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?

Choice A reason: Administering a PRN IV narcotic is the most appropriate intervention. The client is experiencing severe pain (9/10), which is the priority in palliative care. Pain management is central to improving quality of life. IV administration bypasses the gastrointestinal tract, which is important since the client cannot tolerate oral intake due to nausea and vomiting. This intervention directly addresses the client’s primary symptom and aligns with palliative care goals. Choice B reason: Administering an IV antiemetic may help with nausea and vomiting, but the client’s immediate priority is uncontrolled pain. While antiemetics can be considered later, they do not address the most urgent need. Pain relief must come first in this scenario. Choice C reason: Initiating an IV fluid bolus is not indicated. The client’s blood pressure is stable at 110/80 mm Hg, and there is no evidence of hypovolemia. Administering fluids unnecessarily could increase discomfort or cause complications such as fluid overload. Choice D reason: Discouraging straining on stool is a general supportive measure but does not address the client’s immediate problem. While constipation prevention is important in palliative care, it is not the priority intervention in this acute scenario.