The oncoming nurse is assigned to the following clients. Which client should the nurse assess first?

Choice A reason: 10% Dextrose is a hypertonic solution used for caloric supplementation or hypoglycemia treatment. It can cause hyperglycemia and fluid shifts, making it unsuitable for routine preoperative hydration. Surgical patients need balanced electrolyte solutions to replace fluid losses and maintain homeostasis, which 10% dextrose does not provide effectively.

Choice B reason: 3% NaCl, a hypertonic saline, is used for severe hyponatremia or cerebral edema. It risks causing hypernatremia and fluid overload if not carefully monitored. Preoperative patients typically require isotonic fluids to maintain electrolyte balance and hydration, making 3% NaCl inappropriate for standard surgical preparation.

Choice C reason: Lactated Ringer’s is an isotonic solution containing electrolytes like sodium, potassium, and calcium, closely mimicking plasma. It is ideal for preoperative hydration, as it replaces fluid losses, maintains electrolyte balance, and supports hemodynamic stability during surgery. Its balanced composition makes it the standard choice for surgical patients.

Choice D reason: 0.45% NaCl, a hypotonic solution, is used for maintenance hydration or hypernatremia correction. It provides less sodium than needed for surgical fluid replacement and may cause hyponatremia or fluid shifts. Isotonic fluids like Lactated Ringer’s are preferred preoperatively to ensure electrolyte stability and adequate hydration.

Choice A reason: Non-pharmacological options, like acupressure or aromatherapy, address nausea without medication risks. These interventions stimulate the parasympathetic nervous system or reduce gastric irritation, providing relief. Acting first with these methods is safe, effective, and aligns with holistic care, especially when the next antiemetic dose is not yet due.

Choice B reason: Notifying the provider after rounds delays intervention, as nausea requires prompt relief to prevent distress or vomiting. This approach does not address the client’s immediate need and may prolong discomfort. Non-pharmacological methods should be tried first, as they are within the nurse’s scope and can provide quicker relief.

Choice C reason: Discussing anesthesia’s role in nausea provides education but does not alleviate the client’s current symptoms. This cognitive approach addresses understanding, not immediate comfort. While education is valuable, the priority is relieving nausea, making non-pharmacological interventions a more appropriate first step in this scenario.

Choice D reason: Explaining that no other medications are ordered dismisses the client’s discomfort and does not provide relief. This approach fails to utilize the nurse’s scope to implement non-pharmacological interventions, which can effectively manage nausea. It may also reduce trust, as it does not address the client’s immediate needs.