Chapter 38 Nausea and Vomiting
A nurse is caring for a client admitted to the unit for nausea and vomiting who was treated with ondansetron. A friend visiting the client asks the nurse why the client is sleeping. Which is the nurse's best response? · "The client is having anticholinergic effects from the medication." · "The medication makes the client sleepy by blocking the action of the serotonin receptors." · "The drug blocks the postganglionic neurons to depress the vomiting center in the brain." · "I have been instructed to allow the client to sleep."
"The medication makes the client sleepy by blocking the action of the serotonin receptors." Explanation: Ondansetron is a serotonin receptor antagonist and works by antagonizing serotonin receptors, preventing their activation by the emetogenic drugs and toxins. The nurse's best response is telling the friend that the medication blocks the action of the serotonin receptors. It does not block the postganglionic neurons to depress the vomiting center in the brain. Ondansetron does not have anticholinergic effects.
A nurse is preparing to administer hydroxyzine to the nauseated client. Which is included in the teaching plan about the medication? · "The drug will aid in making you feel less nauseated by stimulating your intestines." · "I will mix this medication with applesauce to help you feel better." · "This medication will help with the nausea by making you drowsy." · "The medication may make you feel more alert, like coffee."
"This medication will help with the nausea by making you drowsy." Explanation: Hydroxyzine works by blocking the action of acetylcholine in the brain, which relieves the nausea and vomiting and causes the client to feel less nauseated and sleepy. Hydroxyzine does not affect the intestines and does not need to be mixed with applesauce or food.
The nurse is performing an admission assessment of a female adolescent who has been experiencing nausea and vomiting. Prior to asking the health care provider for an antiemetic, what question would be most important for the nurse to ask this client? · "What was the date of your last period?" · "Have you also had diarrhea?" · "When did you last urinate?" · "What makes your nausea worse?"
"What was the date of your last period?" Explanation: Most antiemetics are not appropriate for use by clients who are pregnant or lactating; therefore, it is most important for the nurse to determine whether the client could be pregnant. The other listed options are less important because they do not address safety risks.
The nurse is performing an admission assessment of a female adolescent who has been experiencing nausea and vomiting. Prior to asking the health care provider for an antiemetic, what question would be most important for the nurse to ask this client? · "Have you also had diarrhea?" · "When did you last urinate?" · "What was the date of your last period?" · "What makes your nausea worse?"
"What was the date of your last period?" · Most antiemetics are not appropriate for use by clients who are pregnant or lactating; therefore, it is most important for the nurse to determine whether the client could be pregnant. The other listed options are less important because they do not address safety risks.
Question 10 of 20 The nurse is caring for a client with a hepatic impairment. The nurse knows that the dose of ondansetron should not exceed what amount? · 12 mg · 6 mg · 10 mg · 8 mg
8 mg Explanation: Most antiemetic drugs are metabolized in the liver and should be used cautiously in clients with impaired hepatic function. With oral ondansetron, do not exceed an 8-mg dose; with IV use, a single, maximal daily dose of 8 mg is recommended.
The use of an antiemetic is not clinically safe for which client reporting nausea and vomiting? · A client experiencing exacerbation of chronic intractable hiccups · A client seen in the emergency room for injuries associated with alcohol intoxication · A client receiving intensive chemotherapy of metastatic cancer · A postoperative client who underwent a an internal fixation of the femur
A client seen in the emergency room for injuries associated with alcohol intoxication Explanation: Additive CNS depression can be seen with any of the antiemetics if they are combined with other CNS depressants, including alcohol. None of the other client's have an obvious contraindication for this form of medication.
The use of an antiemetic is not clinically safe for which client reporting nausea and vomiting? · A client experiencing exacerbation of chronic intractable hiccups · A postoperative client who underwent a an internal fixation of the femur · A client seen in the emergency room for injuries associated with alcohol intoxication · A client receiving intensive chemotherapy of metastatic cancer
A client seen in the emergency room for injuries associated with alcohol intoxication Explanation: Additive CNS depression can be seen with any of the antiemetics if they are combined with other CNS depressants, including alcohol. None of the other client's have an obvious contraindication for this form of medication.
