Clyt 33

Which questions should the healthcare provider ask a patient to confirm the diagnosis of psychogenic vomiting? Select all that apply. Some correct answers were not selected "Do you consume fatty foods?" "Did you have any weight loss?" "Have you undergone any surgery?" "Can you control your vomiting in some situations?" "Do you have any negative attitudes towards therapy?"

"Did you have any weight loss?" "Can you control your vomiting in some situations?" Rationale When a person has chronic and recurrent vomiting, psychogenic vomiting is diagnosed by eliminating all other possible causes. A patient with psychogenic vomiting may not have any weight loss and can control vomiting in some situations, such as in public. Pregnant women may develop nausea and vomiting as a result of intake of fatty foods. Vomiting after surgery is known as postoperative nausea and vomiting. Anticipatory nausea and vomiting occur if the patient has negative attitude towards therapy.

Which questions asked by the nurse will effectively document the history of a patient with nausea and vomiting? Select all that apply. "Do you have asthma or glaucoma?" "What is the color of your vomitus?" "Do you use herbal supplements for nausea and vomiting?" "Do you use any over-the-counter medicines for nausea and vomiting?" "Have you observed the frequency of emesis and volume of the vomitus?"

"Do you have asthma or glaucoma?" "What is the color of your vomitus?" "Have you observed the frequency of emesis and volume of the vomitus?" Rationale A history of obstruction, asthma, or narrow-angle glaucoma may increase the incidence of nausea and vomiting. A complete history of the patient's nausea and vomiting symptoms should include the onset, duration, frequency, volume, and description of the vomitus. A complete medication history should include asking the patient to list all currently taken herbal supplements, over-the-counter medications, or drugs prescribed by a healthcare provider.

Which patient statement indicates that more information concerning the use of a scopolamine patch is required? "The patch should be applied on the skin behind my ear." " should replace the patch in 3 days if need continued therapy." "I should apply the patch 4 hours before I may experience nausea." "I can cut the patch in two because don't need the entire dosage."

"I can cut the patch in two because don't need the entire dosage." Rationale The scopolamine patch should not be cut to decrease the dosage. This patient is in need of additional education regarding this medication. The patient would be correct in placing the patch behind the ear, replacing it in 3 days if continued therapy is required, and applying the patch 4 hours before nausea may be experienced.

Which statement made by the patient would have led the healthcare provider to advise the patient to discontinue taking scopolamine? "My mouth is dry." "I have constipation." "I have blurred vision." "I have difficulty with urination."

"I have difficulty with urination." Rationale When the patient develops urinary retention, scopolamine should be discontinued because urinary retention is a serious problem. Dry mucosa of the mouth can be treated by advising the patient to use candy, ice chips, or chewing gum. Laxatives are used to treat constipation. Blurred vision is a known adverse effect, and the patient should be advised to not drive or operate machinery.

Which statement by the patient indicates a correct understanding of the nurse's instructions about dronabinol? "It is safe to drive while taking this drug." "I can continue to drink beer while taking this drug." "I will have someone stay with me when I first start taking this drug." "To prevent insomnia, I may take diphenhydramine (Benadryl) at bedtime."

"I will have someone stay with me when I first start taking this drug." Rationale Dronabinol may cause dysphoric effects, including drowsiness. Patients should remain under the supervision of : responsible adult during initial use of this drug and after dosage adjustments. Patients should be instructed not to drive, operate machinery, or engage in any hazardous activity until it is determined that they are able to tolerate the drug. Alcohol may increase toxic effects of dronabinol and should be avoided. Diphenhydramine (Benadryl) is an antihistamine that may increase toxic effects of dronabinol, and thus should be avoided.

Which statement by the patient indicates a correct understanding of the nurse's instructions about dronabinol? "It is safe to drive while taking this drug." " can continue to drink beer while taking this drug." "I will have someone stay with me when I first start taking this drug." "To prevent insomnia, I may take diphenhydramine (Benadryl) at bedtime."

"I will have someone stay with me when I first start taking this drug." Rationale Dronabinol may cause dysphoric effects, including drowsiness. Patients should remain under the supervision of a responsible adult during initial use of this drug and after dosage adjustments. Patients should be instructed not to drive, operate machinery, or engage in any hazardous activity until it is determined that they are able to tolerate the drug. Alcohol may increase toxic effects of dronabinol and should be avoided. Diphenhydramine (Benadryl) is an antihistamine that may increase toxic effects of dronabinol, and thus should be avoided.

