Chapter 59: Antiemetic Agents
The obstetrics nurse is caring for a patient who started vomiting before delivering her son. The patient is still complaining of nausea and vomiting an hour after her delivery. What medicine would the nurse expect the physician to order for this patient? A) Hydroxyzine (Vistaril) B) Trimethobenzamide (Tigan) C) Dronabinol (Marinol) D) Nabilone (Cesamet)
Ans: A Feedback: Hydroxyzine is used for nausea and vomiting before or after obstetric delivery or surgery. It is rapidly absorbed, metabolized in the liver, and excreted in urine. It has not been associated with fetal problems during pregnancy and is not thought to enter breast milk; however, as with all drugs, caution should be used during pregnancy and lactation. Tigan, Marinol, and Cesamet are not used for obstetric/gynecology patients.
A 54-year-old patient is going on an ocean cruise. What medication would be most effective for motion sickness? A) Meclizine (Antivert) B) Diphenhydramine (Benadryl) C) Hydroxyzine (Atarax) D) Metoclopramide (Reglan)
Ans: A Feedback: Meclizine (Antivert) is the drug of choice to treat motion sickness associated with an ocean voyage. Options B, C, and D are not correct.
The nurse is discharging a patient being sent home on antiemetic therapy. How would the nurse evaluate the plan of care that this patient has had while hospitalized? A) Monitor for adverse effects. B) Provide comfort and safety measures, including mouth care, ready access to bathroom facilities, assistance with ambulation and periodic orientation, ice chips to suck, protection from sun exposure, and remedial measures to treat dehydration if it occurs. C) Assess the patient carefully for any potential drugdrug interactions. D) Monitor laboratory test results including liver and kidney function tests.
Ans: A Feedback: Monitor for adverse effects (dizziness, confusion, gastrointestinal alterations, cardiac arrhythmias, hypotension, gynecomastia, pink-to-brown-tinged urine, photosensitivity). The evaluation of the patient care plan would not include monitoring laboratory results (assessment phase), providing comfort measures, or assessing for drugdrug interactions (implementation phase).
The nurse is performing an admission assessment of a female teenage patient who has been experiencing nausea and vomiting. What question would be most important for the nurse to ask this patient? A) What is the date of your last period? B) What makes your nausea worse? C) Have you also had diarrhea? D) When did you last urinate?
Ans: A Feedback: Most antiemetics are not appropriate for use by patients who are pregnant or lactating; therefore, it is most important for the nurse to determine whether the patient could be pregnant. Options B, C, and D are not as important as possible pregnancy.
The nurse is working in the medical station at a local amusement park. An adult is being seen complaining of dizziness and feelings of seasickness after going on several rides. What would the nurse suspect the patient may benefit from? A) An anticholinergic B) A histamine H2 blocker C) Substance P/neurokinin 1 receptor antagonist D) Cannabis
Ans: A Feedback: Nausea and vomiting associated with motion sickness is best treated with an anticholinergic that acts as an antihistamine. Histamine H2 blockers affect gastric acid production. Substance P/neurokinin 1 receptor antagonists and cannabis are prescribed only as adjuncts to cancer chemotherapy drugs or other therapy.
A cancer patient is in the outpatient department to receive chemotherapy. The nurse administers prochlorperazine (Compazine) prophylactically before the infusion. What will the nurses teaching for this patient include? A) Avoid driving or any dangerous activities if dizziness or drowsiness occurs. B) Cover the head in extreme of temperatures. C) Take extra precautions to avoid heat stroke. D) Check blood pressure at home on a regular basis.
Ans: A Feedback: Prochlorperazine is an antiemetic that can cause dizziness and drowsiness. A patient who is taking it should be advised not to drive or undertake dangerous activities if these adverse effects occur. The drug does not cause heat loss or inability to sweat that may lead to heat stroke. This drug should not affect blood pressure, so there is no need to test for it.
The nurse is caring for a patient who is vomiting. Which nursing intervention is most important after the patient vomits? A) Rinse patients mouth with water B) Provide a back rub C) Offer dry crackers D) Wash patients face and hands
Ans: A Feedback: Provide the patient with water and a basin to rinse mouth after vomiting. This decreases the bad taste and the corrosion of tooth enamel by gastric acid. Options B, C, and D are not correct.
A high school student starts vomiting and goes to see the school nurse. The student asks the nurse what part of his brain makes him vomit. What area of the brain will the nurse tell the student must be stimulated for vomiting to occur? A) Chemoreceptor trigger zone (CTZ) B) Forebrain C) Hypothalamus D) Thalamus
Ans: A Feedback: The CTZ has to be stimulated in order for vomiting to occur. The GI mucosa, hypothalamus, and thalamus are not associated with eliciting vomiting. The forebrain, hypothalamus, and thalamus have no part in vomiting.