All of the following are centrally acting antiemetics EXCEPT • Antihistamines • Anticholinergics • Adsorbents • Phenothiazines • Serotonin (5-HT3) receptor blockers
Adsorbents Explanation: Adsorbents act locally by binding to digestive mucus. All other medicals act centrally.
A 21-year-old female client has been prescribed metoclopramide for treatment of nausea and vomiting associated with migraines. Which substance should the nurse instruct the client to avoid? · Caffeine · Fluids · Folic acid supplements · Alcohol
Alcohol Explanation: Metoclopramide increases absorption of alcohol, which increases its effect.
Prochlorperazine is contraindicated in what population if other antiemetics are effective? · Pregnant women · Young children · Postoperative patients · All the above
All the above Explanation: Phenothiazines such as prochlorperazine have serious adverse effects. Because of this, they should not be used in pregnant, young, older, or postoperative patients unless vomiting is severe and cannot be controlled by other measures. Promethazine is the exception to these contraindications.
When considering the tendency of antiemetic agents to cross the placenta, which assessment question should the nurse initially ask every childbearing aged woman before initiating the therapy? · "Are you pregnant?" · "Do you plan to get pregnant anytime soon?" · "Are you aware that this medication crosses the placenta?" · "Have you ever been pregnant?"
Are you pregnant?" Explanation: Assess for possible contraindications or cautions that include the current status of pregnancy and lactation because of the potential for adverse effects on the fetus or nursing baby. None of the other questions addresses the status of the woman regarding a current pregnancy.
A nurse correctly identifies which body system as being associated with most of the adverse effects of antiemetics? · Cardiovascular · Renal · Integumentary · Central nervous system (CNS)
Central nervous system (CNS) Most antiemetics cause some CNS depression. Specific antiemetics may cause adverse effects associated with the renal, cardiovascular, and the integumentary systems, but these systems are not associated with the entire classification of antiemetics.
A client is receiving a phenothiazine antiemetic. The nurse instructs the client to use the call light if he needs to get out of bed to go to the bathroom based on the understanding that this group of drugs is associated with: · Central nervous system effects · Urinary abnormalities · Gastrointestinal overstimulation · Endocrine effects
Central nervous system effects Explanation: CNS effects, especially dizziness and drowsiness, are associated with phenothiazines and necessitate safety measures such as assistance with ambulation. GI overstimulation could result in diarrhea or additional vomiting, which might require the client to use the bathroom but not be the basis for assisting the client. The nurse's actions are not related to urinary abnormalities or endocrine effects.
The nurse is caring for a client who has begun vomiting. The nurse is aware that which part of the client's brain has been stimulated? · Hypothalamus · Limbic system · Chemoreceptor trigger zone · Medulla oblongata
Chemoreceptor trigger zone Explanation: The CTZ has to be stimulated in order for vomiting to occur. The limbic system involves emotion, not vomiting or other forms of GI function. The hypothalamus and medulla do not contribute to the vomiting reflex.
The nurse has administered a prescribed dose of ondansetron IV to a client. What assessment finding best indicates therapeutic effect? · Client requests food · Client's vital signs are within reference ranges · Client denies nausea · Client participates in activities
Client denies nausea Nausea is a subjective symptom. The client telling the nurse about a decrease in nausea would be the best indication the drug is working, even though all the listed assessment findings are beneficial.
A client has begun reporting nausea and vomiting. What would the nurse assess to determine the need for therapy? · Number of times client's family reports the client is nauseated · Client's nutritional status and fluid balance · How well the client is eating · Color and amount of vomit
Color and amount of vomit Explanation: Assess complaints of nausea and evaluate emesis, and note color, amount, and frequency of vomiting episodes to determine need for therapy. The nurse is assessing the client, not the family in this instance. How well the client is eating is not an indicator of whether the client needs therapy for nausea and vomiting.
