# A 50-year-old client is being started on patient-controlled analgesia (PCA) with morphine for postoperative pain. Which client and family teaching is most important?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375171&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 50-year-old client is being started on patient-controlled analgesia (PCA) with morphine for postoperative pain. Which client and family teaching is most important?

## Option

1. Anyone who loves you can press the button when you look uncomfortable.
2. Press the button every 5 minutes whether you have pain or not to stay ahead of pain.
3. Only you, the patient, can press the button when you feel pain; the pump has a lockout that limits the dose, and a basal rate or demand dose schedule that the team set; if pain is unrelieved or you feel very drowsy, call the nurse rather than pressing repeatedly. **✔ Correct answer**
4. If the button does not give relief, ask a family member to press it instead.

**Correct answer: 3**

## Explanation

Patient-controlled analgesia (PCA) gives the patient direct control over analgesic delivery within prescribed limits. Built-in safety relies on the principle that only the patient can self-assess pain and self-protect: when sedated, the patient stops pressing, which prevents overdose. Therefore: (1) only the patient presses the button — never family, visitors, or unauthorized staff; this is called PCA-by-proxy and is a documented sentinel event with deaths reported, (2) the pump is programmed with a demand dose, lockout interval (typically 6 to 10 minutes), maximum dose per hour, and possibly a basal infusion, (3) basal infusion is generally avoided in opioid-naive adults because it bypasses the patient-protection mechanism, (4) teach pain self-assessment with a 0 to 10 scale, press for moderate to severe pain before it peaks, and call the nurse if no relief, increasing sedation, or RR less than 10, (5) verify pump settings with two-nurse independent double check at initiation and every shift change, monitor sedation scale (POSS), RR, SpO2, and use continuous capnography when available — especially in patients with sleep apnea, obesity, or comorbid sedatives. PCA-by-proxy, around-the-clock pushing, and family pressing are unsafe.

## In-depth explanation

Only the patient presses the PCA button. Family, friends, and visitors pressing is PCA-by-proxy and is a documented sentinel event.

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