As the patient’s primary pain manager, the nurse is responsible for advocating for changes to the treatment plan when what has been prescribed is not effective or if treatment results in unmanageable and intolerable adverse effects or the potential for such. For example, to prevent clinically significant opioid-induced respiratory depression, the nurse must advocate for the establishment of a strong nonopioid foundation or adding or increasing the dose of nonopioid analgesics (acetaminophen or an NSAID) rather than administering increased opioid doses to a patient who is both excessively sedated and in severe pain (Jarzyna et al., 2011; Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011).