A nurse administers dronabinol to a patient just prior to starting an infusion of chemotherapy drugs. Before allowing the patient to leave the facility, what should the nurse instruct the patient to avoid? · Fluids · Driving · Sleeping · All the above
Driving Explanation: Dronabinol, which may be administered prior to chemotherapy drugs to control nausea and vomiting, can cause dizziness, drowsiness, mood changes, and other mind-altering effects. Patients receiving dronabinol should not drive or perform hazardous tasks requiring alertness, coordination, or physical dexterity, to decrease risks of injury. Additionally, patients should avoid alcohol and other drugs that cause drowsiness
A client with nausea is prescribed promethazine. The nurse will confirm the prescription with the health care provider if what condition is documented in the client's record? · multiple sclerosis · cancer · irritable bowel syndrome · glaucoma
Glaucoma Explanation: Cautious use of promethazine is necessary in people with glaucoma because the drug possesses antimuscarinic activity. There is no reason for caution with use of promethazine for cancer, multiple sclerosis, or irritable bowel syndrome.
After reviewing the various agents used as antiemetics, a group of students demonstrate understanding of the information when they identify which agent as a 5-HT3 receptor blocker? · Granisetron · Chlorpromazine · Aprepitant · Cyclizine
Granisetron Granisetron is classified as a 5-HT3 receptor blocker. Chlorpromazine is a phenothiazine; cyclizine is an anticholinergic/antihistamine; and aprepitant is a substance P/neurokinin-1 receptor antagonist.
The nurse is caring for a client who is receiving ondansetron for nausea associated with chemotherapy. The nurse would teach the client that what adverse effect may occur with this medication? · Headache and dizziness · Fever and diarrhea · Urinary incontinence and photosensitivity · Weakness and rash
Headache and dizziness Explanation: Clients receiving ondansetron most commonly experience headache, dizziness, and myalgia. Rash, fever, diarrhea, and incontinence are unlikely.
The nurse is caring for a client who has just had an episode of vomiting. What is the first intervention that the nurse would complete after the client has finished vomiting? • Weigh the client. • Take vital signs. • Help the client rinse his mouth. • Go prepare an IM injection of an antiemetic.
Help the client rinse his mouth. Explanation: The nurse should immediately help the client rinse out his mouth which helps take away the taste and sensation of vomit.
The nurse is caring for a client who has just had an episode of vomiting. What is the first intervention that the nurse would complete after the client has finished vomiting? · Take vital signs. · Go prepare an IM injection of an antiemetic. · Help the client rinse his mouth. · Weigh the client.
Help the client rinse his mouth. Explanation: The nurse should immediately help the client rinse out his mouth which helps take away the taste and sensation of vomit.
The nurse is caring for a client who has just had an episode of vomiting. What is the first intervention that the nurse would complete after the client has finished vomiting? · Take vital signs. · Weigh the client. · Help the client rinse his mouth. · Go prepare an IM injection of an antiemetic.
Help the client rinse his mouth. Explanation: The nurse should immediately help the client rinse out his mouth which helps take away the taste and sensation of vomit.
Which assessment finding serves to contraindicate the use of an antiemetic agent? • History of chronic liver dysfunction • Currently receiving radiation therapy • Demonstrated signs/symptoms associated with menopause • History of lung cancer
History of chronic liver dysfunction Explanation: Assess for possible contraindications or cautions include a history of impaired hepatic function, which could interfere with the excretion of the drug. None of the other options presents contraindications for the use of an antiemetic agent.
What is the preferred route for administering promethazine? · Intramuscular · Intravenous · Oral · Subcutaneous
Intramuscular Explanation: Promethazine is used for the prevention and treatment of nausea and vomiting associated with surgery, anesthesia, migraines, chemotherapy, and motion sickness. Promethazine is contraindicated for subcutaneous administration. The preferred parenteral route of administration is intramuscular, which reduces risk of surrounding muscle and tissue damage. The nurse avoids intravenous (IV) administration, if possible, because the drug can cause severe tissue injury. While the medication can be prescribed via the oral route, such administration is likely to trigger vomiting with the resulting loss of the medication.
The nurse is preparing medications for a client experiencing nausea. Which action will the nurse take when preparing a dose of ondansetron for this client? · Crush the tablet before providing. · Provide fruit juice to be used to ingest the medication. · Leave the tablet in the blister pack until just before administration. · Push the tablet through the foil on the blister pack.
