An opioid-naive 78-year-old client is prescribed morphine PCA with a continuous basal infusion after hip surgery. Which action should the nurse take before starting the PCA?
1Increase the demand dose so the client can treat severe pain while the basal infusion continues.
2Start the prescription and rely on the lockout interval to prevent respiratory depression.
3Start the basal infusion and plan to give naloxone if the respiratory rate later decreases.
4Hold initiation and contact the prescriber to clarify the basal infusion for this high-risk client.✓ Correct answer
Explanation
A continuous basal opioid infusion increases respiratory-depression risk in opioid-naive clients, and advanced age adds further risk. The nurse should hold initiation and clarify the prescription, advocating for an individualized plan such as demand-only dosing with multimodal analgesia and appropriate monitoring. Increasing the dose, relying on the lockout, or planning rescue treatment after depression occurs does not address the unsafe initial order.
Clinical reasoning summary The PCA demand button provides a partial safety mechanism because a sedated client stops pressing it; a basal infusion bypasses that mechanism. In an opioid-naive older adult, hold initiation and clarify the basal rate before therapy begins.