A patient is postoperative after a cholecystectomy and is actively vomiting. The PACU nurse reviews the patient's current orders. Which of the following medications is appropriate for the patient to receive?

Choice A rationale Promethazine is an antihistamine with potent antiemetic properties often used in the postoperative setting to manage nausea and vomiting. The intravenous route is appropriate for a patient who is actively vomiting and unable to tolerate oral intake. By blocking dopamine receptors in the chemoreceptor trigger zone, it effectively reduces the vomiting reflex. Since the patient is in the PACU and actively emetic, parenteral administration ensures rapid onset of action and reliable systemic absorption. Choice B rationale Ondansetron is a highly effective 5-HT3 receptor antagonist used for postoperative nausea. however, the oral route is contraindicated for a patient who is actively vomiting. If a patient cannot keep fluids down, a pill or disintegrating tablet will likely be expelled before it can be absorbed in the gastrointestinal tract. In the immediate postoperative phase with active emesis, the nurse must prioritize non-oral routes, such as intravenous or intramuscular, to achieve therapeutic effects. Choice C rationale Acetaminophen administered rectally is an analgesic and antipyretic medication. While it bypasses the oral route, it does nothing to address the patient's primary distress, which is active vomiting. The question asks for an appropriate medication for a patient who is vomiting, and Tylenol lacks antiemetic properties. Using a rectal suppository for pain might be a secondary consideration, but it does not treat the underlying gastric distress or the risk of aspiration and dehydration. Choice D rationale Ibuprofen is a nonsteroidal anti-inflammatory drug used for pain and inflammation. Like other oral medications, it is inappropriate for a patient experiencing active emesis. Furthermore, NSAIDs can cause gastric irritation, which might worsen the patient's nausea. In the postoperative period, especially following a cholecystectomy, maintaining a patent airway and stopping vomiting is the priority. Giving an oral medication during active vomiting is ineffective and increases the risk of the patient choking or inhaling vomitus.