Leave the tablet in the blister pack until just before administration. Explanation: Oral ondansetron is well absorbed from the gastrointestinal tract to treat nausea. It is important to leave the disintegrating tablet in the blister pack until administration. The tablet is not crushed before administering because it rapidly dissolves on the tongue. Gentle removal of the tablet from the blister pack is needed; rather than push the pill through the foil backing, the nurse should peel the foil away. Fluids are not required for this medication as it will dissolve on the tongue
The nurse is preparing medications for a client experiencing nausea. Which action will the nurse take when preparing a dose of ondansetron for this client? · Leave the tablet in the blister pack until just before administration. · Push the tablet through the foil on the blister pack. · Crush the tablet before providing. · Provide fruit juice to be used to ingest the medication.
Leave the tablet in the blister pack until just before administration. Explanation: Oral ondansetron is well absorbed from the gastrointestinal tract to treat nausea. It is important to leave the disintegrating tablet in the blister pack until administration. The tablet is not crushed before administering because it rapidly dissolves on the tongue. Gentle removal of the tablet from the blister pack is needed; rather than push the pill through the foil backing, the nurse should peel the foil away. Fluids are not required for this medication as it will dissolve on the tongue.
Vomiting occurs when signals from the chemoreceptor trigger zone reach the vomiting center. Where is the vomiting center located? · Medulla oblongata · Cerebral cortex · Stomach · Inner ear
Medulla oblongata Explanation: The vomiting center is a nucleus of cells in the medulla oblongata.
A hospitalized toddler has been prescribed an antiemetic. The nurse will implement which intervention based on the child's unique needs? · Monitoring for electrolyte imbalances · Encouraging a family member to stay with the child · Monitoring for liver dysfunction · Providing the child with developmentally appropriate activities
Monitoring for electrolyte imbalances Antiemetics should be used with caution in children who are at higher risk for adverse effects, including CNS effects, as well as fluid and electrolyte disturbances. The older adult is at risk for liver related issues when prescribed an antiemetic. Both of the remaining options would be appropriate for any hospitalized child.
A hospitalized toddler has been prescribed an antiemetic. The nurse will implement which intervention based on the child's unique needs? · Encouraging a family member to stay with the child · Providing the child with developmentally appropriate activities · Monitoring for liver dysfunction · Monitoring for electrolyte imbalances
Monitoring for electrolyte imbalances Explanation: Antiemetics should be used with caution in children who are at higher risk for adverse effects, including CNS effects, as well as fluid and electrolyte disturbances. The older adult is at risk for liver related issues when prescribed an antiemetic. Both of the remaining options would be appropriate for any hospitalized child.
What information should the nurse include when educating a client regarding the use of medication Diclegis prescribed for nausea and vomiting. Select all that apply. · One additional tablet can be taken in the afternoon if needed · It is a combination drug that includes a P/NK1 antagonist · It approved for treatment during pregnancy · A total of 4 tablets can be taken daily · Initial dosing is done at bedtime
One additional tablet can be taken in the afternoon if needed · It approved for treatment during pregnancy · A total of 4 tablets can be taken daily · Initial dosing is done at bedtime A combination of doxylamine succinate (an antihistamine) and pyridoxine (vitamin B6 analog) has been approved for the treatment of nausea and vomiting of pregnancy in women who do not respond to nondrug management. This is the only drug approved for this use. Two tablets are taken at bedtime; if the nausea persists, one additional tablet can be taken in the morning and another in the afternoon (a total of four a day).
A client has been told that stimulation of their chemoreceptor trigger zone (CTZ) is responsible for their current symptoms. What nursing action indicates that the nurse is aware of the role of the CTZ? · Planning care to manage the client's nausea and vomiting · Planning interventions to address safety issues associated with orthostatic hypotension · Assessing skin for signs of photosensitivity · Assessing the client for indications of cardiac arrhythmias
Planning care to manage the client's nausea and vomiting Explanation: The CTZ, located in the brain is referred to as the vomiting center. Nausea and vomiting are experienced when this center is stimulated. The remaining options are associated with adverse reactions to antiemetic medications.
