CH 38 Drugs for Nausea and Vomiting (E2), Chapter 38: Drug Therapy for Nausea and Vomiting, Chapter 37 Abrams: Drug therapy for peptic ulcer disease and hyperacidity, Chapter 37 Drug Therapy for Peptic Ulcer Disease and Hyperacidity, Chapter 37: Drug…
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."
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 medication makes the client sleepy by blocking the action of the serotonin receptors."
A nurse is preparing to administer hydroxyzine to the nauseated client. Which is included in the teaching plan about the medication?
"This medication will help with the nausea by making you drowsy."
A client receiving chemotherapy has begun receiving aprepitant. The client also takes oral contraceptives. What should the nurse tell the client in regard to birth control?
"Use alternative means of birth control for 1 month after taking aprepitant."
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?"
Antacids interfere with absorption of what drugs? (4)
-Digoxin -Benzodiazepines -Corticosteroids -Tetracyclines
An 8-year-old client who weighs 61 lbs is undergoing chemotherapy and has been prescribed dolasetron 1.8 mg/kg PO before chemotherapy. How many 50-mg tablets should the nurse administer?
1
How long should you separate administration of antacids from other drugs?
1 to 2 hours
A 1-year-old postoperative client has been experiencing repeated vomiting. What antiemetic drug has a black box warning against use in a client of this age? A) promethazine B) benzquinamide C) buclizine D) cyclizine
A
A client is experiencing nausea and vomiting as a response to radiation therapy. Which antiemetic agent is a phenothiazine administered to control nausea and vomiting? A) prochlorperazine B) metoclopramide C) mesna D) dexamethasone
A
A hospital client has a standing order for aprepitant on an as-needed basis. The client should be encouraged to request a dose of the drug in response to which event? A) anticipation of becoming nauseous B) the same time each day C) the onset of nausea D) when nausea results in vomiting
A
The nurse knows that antiemetics are most effective when administered A) before an emetogenic event occurs B) during an episode of nausea but before vomiting has occurred C) after the patient has experienced nausea and vomiting D) any time; timing of administration has no impact on drug effectiveness
A
The nurse would question an order for which of the following antiemetics for treatment of motion sickness-induced nausea? A) prochlorperazine B) dimenhydrinate C) meclizine D) scopolamine
A
What antiemetic is the most common first-line drug for the treatment of postoperative nausea and vomiting? A) ondansetron B) dronabinol C) dimenhydrinate D) hydroxyzine
A
What is the recommended treatment of nausea and vomiting when caring for a child prescribed pediatric chemotherapy agents? A) corticosteroids and 5-HT3 receptor antagonists B) phenothiazines and benzodiazepines C) proton pump inhibitors and antacids D) prokinetic agents and antihistamines
A
Which should be considered a first-line treatment for the management of morning sickness? A) vitamin B6 B) promethazine C) vitamin E D) diphenhydramine
A
The use of an antiemetic is not clinically safe for which client reporting nausea and vomiting?
A client seen in the emergency room for injuries associated with alcohol intoxication
For which client would the use of prochlorperazine require the greatest caution?
A client who is pregnant
A nurse is planning to administer ondansetron to a client. For which of the following adverse effects of this medication should the nurse monitor? SELECT ALL THAT APPLY. A) Headache B) Diarrhea C) Shortened PR interval D) Hyperglycemia E) Prolonged QT interval
A, B, E
Some medications are more likely to demonstrate the adverse effects of nausea and vomiting than others. With which medications are nausea and vomiting especially associated?
Although the symptoms may occur with most drugs, they are especially associated with alcohol, aspirin, digoxin, anticancer drugs, antimicrobials, estrogen preparations, and opioid analgesics.
The nurse is reviewing a new prescription for promethazine. The nurse will immediately contact the health care provider if the prescription is for which client?
An 18-month-old child
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?"
A client is administered a phenothiazine for nausea and vomiting. What is the action of phenothiazine? A) increases gastric motility B) antagonizes dopamine receptors C) blocks histamine receptors D) antagonizes serotonin receptors
B
A client, prescribed promethazine, has an elevated creatinine level. Which action is appropriate when considering any possible related risk to this client? A) Administer the routine dose. B) Administer a lower dose. C) Administer a higher dose. D) Hold the medication.
