Chapter 38: nausea and vomiting

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.

A client has begun reporting nausea and vomiting. What would the nurse assess to determine the need for therapy?

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.

A client receiving cancer chemotherapy has been prescribed aprepitant for nausea. The nurse should instruct the client to avoid which liquid?

Scopolamine Scopolamine is an anticholinergic drug that is effective in relieving nausea and vomiting associated with motion sickness and radiation therapy for cancer.

A female client is going on a cruise to Nova Scotia with her husband to celebrate their 15th wedding anniversary. She is concerned because she has experienced severe, debilitating seasickness in the past. What would the nurse expect the health care provider to order?

Granisetron Granisetron blocks the 5-HT3 receptors associated with nausea and vomiting in the CTZ and locally. Chlorpromazine acts centrally at the CTZ changing its responsiveness or stimulation. Aprepitant acts directly in the CNS to block receptors associated with nausea and vomiting with little or no effect on serotonin, dopamine, or corticosteroid receptors. Meclizine is an anticholinergic that acts as an antihistamine and blocks the transmission of impulses to the CTZ.

A group of students are reviewing the actions of the various antiemetics. The students demonstrate understanding of the information when they identify which agent as blocking 5-HT3 receptors locally and in the chemoreceptor trigger zone (CTZ)?

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?

Central nervous system (CNS)

A nurse correctly identifies which body system as being associated with most of the adverse effects of antiemetics?

promethazine

A nurse is caring for a 16-month-old client that recently underwent myringotomy surgery. Which antiemetic is contraindicated?

"The medication makes the client sleepy by blocking the action of the serotonin receptors."

A nurse is caring for a client admitted to the unit for nausea and vomiting who was treated with ondansteron. A friend visiting the client asks the nurse why the client is sleeping. Which is the nurse's best response?

Withhold the medication. The nurse should hold the promethazine. Promethazine has antimuscarinic activity that could be an issue considering the client's medical history of glaucoma. The nurse should then discuss the drug's interaction with the prescriber. No laboratory measures are indicated for promethazine.

A nurse is caring for a nauseated client. The client's medical history reveals coronary artery disease (CAD), glaucoma, chronic atrial fibrillation, and arthritis. The nurse is preparing to administer promethazine for the nausea. After a review of the client's history, what is the nurse's priority action?

Medications Infectious disease Pain Migraines Stress

A nurse is caring for client experiencing nausea and vomiting. What factor in the client's history could be a cause? Select all that apply.

"This medication will help with the nausea by making you drowsy." Hydroxyzine works by blocking the action of acetylecholine 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.

A nurse is preparing to administer hydroxyzine to the nauseated client. Which is included in the teaching plan about the medication?

For pediatric clients, ondansetron can be used safely. No dosage adjustment is necessary for older adult clients. Constipation is a common adverse effect of the medication. The medication may decrease mental alertness.

A nurse is preparing to administer ondansetron to a client with vomiting. A nurse should be aware of what drug-related information before administering ondansetron? Select all that apply.

Dolasetron Granisetron Aprepitant Nabilone Dolasetron is a 5-HT3 receptor blocker indicated for use with cancer chemotherapy. Granisetron is a 5-HT3 receptor blocker indicated for use with cancer chemotherapy. Aprepitant is a substance P/neurokinin I receptor antagonist indicated for use with cancer chemotherapy. Nabilone is a cannabinoid agent indicated for use with cancer chemotherapy. Hydroxyzine is typically used to treat prepartum, postpartum, and postoperative nausea and vomiting.

A patient develops significant nausea and vomiting related to antineoplastic chemotherapy. Which agent would be most appropriate to use in this situation? (Select all that apply.)

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.

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?

Substance P/neurokinin 1 antagonist

Aprepitant (Emend) is the prototype of which class of antiemetic medications?

motion sickness.

