# A client is using patient-controlled analgesia after surgery. A family member says, "I press the button while he sleeps so the pain does not come back." The client is drowsy but rousable, with respirations of 12/min. Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522682&lang=en  
> language: en  
> subject: Pharmacological Pain Management  
> category: PPT

## Question

A client is using patient-controlled analgesia after surgery. A family member says, "I press the button while he sleeps so the pain does not come back." The client is drowsy but rousable, with respirations of 12/min. Which action should the nurse take first?

## Option

1. Lower the programmed demand dose and keep watching the sedation level
2. Record the family report and review the pump history at the end of the shift
3. Explain that only the client presses the button and check the sedation level **✔ Correct answer**
4. Remove the pump and ask the provider for a different route for the analgesia

**Correct answer: 3**

## Explanation

Proxy dosing defeats the safety design of patient-controlled analgesia, because sedation stops a client from pressing the button. Stopping the practice and assessing sedation protects the client immediately.

## In-depth explanation

Quick answer
Stop the proxy dosing through teaching and assess how sedated the client is.

Why this is correct
The pump is safe because a sedated client cannot self-administer. When someone else presses the button, that limit disappears and respiratory depression can develop, so the teaching and the sedation check happen now.

Easy analogy or mental picture
It is like disabling a dead-man switch on a machine. The comparison explains why the safeguard matters and does not suggest the analgesia itself is inappropriate.

Memory hook
The button belongs to the client alone.

NCLEX decision rule
When proxy dosing is discovered, stop it and assess sedation and respiratory status. Prescription changes follow the assessment rather than substitute for it.

Why the other choices are wrong
Changing the dose, documenting for later, and removing the pump are each plausible follow-ups, but none of them stops the unsafe practice at the bedside right now.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]MedlinePlus: Pain RelieversU.S. National Library of Medicine

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=522682&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522682&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522682&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522682&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522682&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._