What are some nonpharmacologic measures a nurse can use to help a patient who is nauseated or vomiting? (Select all that apply.) A) Quiet environment B) Visitors C) Soft, bland meals (if not contraindicated) D) Deep breathing E) Carbonated drinks (if not contraindicated)
Ans: A, D, E Feedback: Provide support and encouragement, as well as other measures (quiet environment, carbonated drinks, deep breathing), to help the patient cope with the discomfort of nausea and vomiting and drug effects. Visitors do not support the quiet environment needed. Patients who are nauseated or vomiting generally do not want to eat.
People taking phenothiazines need to be assessed for extrapyramidal symptoms. What effects are considered adverse effects of the phenothiazines? A) Dysphoria, anxiety, and dizziness B) Drowsiness, dystonia, and blurred vision C) Dry mouth, blurred vision, and urinary retention D) Hypertension, confusion, and shuffling gait
Ans: B Feedback: Adverse effects include drowsiness, dystonia, photophobia, blurred vision, and discolored pink to red-brown urine. Adverse effects of the phenothiazines do not include dysphoria, urinary retention, or confusion.
A 57-year-old patient is to receive metoclopramide (Reglan) for nausea. What statement by the patient leads the nurse to believe that the patient has understood the nurses teaching? A) During episodes of nausea, I will drink clear liquids. B)bI may be drowsy as a result of taking this medication. C) This medication should be taken on a full stomach. D) I will need to take supplemental potassium while I am taking this medication.
Ans: B Feedback: Adverse effects include drowsiness, fatigue, restlessness, extrapyramidal symptoms, and diarrhea. The other statements are incorrect and would tell the nurse that this patient does not understand the teaching about this drug.
What is an example of a locally acting antiemetic? A) Phenothiazine B) Antacid C) Nonphenothiazine D) Antihistamine
Ans: B Feedback: An antacid is an example of a locally acting antiemetic. Phenothiazines, nonphenothiazines, and antihistamines are examples of centrally acting antiemetics.
What medication, given with aprepitant (Emend), is used to effectively manage chemotherapy-induced emesis? A) Bonamine B) Dexamethasone C) Phenergan D) Ativan
Ans: B Feedback: Aprepitant acts directly in the central nervous system to block receptors associated with nausea and vomiting with little to no effect on serotonin and dopamine levels, nor corticosteroid receptors. It is approved for use in treating nausea and vomiting associated with highly emetogenic antineoplastic chemotherapy, including cisplatin therapy. It is given orally, in combination with dexamethasone. Bonamine, Phenergan, and Ativan are not used in conjunction with Emend.
The patient has begun complaining about nausea and vomiting. What would the nurse assess to determine the need for therapy? A) How well the patient is eating B) Color, amount, and frequency of vomiting episodes C) Number of times patients family complains of vomiting episodes D) Number of times patients family reports the patient is nauseated
Ans: B Feedback: 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 patient, not the family in this instance. How well the patient is eating is not an indicator of whether the patient needs therapy for nausea and vomiting.
What is an appropriate nursing action for a hospitalized patient receiving aprepitant (Emend)? A)Elevate the head of the bed. B) Encourage fluids. C) Take the patients temperature. D) Place an NPO sign on the door.
Ans: B Feedback: Because dehydration is an adverse effect of aprepitant, the nurse will want to encourage the patient to drink as much liquid as possible. Elevating the head of the bed would be unnecessary; the patients temperature would not be affected by aprepitant; we are encouraging fluids so placing an NPO sign on the door would not be appropriate for this patient.
The nurse is caring for a patient who has begun vomiting after undergoing bariatric surgery. When including this complication in the plan of care, what would be an appropriate nursing diagnosis related to the adverse effects of drowsiness and weakness associated with an antiemetic? A) Acute pain related to central nervous system (CNS), skin, and gastrointestinal (GI) effects B) Risk for injury related to CNS effects C) Decreased cardiac output related to cardiac effects D) Deficient knowledge regarding drug therapy
Ans: B Feedback: Because the patient is experiencing CNS effects, the nurse will be concerned about the patients safety. The appropriate nursing diagnosis would be risk for injury related to CNS effect. Acute pain related to CNS, skin, and GI effects; decreased cardiac output related to cardiac effects; and deficient knowledge regarding drug therapy would not be appropriate because no evidence is provided in the question to support any of these diagnoses.
