Two days after a nephrectomy, the client reports abdominal pressure and nausea. Which assessment should the nurse implement?

A. Auscultate bowel sounds: After a nephrectomy, abdominal pressure and nausea often suggest delayed return of bowel function or paralytic ileus due to anesthesia or surgical manipulation. Assessing bowel sounds is the most appropriate first step to determine gastrointestinal motility. B. Ambulate client in hallway: Early ambulation can help stimulate peristalsis, but it should follow assessment. Implementing ambulation without first evaluating bowel sounds may overlook possible complications like ileus or obstruction. C. Palpate the abdomen: Palpation could worsen discomfort and is less informative initially than auscultation. Bowel sounds provide earlier and safer data about peristaltic activity, while palpation is more useful after auscultation findings are known. D. Measure hourly urine output: Monitoring urine output is critical after nephrectomy to assess kidney function, but it does not directly address the client’s symptoms of abdominal pressure and nausea. The priority assessment in this scenario is gastrointestinal function.