A postoperative client using morphine patient-controlled analgesia is difficult to arouse and has a respiratory rate of 8/min. The nurse sees the client's spouse press the PCA button. Which action is the priority?
1Reset the PCA lockout interval and allow the spouse to continue pressing when the client appears uncomfortable.
2Stop the spouse, stop the opioid delivery, support ventilation, activate urgent help, and prepare naloxone per protocol.✓ Correct answer
3Document who pressed the button and reassess sedation and respirations after the next scheduled vital signs.
4Reduce the PCA dose and teach the spouse to press only when the client is asleep and cannot request medication.
Explanation
Only the client should activate a standard PCA button because sedation normally prevents additional self-dosing. A difficult-to-arouse client with 8 respirations/min has opioid-induced respiratory depression; the priority is to stop opioid delivery, support ventilation, summon urgent help, and prepare naloxone according to protocol. Documentation and education follow stabilization.
Clinical reasoning PCA-by-proxy removes a built-in safety feature: a sedated client cannot press the button, but another person can continue delivering opioid. Respiratory rate 8/min with reduced arousal signals an emergency.
Decision rule Stop further opioid exposure, support airway and ventilation, call for immediate assistance, and prepare reversal. Stabilize the client before reporting and re-education.