The palliative care nurse is admitting a client who has metastatic bone cancer and is unable to eat or drink without immediate nausea and vomiting. The client is reporting pain of 9 on a 0 to 10 scale, and the vital signs are recorded as a heart rate of 99 beats/minute, respirations 38 breaths/minute, blood pressure 110/80 mm Hg, and an oxygen saturation of 95% on 2L/nasal cannula. Which intervention should the nurse implement?

A. Discourage straining on stool: While preventing straining can reduce discomfort, constipation or straining is not the immediate priority. The client is experiencing severe pain (9/10) with vital signs indicating mild tachypnea but stable hemodynamics, making pain management the most urgent intervention. B. Medicate with PRN IV narcotic: The client’s reported pain is severe and requires prompt relief. Administering an IV opioid allows for rapid onset and effective pain control, which is a priority in palliative care. Managing severe pain can also reduce secondary physiological stress, including elevated heart rate and respirations, and improves overall comfort and quality of life. C. Administer an IV antiemetic: Nausea and vomiting are significant concerns, but they are not immediately life-threatening in this context. While antiemetics should be administered as prescribed, addressing severe pain takes precedence because unrelieved pain can exacerbate other symptoms and negatively affect comfort. D. Initiate infusion for an IV fluid bolus: The client’s blood pressure is 110/80 mm Hg, and heart rate is 99 bpm—mildly elevated but not critically hypotensive. There is no indication of fluid deficit requiring a bolus at this time. Initiating IV fluids is secondary to managing severe pain in this palliative scenario.