Which statement made by the mother indicates ineffective learning on measures to prevent nausea and vomiting while riding in a car for a young child with motion sickness? "I will provide diverting activities." "I will keep the side windows open." "I will initiate hygiene measures to provide comfort." "I will position the child facing forward so that the child can see the horizon."

"I will keep the side windows open." Rationale Side windows should be closed with screens SO that the child cannot watch rapidly passing objects. Diverting activities should be provided to prevent nausea and vomiting. Hygiene measures should be initiated if the child begins to vomit. The child should be faced forward while riding in a car so that he or she can see the horizon.

Which dosage of a neurokinin-1 (NK1)-receptor antagonist is appropriate for anticipated is nausea and vomiting for a preoperative patient? 40 mg capsule 80 mg capsule 125 mg capsule 130 mg infusion for 20 to 30 minutes

40 mg capsule Rationale Aprepitant (Emend) is an NK1-receptor antagonist prescribed to treat postoperative nausea and vomiting. A 40 mg capsule before 3 hours of induction of anesthesia is prescribed to prevent vomiting. On days 2 and 3 of chemotherapy, an 80 mg capsule is prescribed. A 125 mg capsule is prescribed 1 hour before initiating chemotherapy. A 130 mg infusion for 20 to 30 minutes is administered before initiation of chemotherapy to prevent chemotherapy-induced nausea and vomiting.

A patient with parkinsonism underwent radiation therapy and is suffering from radiation- induced nausea and vomiting. The healthcare provider prescribes ondansetron and insists the patient discontinue apomorphine medication. The prescribed antiemetic drug blocks which receptors? 5-HT 3 histaminic cholinergic dopaminergic

5-HT 3 Rationale Serotonin antagonists act by blocking 5-HT 3 receptors to prevent emesis. Antihistaminic agents act by blocking histaminic receptors. Anticholinergic agents counterbalance the excessive amounts of acetylcholine present at the chemoreceptor trigger zone and the vomiting center (VC). Dopamine antagonists inhibit dopamine receptors that are part of the pathway to the VC, which provides an antiemetic effect.

A patient has a flight at 10 AM and wants to take a scopolamine patch (Transderm Scop) to prevent motion sickness. When would the nurse instruct the patient to apply the patch? 4 AM 6 AM 8 AM 10 AM

6 AM Rationale A scopolamine patch should be applied 4 hours before it is needed. The patient's flight is at 10 AM, SO the patch should be applied at 6 AM. Application of the patch 2 hours before a flight will not be as effective in treating motion sickness. The patient does not need to be applied 6 hours in advance of when it is needed.

Which interventions by the nurse indicate effective learning about how to care for an adult patient with vomiting? Select all that apply. Advise the patient to drink clear juices. Advise the patient to discontinue solid foods. Offer small amounts of fluids every 30 to 60 minutes. Advise the patient to consume milk products and whole grains. Advise the patient to consume nothing by mouth (NPO) and expect a nasogastric (NG) tube to be placed if vomiting is severe.

Advise the patient to drink clear juices. Advise the patient to discontinue solid foods. Advise the patient to consume nothing by mouth (NPO) and expect a nasogastric (NG) tube to be placed if vomiting is severe. Rationale The patient should be advised to drink clear juices if he or she experiences vomiting. Solid foods should be discontinued to alleviate symptoms. If the condition is severe, the patient is kept NPO and an NG tube is placed. Infants rather than adults should be offered fluids every 30 to 60 minutes. Milk products and whole grains should be avoided because these foods increase nausea and vomiting.

Which interventions would be most appropriate for a pregnant a woman who complains of severe persistent vomiting and reports that she is unable to eat anything for the past 2 days? Select all that apply. Advising the patient to take ginger Providing fluid and electrolyte therapy Administering prochlorperazine (Compazine) Providing vitamin B 6 and antihistamine therapy Administering ondansetron (Zofran) and metoclopramide (Reglan)

Advising the patient to take ginger Providing fluid and electrolyte therapy Administering ondansetron (Zofran) and metoclopramide (Reglan) Rationale Ginger is advised for pregnant women with morning sickness. Fluid and electrolyte therapy is provided to the patient to remedy starvation. Ondansetron (Zofran) and metoclopramide (Reglan) are also administered to control this condition. Prochlorperazine (Compazine), vitamin B 6, and antihistamine therapy are given when there is persistent severe vomiting. However, ondansetron (Zofran) and metoclopramide (Reglan) are considered most effective in treating hyperemesis gravidarum.

