A patient using a PCA pump reports pain at night. Which sequence describes the proper nursing response?

• A. Reassure patient and increase dose without assessment
• B. Sleep through the night and monitor later
• C. Assess patient first, check pump, then call physician
• D. Notify family to change analgesia

Answer: (C)

When a patient on a PCA pump reports pain, the priority is a safe, real‑time assessment and verification of the device. Start by evaluating the patient’s current status: pain intensity and location, onset, and any signs of adverse effects such as shallow breathing, sedation, or confusion. Check vital signs and airway status to rule out problems like respiratory depression. Then examine the PCA setup: confirm the current settings (basal rate, dose per bolus, lockout interval), verify the pump is delivering accurately, check the reservoir level, and determine whether the patient has pressed the button or if there could be a technical issue (malfunction, occlusion, or line trouble). If the assessment suggests analgesia is inadequate or a device issue is present, contact the prescriber to review and adjust the order as needed. This sequence—assessing the patient, checking the pump, and then notifying the physician—ensures safe, effective pain control. Reassuring and increasing the dose without assessment, delaying action, or involving family to change analgesia don’t address the underlying issue and aren’t appropriate.