A client has been told that stimulation of their chemoreceptor trigger zone (CTZ) is responsible for their current symptoms. What nursing action indicates that the nurse is aware of the role of the CTZ? · Assessing skin for signs of photosensitivity · Planning interventions to address safety issues associated with orthostatic hypotension · Assessing the client for indications of cardiac arrhythmias · Planning care to manage the client's nausea and vomiting
Planning care to manage the client's nausea and vomiting Explanation: The CTZ, located in the brain is referred to as the vomiting center. Nausea and vomiting are experienced when this center is stimulated. The remaining options are associated with adverse reactions to antiemetic medications.
the nurse is caring for a client who is vomiting. Which nursing intervention is most important after the client vomits? • Wash client's face and hands • Offer dry crackers • Provide mouth care • Distract the client
Provide mouth care Explanation: For many patients, mouth care, ice chips, or small sips of water may also help to relieve the discomfort and ease the sensation of nausea. There is no obvious need for hand hygiene. Eating may exacerbate the client's nausea, and distraction may or may not be effective.
Ondansetron (Zofran) belongs to which pharmacological category of medications? · Dopamine receptor antagonist · Selective 5-HT3 receptor antagonist · Prokinetic · Anticholinergic
Selective 5-HT3 receptor antagonist Explanation: Ondansetron (Zofran) is a selective 5-HT3 receptor antagonist.
A client who is prone to motion sickness is going on a fishing trip on a boat and has been prescribed an antiemetic. What action should the nurse recommend? • Increased fluid intake to prevent urinary retention • Take two doses if relief is not achieved • Avoid eating or drinking for 6 hours before the trip • Take the medication 30 minutes before departing
Take the medication 30 minutes before departing Explanation: If used to prevent motion sickness, antiemetics should be given 30 minutes before activity that involves motion. There is no need to fast before taking the medication, and double doses would be unsafe. Most antiemetics do not cause urinary retention, and excessive fluid intake may exacerbate nausea.
Which intervention has priority when caring for an older adult client who has been prescribed a phenothiazine for reported nausea? · Assessing the client for pink tinged urine · Frequent oral care to manage oral dryness · Monitoring the client for signs of anorexia · The client is identified as a possible falls risk
The client is identified as a possible falls risk Older adults are more likely to develop adverse effects associated with the use of these drugs. Safety measures may be needed if these effects occur and interfere with the patient's mobility and balance increasing their risk for falls. While the other options present possible side effects, none have the priority of falls management.
Which intervention has priority when caring for an older adult client who has been prescribed a phenothiazine for reported nausea? · Assessing the client for pink tinged urine · Monitoring the client for signs of anorexia · The client is identified as a possible falls risk · Frequent oral care to manage oral dryness
The client is identified as a possible falls risk Explanation: Older adults are more likely to develop adverse effects associated with the use of these drugs. Safety measures may be needed if these effects occur and interfere with the patient's mobility and balance increasing their risk for falls. While the other options present possible side effects, none have the priority of falls management.
In which of the following scenarios would the nurse question the order for ondansetron (Zofran)? · Treatment of nausea and vomiting as a result of chemotherapy · Treatment of gastresophageal reflux · Prevention of nausea and vomiting from chemotherapy · Prevention of postoperative nausea or vomiting
Treatment of gastresophageal reflux Explanation: Because the mechanism of action of ondansetron (Zofran) does not act directly on the gastrointestinal system as other antiemetics do, the nurse should question this order as a treatment for gastresophageal reflux
In which of the following scenarios would the nurse question the order for ondansetron (Zofran)? · Treatment of gastresophageal reflux · Prevention of postoperative nausea or vomiting · Treatment of nausea and vomiting as a result of chemotherapy · Prevention of nausea and vomiting from chemotherapy
Treatment of gastresophageal reflux Explanation: Because the mechanism of action of ondansetron (Zofran) does not act directly on the gastrointestinal system as other antiemetics do, the nurse should question this order as a treatment for gastresophageal reflux.