Which class of drugs may intensify postoperative nausea and vomiting (PONV)? Analgesics Anticholinergic agents Histamine-2 antagonists Nonsteroidal antiinflammatory agents

Analgesics Rationale Analgesics are emetogenic in nature; therefore the use of these drugs may intensify PONV. Anticholinergic agents are antiemetic agents that decrease the risk of PONV. Histamine-2 antagonists are used to reduce gastric secretions, which minimize nausea and vomiting. Nonsteroidal antiinflammatory agents are not emetogenic; they reduce the risk of PONV by providing pain relief.

Which principle guides care planning for a patient with recurrent nausea and vomiting? Tolerance to antiemetics develops rapidly. Administer one type of antiemetic at a time. Antiemetics are ineffective in cases of anticipatory vomiting. Antiemetics are more effective when given before the onset of nausea.

Antiemetics are more effective when given before the onset of nausea. Rationale Antiemetics work best when given before nausea starts. Antiemetics can be effective in the treatment of anticipatory vomiting, which typically occurs 2 to 4 hours before the chemotherapy treatment is begun. Tolerance to antiemetics is not a particular problem. Combinations of antiemetics are often used in the treatment of chemotherapy-induced nausea and vomiting on the assumption that antineoplastic agents produce emesis by more than one mechanism.

Which drug causes profound hypotension and loss of consciousness when used with serotonin antagonists? Meclizine (Antivert) Aprepitant (Emend) Dronabinol (Marinol) Apomorphine (Apokyn)

Apomorphine (Apokyn) Rationale Apomorphine (Apokyn), f used concurrently with serotonin antagonists, can cause hypotension and loss of consciousness. Meclizine (Antivert) enhances sedation when given along with central nervous system depressants. Aprepitant (Emend) causes reduced international normalized ratio when given with warfarin. Dronabinol (Marinol) is a cannabinoid and increases toxic effects of antihistamines, analgesics, and antidepressants when coadministered.

Which drug causes profound hypotension and loss of consciousness when used with serotonin antagonists? Meclizine (Antivert) Aprepitant (Emend) Dronabinol (Marinol) Apomorphine (Apokyn)

Apomorphine (Apokyn) Rationale Apomorphine (Apokyn), if used concurrently with serotonin antagonists, can cause hypotension and loss of consciousness. Meclizine (Antivert) enhances sedation when given along with central nervous system depressants. Aprepitant (Emend) causes reduced international normalized ratio when given with warfarin. Dronabinol (Marinol) is a cannabinoid and increases toxic effects of antihistamines, analgesics, and antidepressants when coadministered.

Which drugs may be responsible for constipation and diarrhea in a patient undergoing antiemetic drug therapy for acute and delayed chemotherapy-induced nausea and vomiting (CINV)? Select all that apply. Aprepitant Midazolam Cyclizine Dronabinol Ondansetron

Aprepitant Ondansetron Rationale Neurokinin-1 (NK1) receptor antagonists are used to prevent acute and delayed CINV caused by highly emetogenic antineoplastic agents. The most common gastrointestinal adverse effects of NK1 receptor antagonist drugs such as aprepitant are constipation, diarrhea, and loss of appetite. Serotonin (5- hydroxytryptamine) type 3 receptor (5-HT 3) antagonists such as ondansetron are used in the treatment of emesis associated with acute CINV. Their gastrointestinal adverse effects include constipation and diarrhea. Midazolam is a benzodiazepine antiemetic drug that does not cause constipation or diarrhea. Cyclizine is an anticholinergic used to prevent nausea and vomiting associated with motion sickness; it is not used in the treatment of acute CINV. Side effects of cyclizine include blurred vision, constipation, and urinary retention as well as dry mucosa of the mouth, throat, and nose. Dronabinol is cannabinoid drug that may have psychological dysphonic effects rather than gastrointestinal effects.

Which medication requires the patient to use an additional method of contraception while taking the estrogen-containing contraceptive ethinyl estradiol and norgestimate? Aprepitant Meclizine Palonosetron Hydroxyzine

Aprepitant Rationale Aprepitant is a neurokinin-1 (NK1) receptor antagonist. Patients taking estrogen-containing contraceptives should be advised to use an alternate or additional method of contraception for the next month because this drug may enhance the metabolism of estrogens. Meclizine, hydroxyzine, and palonosetron do not interact with estrogen-containing contraceptives.

