of pain and should not be used on a postoperative client. If the pump was set incorrectly, there is no need to adjust the rates. Questioning the client and re-educating him/her if needed are always appropriate, but it is not the priority since the pump most likely was set incorrectly.

A Postoperative Client That Recently Returned from Surgery Has a Morphine