Nursing Acceleration Challenge Exam (NACE) PN-RN Practice Test

What action should a nurse take first when a postoperative patient complains of severe nausea?

1. Turn the patient on one side.

2. Advise the patient to take deep breaths.

3. Check orders for an antiemetic.

4. Notify the physician.

The correct answer is: Turn the patient on one side.

When a postoperative patient complains of severe nausea, the priority action is to turn the patient on one side. This maneuver serves multiple purposes. It helps to prevent aspiration if the patient were to vomit, thereby ensuring airway safety. By positioning the patient laterally, the risk of inhaling stomach contents into the lungs decreases significantly, which can lead to serious complications such as aspiration pneumonia. Furthermore, turning the patient may provide some comfort and relieve the discomfort associated with nausea. It also allows for better drainage of any emesis if it occurs. While considering other options, checking orders for an antiemetic is important but should follow immediately after ensuring the patient's safety by addressing the immediate symptom of nausea. Advising deep breathing may help with anxiety but does not directly address the physical response of nausea. Notifying the physician could be necessary depending on the situation, but in the immediate context of severe nausea, ensuring the patient is in a safe and appropriate position should take precedence.