B
A nurse is caring for a client who has diabetes and is experiencing nausea due to gastroparesis. The nurse should expect a prescription for which of the following medications? A) Lubiprostone B) Metoclopramide C) Bisacodyl D) Loperamide
B
Following administration of hydroxyzine, the nurse should assess the client for which side effect? A) pruritus B) drowsiness C) urinary frequency D) bradycardia
B
When administering 5-HT3 receptor antagonists before cancer chemotherapy, the nurse should also be prepared to administer which of the following adjunctive medications? A) promethazine B) dexamethasone C) dronabinol D) hydroxyzine
B
When reviewing a newly admitted client's previous medication record, the nurse notes that the client has previously been treated with aprepitant. The nurse is justified is suspecting that this client's medical history includes which therapy/treatment? A) placement of a nasogastric tube B) chemotherapy C) endoscopy D) radiation therapy
B
Which nonpharmacological measure has demonstrated some effect in treating nausea and vomiting in pregnant women? A) Ginkgo biloba B) ginger C) garlic D) ginseng
B
Which statement indicates that the client has understood the teaching provided on hydroxyzine? A) "I will take repeated doses of this medication until my nausea resolves." B) "I may experience drowsiness with this medication." C) "I should eat before I take this medication." D) "I will need to take potassium with this medication."
B
A 30-year-old female has been ordered dronabinol. Which of the following statements are true for dronabinol? SELECT ALL THAT APPLY. A) The drug is most effective when given every 2 hours. B) It is approved for nausea and vomiting related to chemotherapy in people with cancer. C) Adverse effects include drowsiness or euphoria. D) Insufficient research is available to support its use as a treatment for nausea and vomiting. E) It is approved as an appetite stimulant for anorexia in people with AIDS. F) The drug is used as a first-line treatment in women with hyperemesis gravidarum associated with pregnancy.
B, C, E
A client diagnosed with Parkinson's disease develops nausea and vomiting. Promethazine may be contraindicated because it depletes levels of what neurotransmitter? A) acetylcholine B) serotonin C) dopamine D) adenosine
C
A client is undergoing a course of radiotherapy for the treatment of leukemia. Treatments in the past have caused the client severe nausea and vomiting. The oncology nurse should normally administer antiemetics on what schedule? A) simultaneous with radiation treatment B) the night before a scheduled radiation treatment C) 30 to 60 minutes before the treatment D) 10 to 15 minutes before the treatment
C
A client, prescribed an antihistamine for nausea, should be monitored for which adverse effect of this classification of medication? A) diarrhea B) prolonged QRS complex C) urinary retention D) inverted T wave
C
A client, scheduled to begin chemotherapy for the treatment of breast cancer, is anxious about the possibility of experiencing nausea. When explaining the physiology of nausea and vomiting, the nurse should include what informational statement? A) The vomiting center is a cluster of cells in the cerebellum. B) The vomiting center sends afferent signals to the chemoreceptor trigger zone (CTZ). C) The chemoreceptor trigger zone (CTZ) is composed of neurons in the fourth ventricle. D) The chemoreceptor trigger zone (CTZ) is located partly within the central nervous system and partly in the peripheral nervous system.
C
An adult hospital client has been experiencing intractable nausea and vomiting for several hours, so the nurse has obtained an order for an antiemetic from the primary care provider. The order reads: "Promethazine 25 mg subcutaneously every 6 hours PRN." The nurse should contact the care provider to question what aspect of this order? A) the drug B) the dose C) the route D) the frequency
C
A nurse correctly identifies which body system as being associated with most of the adverse effects of antiemetics?
Central nervous system (CNS)
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?
Chemoreceptor trigger zone
What is the prototype of H2 receptor antagonist?
Cimetidine (tagamet)
What is the best indicator of decreased nausea after administering ondansetron (Zofran) IV?
Client states, "I feel less nauseated."
A client has begun reporting nausea and vomiting. What would the nurse assess to determine the need for therapy?
Color and amount of vomit
A client prescribed promethazine for nausea and vomiting should be monitored for which adverse effect? A) urinary incontinence B) tachycardia C) taste alteration D) confusion
D
A nurse is caring for a client who received prochlorperazine 4 hours ago. The client reports spasms of the face. The nurse should expect a prescription for which of the following medications? A) Fomepizole B) Naloxone C) Phytonadione D) Diphenhydramine
D
A woman sends her partner to the store to purchase an over-the-counter product to resolve the vomiting she has experienced during a migraine. She has a history of diabetes mellitus and hypertension. She has an appointment with her health care provider in the morning. Which of the following drugs would be the best for the partner to purchase? A) promethazine B) phosphorated carbohydrate solution C) meclizine D) dimenhydrinate
D
An adult client being administered hydroxyzine for nausea should be monitored for which adverse effect? A) thrombocytopenia B) palpitations C) hypertonic muscle tone D) dry mouth
D
An older adult client is administered dimenhydrinate. Which is the priority nursing intervention for this client? A) Encourage fluids with this client. B) Have the client void after administration. C) Maintain IV access. D) Protect from injury.