A patient develops intractable hiccoughs after surgery. The nurse anticipates that the physician will order which drug? A) Metoclopramide (Reglan) B) Chlorpromazine (Thorazine) C) Meclizine (Antivert) D) Granisetron (Kytril)
Ans: B Feedback: Chlorpromazine is a phenothiazine; phenothiazines are the drug of choice for intractable hiccoughs. Thus, options A, C, and D are not correct.
A nursing student correctly identifies which body system as being associated with most of the adverse effects of antiemetics? A) Renal B) Central nervous system (CNS) C) Cardiovascular D) Integumentary
Ans: B Feedback: 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.
What is the therapeutic action of the phenothiazines in reducing nausea? A) Increasing gastric motility B) Change responsiveness of the chemoreceptor trigger zone (CTZ) C) Blocking histamine receptors D) Producing sedation
Ans: B Feedback: Phenothiazines are centrally acting antiemetics, which change the responsiveness or stimulation of the CTZ in the medulla.
What is the main action of antiemetics? A) Altering central nervous system (CNS) actions to decrease perception of nausea B) Speeding up the gastrointestinal (GI) tract so the stomach empties rapidly C) Depressing hyperactive vomiting reflex D) Changing the perception of motion in motion sickness
Ans: C Feedback: Antiemetics act by depressing the hyperactive vomiting reflex, either locally or through alteration of CNS actions. Options A, B, and D are not the main action of antiemetics.
Prochlorperazine (Compazine) is contraindicated in which population? A) Children under the age of 12 years B) Preoperative patients C) Pregnant women D) People weighing <100 pounds
Ans: C Feedback: Caution should be used in individuals with renal dysfunction, moderate liver impairment, active peptic ulcer, or during pregnancy and lactation. Compazine can be used in children under the age of 12, preoperative patients, and people weighing <100 pounds.
When would the nurse recommend that a traveler take an oral antiemetic to prevent motion sickness? A) When symptoms first begin B) 10 minutes prior to trip C) 30 minutes prior to trip D) 1 day prior to trip
Ans: C Feedback: For prevention of motion sickness, give antiemetics 30 minutes before travel and every 4 to 6 hours, if necessary. The nurse would not recommend taking them with the first symptoms, 10 minutes before the trip, or 1 day prior to the trip.
A clinic nurse is caring for a 5-year-old brought to the clinic with a history of intermittent vomiting for 24 hours. The nurse would recognize that which drug is not recommended for use in children? A) Dimenhydrinate B) Promethazine C) Metoclopramide D) Diphenhydramine
Ans: C Feedback: Metoclopramide is indicated for treatment of nausea and vomiting, especially related to chemical stimulation of the chemoreceptor trigger zone in adults. It does not have a pediatric dose for use as an antiemetic. Options A, B, and D are not correct.
The nurse is aware that patients who experience motion sickness are experiencing problems with which body system? A) Gastrointestinal B) Peripheral nervous system C) Vestibular D) Central nervous system (CNS)
Ans: C Feedback: Motion sickness is related to the vestibular (i.e., inner ear) system. This disturbance in this system may also cause disturbances in the GI (nausea) and CNS (dizziness) systems. The peripheral nervous system is not involved.
The nurse is caring for an oncology patient who is vomiting. When writing a plan of care for this patient, what would be an appropriate nursing diagnosis? A) Risk for injury related to cardiovascular effects B) Deficient knowledge regarding motion sickness C) Decreased cardiac output related to cardiac effects D) Acute pain related to constipation
Ans: C Feedback: Nursing diagnoses related to drug therapy might include decreased cardiac output related to cardiac effects. Answers A, B, and D are not appropriate nursing diagnoses for this patient.
The nurse is caring for a patient who is receiving ondansetron (Zofran) for nausea associated with chemotherapy. The nurse would teach the patient that what adverse effect may occur with this medication? A) Weakness and rash B) Dysuria and photosensitivity C) Headache and myalgia D) Fever and diarrhea
Ans: C Feedback: Patients receiving ondansetron (Zofran) most commonly experience headache, dizziness, and myalgia. There may also be pain at the injection site, rash, constipation, hypotension, and urinary retention. Options A, B, and D are not correct.
A 25-pound child is in the clinic because of vomiting the last 24 hours. The nurse is to administer trimethobenzamide (Tigan). What dose will the nurse administer by what route? A) 0.25 mg IV B) 1.1 mg/kg IM C) 100 mg rectally D) 200 mg orally.