The nurse is caring for a male client who has benign prostatic hypertrophy. The nurse would be alert for what complication if this client is given promethazine for treatment of nausea? · Hematuria · Urinary retention · Polyuria · Dysuria
Urinary retention Explanation: Promethazine may cause urinary retention, which may be problematic in a client who already has benign prostatic hypertrophy.
What are the most common adverse effects associated with drug therapy? · nausea and vomiting · lethargy and elevated temperature · respiratory depression and skin rash · elevated temperature and anorexia
nausea and vomiting Nausea and vomiting are the most common adverse effects of drug therapy. While the other options are possible, they are not as common as is nausea and vomiting.
The order for the patient reads: ondansetron (Zofran) 2 mg IV now. The vial of Zofran on the floor contains 4mg/5mL. How many mL should be administered?
· 2.5 Explanation: The vial contains 4 mg in each 5 mL. This can be calculated in two ways. The order is for 2 mg. Because 2 mg is half of 4 mg, then half of 5 or 2.5 mL would be given. Another method is to determine how many mg there are in each mL (4mg/5 mL = 0.8 mg/mL); to determine how may mL are needed for 2 mg, divide 2 by 0.8 and the answer is 2.5 mL.
A client has begun reporting nausea and vomiting. What would the nurse assess to determine the need for therapy? · How well the client is eating · Number of times client's family reports the client is nauseated · Client's nutritional status and fluid balance · Color and amount of vomit
· Color and amount of vomit Assess complaints of nausea and evaluate emesis, and note color, amount, and frequency of vomiting episodes to determine need for therapy. The nurse is assessing the client, not the family in this instance. How well the client is eating is not an indicator of whether the client needs therapy for nausea and vomiting
The home care nurse is visiting a client who is receiving antiemetics. Which actions will the nurse perform to ensure safe and effective treatment for the client? (Select all that apply.) · Take the medication approximately 5 minutes before taking the medication that makes you nauseated. · Encourage the client to get up and walk after taking the medication. · Do not drive while taking antinausea medicine. · Encourage client to sip on clear fluids to prevent dehydration. · Reinforce teaching about dosage.
· Encourage the client to get up and walk after taking the medication. · Do not drive while taking antinausea medicine. · Reinforce teaching about dosage. The home care nurse would reinforce medication teaching which would include how much medication and when to take the medication. It is usually taken 30 to 60 minutes before the event that causes nausea. The client should sit or lie quietly after taking the medication because it may cause sedation. This is also a reason that the client should not drive. The client should be encouraged to drink clear liquids to prevent dehydration.
A client receiving cancer chemotherapy has been prescribed aprepitant for nausea. The nurse should instruct the client to avoid which liquid? · Orange juice · Coffee · Grapefruit juice · Whole milk
· Grapefruit juice Foods and herbs are known to affect aprepitant concentration. Grapefruit juice decreases the metabolism of aprepitant, and this effect can last up to 24 hours. Therefore, grapefruit juice consumption can result in a cumulative increase in the serum level of aprepitant. Orange juice, coffee, and whole milk do not affect aprepitant metabolism.
The nurse is preparing medications for a client experiencing nausea. Which action will the nurse take when preparing a dose of ondansetron for this client? • Provide fruit juice to be used to ingest the medication. • Push the tablet through the foil on the blister pack. • Leave the tablet in the blister pack until just before administration. • Crush the tablet before providing.
· Leave the tablet in the blister pack until just before administration. Explanation: Oral ondansetron is well absorbed from the gastrointestinal tract to treat nausea. It is important to leave the disintegrating tablet in the blister pack until administration. The tablet is not crushed before administering because it rapidly dissolves on the tongue. Gentle removal of the tablet from the blister pack is needed; rather than push the pill through the foil backing, the nurse should peel the foil away. Fluids are not required for this medication as it will dissolve on the tongue.
