A nurse is caring for a client who had total hip arthroplasty 1 day ago and is receiving morphine sulfate by PCA pump for pain control.The client reports nausea and vomiting.Which of the following actions should the nurse take?
Explanation & Rationale
Choice A rationaleAdministering an antiemetic is the most appropriate initial action to address the client's reported nausea and vomiting, which are common side effects of morphine sulfate, an opioid analgesic administered via a PCA pump. An antiemetic medication can help alleviate these symptoms and improve the client's comfort.Choice B rationaleAuscultating bowel sounds is important for assessing gastrointestinal function, but it does not directly address the client's immediate complaint of nausea and vomiting. While opioid-induced constipation and decreased bowel motility are potential side effects, the immediate priority is to relieve the distressing symptoms.Choice C rationaleEncouraging the use of the incentive spirometer is crucial for preventing postoperative pulmonary complications such as atelectasis, especially after surgery involving anesthesia and pain medication. However, it does not directly address the client's current nausea and vomiting.Choice D rationaleInserting a nasogastric tube is a more invasive intervention and is typically reserved for situations involving severe, persistent vomiting, abdominal distension, or concerns about bowel obstruction. It is not the first-line treatment for nausea and vomiting related to opioid use after surgery.