Ans: C Feedback: The nurse will administer 100 mg rectally. The other doses are inappropriate. A usual dose of palonosetron for an adult is 0.25 mg IV. A usual dose of hydroxyzine for a child is 1.1 mg/kg IM, and a usual dose of trimethobenzamide for a child weighing more than 30 pounds is 200 mg orally.
A patient has received a prescription for nabilone (Cesamet) for treatment of nausea. The nurse is aware that this medication is used for what reason? A) The patient has a substance abuse problem. B) The patient is under age 18. C) The patient is experiencing motion sickness. D) The patient has not responded to other medications.
Ans: D Feedback: Nabilone is a miscellaneous agent that is developed from the active ingredient of marijuana. It is used to treat nausea and vomiting related to cancer chemotherapy and is used only after the patient has not responded to other antiemetic medications. It should not be used in patients under 18 and because it is derived from marijuana it would not be appropriate to use for a patient with a history of substance abuse.
What symptom may be related to the use of dronabinol (Marinol)? A) Bradycardia B) Hypertension C) Rash D) Anxiety
Ans: D Feedback: Dronabinol and nabilone are only approved for use in managing nausea and vomiting associated with cancer chemotherapy in patients who have not responded to other treatment. The exact mechanisms of action of dronabinol and nabilone are not understood. They are readily absorbed and metabolized in the liver, with excretion through bile and urine. They are controlled substances. Dronabinol is a category C-III controlled substance and nabilone is a category C-II substance. They must be used under close supervision because of the possibility of altered mental status. Dronabinol does not cause bradycardia, hypertension, or a rash.
A female college student with migraine headaches that cause nausea and vomiting has been prescribed trimethobenzamide (Tigan). It is important for the nurse to caution the student to avoid using what? A) St. Johns wort B) Calcium channel blockers C) Selective serotonin reuptake inhibitors (SSRIs) D) Alcohol
Ans: D Feedback: Locally acting antiemetics depress areas of the CNS. If combined with other CNS depressants, such as alcohol, patients could experience increasing CNS depression including dizziness and somnolence. St. Johns wort, calcium channel blockers, and SSRIs are not CNS depressants.
What is the best indicator of decreased nausea after administering ondansetron (Zofran) IV? A) Heart rate 64 beats/min B) Blood pressure 110/64 C) Patient hungry D) Patient states, I feel less nauseated.
Ans: D Feedback: Monitor patients response to the drug (relief of nausea and vomiting).Nausea is a subjective symptom. The patient telling the nurse about a decrease in nausea would be the best indication the drug is working. Therefore, answers A, B, and C are incorrect.
A womens community group is attending the first-aid class the nurse is teaching. The nurse will instruct the women to do what if a child ingests a possible overdose of medication or other potential poison? A) Call an ambulance. B) Make an appointment to see the health care provider. C) Induce vomiting by sticking a finger down the childs throat. D) Call the local poison control center and follow their directions.
Ans: D Feedback: New guidelines suggest that potential ingestion with poison should prompt an immediate call to the local poison control center and then follow their directions. An ambulance may not be needed and it may take too long to get an appointment with a health care provider. Induction of vomiting could be harmful and does not represent the best treatment.
The clinic nurse is caring for a 55-year-old farmer who has been prescribed an antiemetic for an inner ear problem. The patient states I need to get back to work. With this patient especially, what will the nurse caution him about? A) Weight gain B) Suicidal ideation C) Diarrhea D) Photosensitivity
Ans: D Feedback: Photosensitivity is a common adverse reaction with many antiemetics. The nurse should advise the patient to use sunscreen and wear protective garments if exposure cannot be avoided, which is unlikely considering the patients occupation. Weight gain, suicidal ideation, and diarrhea have not been identified as adverse effects of antiemetics.
The nurse is caring for a child who has been vomiting intermittently for 24 hours. What is the drug of choice for children who need an antiemetic? A) Dronabinol (Marinol) B) Metoclopramide (Reglan) C) Meclizine (Antivert) D) Prochlorperazine (Compazine)
Ans: D Feedback: Prochlorperazine is often the drug of choice with children because it has established oral, rectal, and parenteral doses. The other three options are not recommended for children.
How does buclizine (Bucladin) function as an effective antiemetic? A) Lowers blood glucose levels B) Lowers HA1c C) Increases sensitivity to insulin D) Promotes anticholinergic effects
Ans: D Feedback: These drugs are anticholinergics that act as antihistamines and block the transmission of impulses to the chemoreceptor trigger zone (CTZ). Options A, B, and C are not correct.