Which premedication assessment would help reduce the risk of 48 hours postchemotherapy emesis in a patient taking aprepitant (Emend)? Collecting data regarding emesis Assessing premedication bowel pattern Checking for the history of closed-angle glaucoma Obtaining baseline data about the degree of alertness

Assessing premedication bowel pattern Rationale An incidence of emesis 48 hours after chemotherapy indicates delayed emesis. This can be treated with the antiemetic drug aprepitant (Emend), which is a potent and selective neurokinin-1 antagonist that blocks the effects of substance P in the central nervous system. This drug may cause constipation or diarrhea; therefore bowel pattern assessments should be performed before initiating the therapy. Collecting data about emesis helps prove effectiveness of the therapy, but not the risks associated with posttherapy. Checking the history of closed-angle glaucoma helps reduce the risk associated with posttherapy of anticholinergic agents. Obtaining baseline data about the degree of alertness will not have a dramatic effect on the assessment of the posttherapy risks.

Which nursing interventions does the nurse perform when administering trimethobenzamide? Select all that apply. Monitor for suppressed cough reflex. Avoid escape of solution along the route. Keep naloxone (Narcan) readily available. Administer the drug in the vastus lateralis muscle. Monitor for burning upon injection of the medication. Do not administer if the patient is allergic to local anesthetics.

Avoid escape of solution along the route. Monitor for burning upon injection of the medication. Do not administer if the patient is allergic to local anesthetics. Rationale Injectable trimethobenzamide may cause skin irritation and the nurse should avoid the escape of solution along the route. Trimethobenzamide may cause burning, stinging, and pain on injection. Injectable trimethobenzamide contains benzocaine and should not be used in patients allergic to benzocaine or local anesthetics. Trimethobenzamide does not suppress the cough reflex. Naloxone is the antidote for narcotic analgesics. Trimethobenzamide should be administered in the upper, outer quadrant of the gluteal region.

Which alteration could be the possible cause of antiemetic-induced dystonia and tardive dyskinesia? Blockage of dopamine receptors in the other parts of the brain Inhibition of pathways to the vomiting center (VC) Blockage of 5-HT 3 receptors located centrally in the chemoreceptor trigger zone (CTZ) Balancing acetylcholine at the CTZ and the VC

Blockage of dopamine receptors in the other parts of the brain Rationale Dopamine antagonists prevent emesis by inhibiting dopamine receptors that are part of the pathway to the VC. Unfortunately, dopamine receptors in other parts of the brain are also blocked, which may produce extrapyramidal symptoms of dystonia, parkinsonism, and tardive dyskinesia. Cannabinoids act via several mechanisms to inhibit pathways to the VC; there is no dopamine antagonist activity with these agents, so these medications do not produce extrapyramidal symptoms. Blocking 5-HT 3 receptors located centrally in the CTZ blocks the effects of substance P in the central nervous system and has no affinity for serotonin, dopamine, or corticosteroid receptors. Balancing acetylcholine at the CTZ and the VC also will not cause extrapyramidal symptoms.

Which assessment may be most suitable to determine the severity of morning sickness in a patient who reports severe nausea and vomiting in the 21st week of pregnancy? Blood pressure levels Blood levels for glucose Blood levels for thyroid hormone Blood levels of free and bound estradiol

Blood levels of free and bound estradiol Rationale Nausea and vomiting in pregnancy is commonly known as morning sickness. Only 9% of women report vomiting after 20 weeks of pregnancy. The cause of morning sickness is unknown, but its occurrence and severity appear to be related to the levels of free and bound estradiol and sex hormone-globulin-binding capacity. It is not related to blood pressure, blood glucose levels, or blood levels of thyroid hormone.

Which adverse effects are anticipated in a patient taking meclizine for motion sickness? Select all that apply. Diarrhea Blurred vision Hallucinations Urinary retention Enhanced sedation

Blurred vision Urinary retention Enhanced sedation Rationale Meclizine is an anticholinergic antiemetic drug; side effects may include blurred vision, urinary retention, and enhanced sedation. Constipation, not diarrhea, is a side effect associated with meclizine. Hallucinations are a side effect of cannabinoids.

When does the nurse expect to administer antiemetics to a patient with chemotherapy-induced nausea and vomiting (CINV)? Concurrently with the chemotherapy Both before and after chemotherapy is given 30 minutes before the chemotherapy is given 48 to 72 hours after the chemotherapy is given

Both before and after chemotherapy is given Rationale For the treatment of CINV, all antiemetics should be administered an adequate time before chemotherapy is initiated and should be continued for an appropriate time after the antineoplastic agent has been discontinued. The type(s) of antiemetic and how long before and after chemotherapy they are given depend on the emetogenic potential of the antineoplastic agents being used.