What is the therapeutic action of the phenothiazines in reducing nausea? • Increasing gastric motility • Producing sedation • Blocking histamine receptors • Change responsiveness of the chemoreceptor trigger zone (CTZ)
· change responsiveness of the chemoreceptor trigger zone (CTZ) Explanation: Phenothiazines are centrally acting antiemetics, which change the responsiveness or stimulation of the CTZ in the medulla. They do not change gastric motility or block histamine receptors. Sedation would be an adverse effect, not a therapeutic effect.
The nurse is caring for a client who has been experiencing severe motion sickness. Which response will the nurse make when the client asks, "Why does this occur?" "Changes in body motion stimulate receptors in the ear, and nerve impulses are transmitted to the vomiting center." "It occurs because drugs you are taking stimulate the release of serotonin to initiate the vomiting reflex." "Vomiting with motion is mediated by afferent signals from the higher centers of the cerebral cortex to the vomiting center." "Neurons in the fourth ventricle of the cerebral cortex are stimulated by emetic substances in the blood."
• "Changes in body motion stimulate receptors in the ear, and nerve impulses are transmitted to the vomiting center." Explanation: In motion sickness, rapid changes in body motion stimulate receptors in the inner ear, and nerve impulses are transmitted to the vomiting center via the vestibular branch of the auditory nerve, which is concerned with equilibrium. Although the other statements accurately describe mechanisms that lead to vomiting, none are associated with motion sickness. Drugs that have the ability to cause vomiting (emetogenic) are thought to do so by stimulating the release of serotonin from the enterochromaffin cells of the small intestine; the serotonin activates receptors located on vagal afferent nerves in the chemoreceptor trigger zone (CTZ) to initiate the vomiting reflex. The CTZ, composed of neurons in the fourth ventricle, can also be activated by the presence of emetic substances in the blood. Anticipatory nausea and vomiting triggered by memories and fear of nausea and vomiting is mediated by afferent signals from the higher centers of the cerebral cortex to the vomiting center.
For which client would the use of prochlorperazine require the greatest caution? • A client receiving chemotherapy • A client who is pregnant • A 4-year-old client • A client who is 6 hours postoperative
• A client who is pregnant Explanation: Caution should be used during pregnancy and lactation. The drug is approved for pediatric use and can be used safely and effectively in the treatment of nausea associated with anesthesia or chemotherapy.
What would increase the risk of sedation in a patient receiving meclizine? (Select all that apply.) • Alcohol • Hydrocodone • Caffeine • Diazepam • Codeine
• Alcohol • Diazepam • Codeine Explanation: A patient receiving meclizine has an increased risk of sedation if the patient combines the drug with alcohol, or other drugs that cause CNS depression such as diazepam, codeine, or hydrocodone.
The nurse is caring for a client who has begun vomiting. The nurse is aware that which part of the client's brain has been stimulated? • Hypothalamus • Limbic system • Chemoreceptor trigger zone • Medulla oblongata
• Chemoreceptor trigger zone Explanation: The CTZ has to be stimulated in order for vomiting to occur. The limbic system involves emotion, not vomiting or other forms of GI function. The hypothalamus and medulla do not contribute to the vomiting reflex.
The nurse has administered a prescribed dose of ondansetron IV to a client. What assessment finding best indicates therapeutic effect? • Client requests food • Client denies nausea • Client participates in activities • Client's vital signs are within reference ranges
• Client denies nausea Explanation: Nausea is a subjective symptom. The client telling the nurse about a decrease in nausea would be the best indication the drug is working, even though all the listed assessment findings are beneficial.
A nurse administers dronabinol to a patient just prior to starting an infusion of chemotherapy drugs. Before allowing the patient to leave the facility, what should the nurse instruct the patient to avoid? • Sleeping • Driving • Fluids • All the above
• Driving Explanation: Dronabinol, which may be administered prior to chemotherapy drugs to control nausea and vomiting, can cause dizziness, drowsiness, mood changes, and other mind-altering effects. Patients receiving dronabinol should not drive or perform hazardous tasks requiring alertness, coordination, or physical dexterity, to decrease risks of injury. Additionally, patients should avoid alcohol and other drugs that cause drowsiness.
