# A 58-year-old male is on postoperative day 1 following laparoscopic cholecystectomy. He rates his abdominal pain as 8/10 and states it feels different from earlier. His last PRN morphine dose was 5 hours ago (ordered q4h). Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372689&lang=en  
> language: en  
> subject: Nonpharmacological Comfort  
> category: BCC

## Question

A 58-year-old male is on postoperative day 1 following laparoscopic cholecystectomy. He rates his abdominal pain as 8/10 and states it feels different from earlier. His last PRN morphine dose was 5 hours ago (ordered q4h). Which action should the nurse take first?

## Option

1. Administer the prescribed morphine dose immediately since the patient's last dose was over 5 hours ago and the order allows administration.
2. Immediately notify the surgeon about the patient's report that the abdominal pain feels different from earlier in the day.
3. Ask the patient to wait 30 minutes before reassessing the pain, as postoperative discomfort may naturally decrease without intervention.
4. Conduct a comprehensive pain assessment including location, quality, onset, duration, and aggravating/relieving factors. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Pain assessment must precede any intervention. A change in pain character (location, quality) after laparoscopic cholecystectomy may indicate a complication such as bile leak or referred shoulder pain from residual CO2. The nurse first applies the PQRST framework to characterize the pain fully before administering analgesics or escalating to the surgeon. Administering opioids without assessment could mask diagnostic signs. Asking the patient to wait is not evidence-based when pain is 8/10. Notifying the surgeon is premature before the nurse has completed their own assessment.

## In-depth explanation

When a postoperative patient reports pain that feels "different," that language is a red flag requiring structured assessment before any action. Use PQRST: Provocation, Quality, Region/Radiation, Severity, Timing. For laparoscopic procedures, be alert to referred right-shoulder pain from diaphragmatic irritation by residual CO2 gas — this is normal — versus new RUQ tenderness suggesting bile leak. Only after characterizing the pain can the nurse decide whether PRN analgesia, positioning, or surgeon escalation is appropriate.

## Clinical scenario

A **58-year-old male** is on **postoperative day 1** following **laparoscopic cholecystectomy**. He rates his abdominal pain as **8/10** and states it feels **different from earlier**. His last PRN morphine dose was **5 hours ago** (ordered q4h).

## Key concepts

- **PQRST Pain Assessment** — A structured pain assessment framework: Provocation, Quality, Region/Radiation, Severity, Timing. Used to fully characterize pain before selecting an intervention.
- **Referred Pain** — Pain perceived at a site distant from its origin. After laparoscopic surgery, residual CO2 gas can irritate the diaphragm, causing right shoulder pain — a common, expected finding.
- **PRN Analgesics** — Medications ordered to be given as needed. The nurse must assess whether the criteria for administration are met; PRN does not mean automatic administration on a schedule.

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