Different medications are used to treat the differing causes of nausea and vomiting. Antihistamines may be effective in the treatment of nausea and vomiting created by:

blocking toxins by antagonizing serotonin receptors

How does ondansetron achieve its therapeutic effect when prescribed for postoperative nausea?

Ondansetron

Medications are given post-operatively to prevent or treat severe nausea and vomiting associated with the surgery. What serotonin receptor antagonist would the nurse expect the surgeon to order?

Neurologic disorders Metabolic disorders

Nausea and vomiting have many, many causes. Which of the following are causes for nausea and/or vomiting? Select all that apply.

Selective 5-HT3-receptor antagonist, blocking serotonin, both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone

Ondansetron (Zofran) belongs to which pharmacological category of medications?

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.

Prochlorperazine is contraindicated in what population if other antiemetics are effective?

motion sickness radiation therapy

Scopolamine, an anticholinergic drug, is particularly effective in treating nausea and vomiting triggered by what cause? Select all that apply.

Serotonin 5-HT3 receptor antagonists

Several neurotransmitters have been identified with nausea and vomiting. In this capacity, they act as neuromediators. What neuromediator is thought to be involved in the nausea and vomiting that accompanies chemotherapy?

A 10 month old experiencing vomiting after chemotherapy Palonosetron is approved for use in children 1 month of age and older. None of the other The 5-HT3 receptor blockers have been approved for children under the age of 2 years.

The 5-HT3 receptor blocker, palonosetron, is especially suited for administration to which client?

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.

The nurse has administered a prescribed dose of ondansetron IV to a client. What assessment finding best indicates therapeutic effect?

Chemoreceptor trigger zone

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?

Cholestatic jaundice

The nurse is caring for a client with liver disease who is receiving promethazine for nausea. What adverse effect may occur in this client?

Urinary retention Promethazine may cause urinary retention, which may be problematic in a client who already has benign prostatic hypertrophy.

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?

"What was the date of your last period?"

The nurse is performing an admission assessment of a teenage client who has been experiencing nausea and vomiting. What question would be most important for the nurse to ask this client?

The medication affects the brain's medulla The medication is used cautiously during pregnancy and lactation The medication is contraindicated in clients experiencing renal dysfunction The medication has been associated with cardiac arrhythmias

The nurse is preparing to provide a client, experiencing intractable hiccups, medication information regarding a prescribed phenothiazine. What information should the nurse provide? Select all that apply.

tachycardia blurred vision urinary retention acute confusion

The nurse is providing care for an adult client whose nausea is being treated with promethazine. The nurse should consequently assess for what adverse effect? Select all that apply.

It approved for treatment during pregnancy Initial dosing is done at bedtime One additional tablet can be taken in the afternoon if needed A total of 4 tablets can be taken daily

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.

Blocks the action of acetylcholine in the brain The inhibition on acetylcholine in the brain is what causes hydroxyzine (Vistaril) to have an antiemetic effect. It also inhibits histamine in the respiratory tract and relaxes smooth muscle, but these are unrelated to its antiemetic effects. It does not interfere with dopamine receptors.

What is the mechanism of action of hydroxyzine (Vistaril), an antihistamine, that enables it to have antiemetic effects?

Intramuscular

What is the preferred route for administering promethazine?

children under the age of 2

When teaching a group of recent nursing graduates about the clinical use of promethazine, a nursing educator should emphasize that this drug is absolutely contraindicated in which client population?

Medulla oblongata The medulla oblongata is the vomiting center as well as the center for other autonomic functioning. It is located in the hindbrain. The pineal gland and the pituitary gland are glands located in the forebrain and are responsible for endocrine functioning. The hypothalamus is a part of the limbic system.

Which part of the brain is responsible for autonomic functioning such as ventilation, cardiac conduction, and vomiting?

Death can occur with older adult clients who receive perphenazine.

Which statement best identifies the FDA black box warning for perphenazine?

Institute safety precautions

Which would be most important for the nurse to do when administering a phenothiazine antiemetic to a patient?