After reviewing the various agents used as antiemetics, a group of students demonstrate understanding of the information when they identify which agent as a 5-HT3 receptor blocker? • Aprepitant • Chlorpromazine • Cyclizine • Granisetron
• Granisetron Explanation: Granisetron is classified as a 5-HT3 receptor blocker. Chlorpromazine is a phenothiazine; cyclizine is an anticholinergic/antihistamine; and aprepitant is a substance P/neurokinin-1 receptor antagonist.
The nurse is caring for a client who is receiving ondansetron for nausea associated with chemotherapy. The nurse would teach the client that what adverse effect may occur with this medication? • Urinary incontinence and photosensitivity • Headache and dizziness • Fever and diarrhea • Weakness and rash
• Headache and dizziness Explanation: Clients receiving ondansetron most commonly experience headache, dizziness, and myalgia. Rash, fever, diarrhea, and incontinence are unlikely.
A hospitalized toddler has been prescribed an antiemetic. The nurse will implement which intervention based on the child's unique needs? • Providing the child with developmentally appropriate activities • Encouraging a family member to stay with the child • Monitoring for electrolyte imbalances • Monitoring for liver dysfunction
• Monitoring for electrolyte imbalances Explanation: Antiemetics should be used with caution in children who are at higher risk for adverse effects, including CNS effects, as well as fluid and electrolyte disturbances. The older adult is at risk for liver related issues when prescribed an antiemetic. Both of the remaining options would be appropriate for any hospitalized child.
A client has been told that stimulation of their chemoreceptor trigger zone (CTZ) is responsible for their current symptoms. What nursing action indicates that the nurse is aware of the role of the CTZ? • Planning care to manage the client's nausea and vomiting • Assessing the client for indications of cardiac arrhythmias • Planning interventions to address safety issues associated with orthostatic hypotension • Assessing skin for signs of photosensitivity
• Planning care to manage the client's nausea and vomiting Explanation: The CTZ, located in the brain is referred to as the vomiting center. Nausea and vomiting are experienced when this center is stimulated. The remaining options are associated with adverse reactions to antiemetic medications.
A 54-year-old client, who is preparing to go on an ocean cruise, asks for a medication to relieve the symptoms of seasickness. What medication would a health care provider most likely prescribe? • Ondansetron • Scopolamine • Dronabinol • Palonosetron
• Scopolamine Explanation: Scopolamine, an anticholinergic drug, is effective in relieving nausea and vomiting associated with motion sickness and radiation therapy for cancer. A transdermal patch is often prescribed for seasickness. Ondansetron and palonosetron are prescribed for moderate to severe nausea associated with cancer chemotherapy, radiation therapy, and postoperative status. Dronabinol is a Schedule III drug used only for nausea and vomiting associated with chemotherapy unrelieved by other antiemetic drugs.
The nurse is discussing the possible side effects of chemotherapy with a client. What information obtained during the client's admission assessment and interview will have a direct influence on the management of nausea and vomiting • The client has been prescribed phenothiazine for anxiety • There is a history of cancer in the client's family • The cancer has been identified at stage 2 • The client has identified several food allergies
• The client has been prescribed phenothiazine for anxiety Explanation: Phenothiazine is antianxiety drug that blocks the responsiveness of the CTZ to stimuli, leading to a decrease in nausea and vomiting. None of the other options are related to chemotherapy induced nausea and vomiting.
in which of the following scenarios would the nurse question the order for ondansetron (Zofran)? • Treatment of gastresophageal reflux • Prevention of postoperative nausea or vomiting • Prevention of nausea and vomiting from chemotherapy •Treatment of nausea and vomiting as a result of chemotherapy
• Treatment of gastresophageal reflux Explanation: Because the mechanism of action of ondansetron (Zofran) does not act directly on the gastrointestinal system as other antiemetics do, the nurse should question this order as a treatment for gastresophageal reflux.
The nurse is caring for a male client who has benign prostatic hypertrophy. The nurse would be alert for what complication if this client is given promethazine for treatment of nausea? • Dysuria • Polyuria • Hematuria • Urinary retention
• Urinary retention Explanation: Promethazine may cause urinary retention, which may be problematic in a client who already has benign prostatic hypertrophy.