D
What is the main action of antiemetics?
Depressing hyperactive vomiting reflex
What are the common adverse effects of cimetidine?
Diarrhea, dizziness, drowsiness, headache, confusion, and gynecomastia
A patient develops significant nausea and vomiting related to antineoplastic chemotherapy. Which agent would be most appropriate to use in this situation?
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 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?
Driving
Which of the following are adverse effects from anticholinergics?
Drowsiness Dizziness Urinary retention
What are the three other H2 receptor antagonist other than the prototype?
Famotidine (pepcid) Nizatadine (axid) Rantidine (zantac)
The nurse is caring for a 19-month-old child who has been hospitalized with dehydration secondary to nausea and vomiting. The nurse is aware that promethazine will not be used for this client because it can cause what in children under the age of 2?
Fatal respiratory depression
What is the most common disorder of the esophagus?
GERD
What does GERD expose the esophageal mucosa to?
Gastric acid and pepsin
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)?
Granisetron
A client receiving cancer chemotherapy has been prescribed aprepitant for nausea. The nurse should instruct the client to avoid which liquid?
Grapefruit juice
Antihistamines work on what type of receptor?
H1
What is used to block histamine effect in the bowel on H2 receptor?
H2 receptor antagonist
What is used as prevention and treatment of peptic ulcer disease, GERD, esophagitis, GI bleeding due to stress ulcers, Zollinger - Ellison Syndrome?
H2 receptor antagonist (cimetidine)
What are the receptors called that are located on the parietal cells to increase production of hydrochloric acid?
H2 receptors
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
Increased recumbent position and bending over can cause what?
Heartburn
What is the main symptom of GERD?
Heartburn
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?
Help the client rinse his mouth
What is the cause of GERD?
Incompetent lower esophageal sphincter
To induce vomiting for therapeutic reasons, various substances can be used. Which of the following is used to induce vomiting?
Ipecac
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.
What are the other five antacids other than the prototype?
Maalox Tums Amphogel Gelusil Titralac
A 54-year-old patient is going on an ocean cruise. What medication would be most effective for motion sickness?
Meclizine (Antivert) is the drug of choice to treat motion sickness associated with an ocean voyage.
Which part of the brain is responsible for autonomic functioning such as ventilation, cardiac conduction, and vomiting?
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
A client reports taking antihistamines to treat nausea. The nurse correctly suspects that the nausea results from what trigger?
Motion sickness
What is the prototype of antacids?
Mylanta
What accounts for most cases of peptic ulcer disease?
NSAIDs and H. Pylori
How can H2 receptor antagonist (cimetidine) be given?
PO and IV
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
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?
Scopolamine
Ondansetron (Zofran) belongs to which pharmacological category of medications?
Selective 5-HT3 receptor antagonist
Aprepitant (Emend) is the prototype of which class of antiemetic medications?
Substance P/neurokinin 1 antagonist
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
Which intervention has priority when caring for an older adult client who has been prescribed a phenothiazine for reported nausea?
The client is identified as a possible falls risk
A client plans to take over-the-counter dimenhydrinate to treat motion sickness on an upcoming ocean cruise. The nurse should include what teaching point when discussing appropriate use of the drug?
The drug takes up to 4 hours to achieve full effect.
Which statement is true regarding antiemetic medications?
They are most effective as prophylaxis treatment.
In which of the following scenarios would the nurse question the order for ondansetron (Zofran)?
Treatment of gastresophageal reflux
True or false: Histamine causes strong stimulation of gastric acid secretion
True
True or false: Peptic ulcers are found in the esophagus, stomach, and duodenum.
True
A woman who is 7 weeks pregnant is experiencing morning sickness but does not want to use any medications to treat the nausea. What nonpharmacologic therapy would be helpful to this client?
Wear acupressure wristbands.
What drugs are able to neutralize gastric acid?
antacids
What can aluminum-containing antacids cause?
constipation
What can magnesium cause?
diarrhea and hypermagnesemia
A pregnant woman in her first trimester is experiencing mild to moderate nausea and vomiting. She does not want to take any pharmacologic medication because she is concerned about the effects on the baby. What could the nurse recommend as an alternative therapy?
ginger
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?
glaucoma
OTC H2 receptor antagonist is used for what?
heartburn
What is pyrosis?
heartburn
A client has been prescribed promethazine for recurrent nausea. The nurse should anticipate what preferred route for administration?
intramuscular injection
What are the most common adverse effects associated with drug therapy?
nausea and vomiting
True or false: Gastric and duodenal ulcers are more common than esophageal ulcers
true
