The nurse is caring for a client being transitioned from the postanesthesia care unit (PACU) to the surgical nursing floor. Which nursing action is first when a client states, "I am nauseated"?
A) Obtain an emesis basin and cool washcloth.
B) Check the medication record for antiemetic medication orders.
C) Obtain vital signs.
D) Encourage sips of clear liquids.
A
Feedback:
Nausea is a frequent symptom in the postoperative period. When a client states being nauseated, the nurse's first action is to provide an emesis basin in case the client vomits. Once the client is provided for, next the nurse would check the MAR to provide a prescribed antiemetic. Vital signs would be obtained per postoperative protocol, and liquids would be held until the nausea subsides.
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