Which patient is most susceptible to a high incidence of postoperative nausea and vomiting (PONV)? A B C D

C Rationale Postoperative nausea and vomiting is a common postsurgery complication. Surgical procedures such as extraocular muscle and middle ear manipulations, testicular tractions, and abdominal surgeries have a higher incidence of PONV. Children ages 11 to 14 years have the highest incidence based on age group. Therefore a patient C, a teenager who has undergone abdominal surgery, is at the highest risk for PONV. Patient A is at a high risk of PONV because of hormonal differences, but not as high as patient C. Patient B is at a lower risk because underweight patients generally lack adipose tissue where fat-soluble anesthetics accumulate. Patient D would be generally given regional anesthesia or spinal anesthesia, which is associated with less PONV compared with general anesthesia.

Which drug should be prescribed to a patient who developed nausea and vomiting as a result of increased gastric secretions? Meclizine Ondansetron (Zofran) Cimetidine (Tagamet) Metoclopramide

Cimetidine (Tagamet) Rationale Histamine-2 antagonists such as cimetidine (Tagamet) reduce gastric secretions to minimize nausea and vomiting. Anticholinergic antagonists, such as meclizine, counterbalance acetylcholine levels at the chemoreceptor trigger zone (CTZ) and vomiting center (VC). Serotonin antagonists such as ondansetron (Zofran) block serotonin receptors located in the CTZ that induce vomiting. Dopamine antagonists such as metoclopramide inhibit dopamine receptors that trigger the VC.

Which drug has a high potential for emesis when given intravenously? Paclitaxel (Taxol) Cisplatin (Platinol-AQ) Carboplatin (Paraplatin) Daunorubicin (Cerubidine)

Cisplatin (Platinol-AQ) Rationale Cisplatin (Platinol-AQ) has a high potential for emesis with IV antineoplastic agents. Paclitaxel (Taxol) has a low potential for emesis. Carboplatin (Paraplatin) and daunorubicin (Cerubidine) have moderate potentials for emesis.

Which drug has a high potential for emesis when given intravenously? Paclitaxel (Taxol) Cisplatin (Platinol-AQ) Carboplatin (Paraplatin) Daunorubicin (Cerubidine)

Cisplatin (Platinol-AQ) Rationale Cisplatin (Platinol-AQ) has high potential for emesis with IV antineoplastic agents. Paclitaxel (Taxol) has a low potential for emesis. Carboplatin (Paraplatin) and daunorubicin (Cerubidine) have moderate potentials for emesis.

What drug combination is used to treat vomiting in a patient with cancer who is taking etoposide (VePesid)? Ondansetron (Zofran) and granisetron (Kytril) Aprepitant (Emend) and dolasetron (Anzemet) Dexamethasone (Decadron) and ondansetron (Zofran) Dexamethasone (Decadron) and metoclopramide (Reglan)

Dexamethasone (Decadron) and metoclopramide (Reglan) Rationale Etoposide (VePesid) has a low emetic potential. Dexamethasone (Decadron) and metoclopramide (Reglan) therapy is recommended to treat nausea and vomiting for chemotherapy with a low emetic potential. A combination of ondansetron (Zofran) and granisetron (Kytril), aprepitant (Emend) and dolasetron (Anzemet), and dexamethasone (Decadron) and ondansetron (Zofran) are used to treat nausea and vomiting associated with chemotherapy with a high emetic potential.

Which instructions would be provided to a patient who is prescribed nabilone (Cesamet)? Select all that apply. Do not operate heavy machinery. Administer the drug under supervision. Discontinue the drug if rashes develop. This drug may cause orthostatic hypotension. Schedule a check of the international normalized ratio (INR).

Do not operate heavy machinery. Administer the drug under supervision. Rationale When nabilone (Cesamet) is prescribed, the patient should not operate heavy machinery and should remain under supervision because this drug may cause dysphoria. Prochlorperazine (Compazine) may cause rashes and orthostatic hypotension. The INR should be checked in patients who are concurrently taking aprepitant and warfarin.

Which antiemetic medication for chemotherapy-induced nausea and vomiting can cause chest discomfort once therapy is initiated? Select all that apply. Lorazepam Droperidol Granisetron Fosaprepitant Dimenhydrinate

Droperidol Granisetron Rationale Butyrophenones such as droperidol must be administered parenterally and require an electrocardiogram before and after administration because of the increased risk of Q-T interval prolongation. Serotonin (5-HT 3) receptor antagonists such as granisetron cause cardiovascular adverse effects, which lead to prolongation of the corrected Q-T (Q-T c) interval. Lorazepam causes amnesic and sedative effects. Fosaprepitant causes nausea, hiccups, constipation, diarrhea, loss of appetite, headache, and hair loss. Dimenhydrinate may cause sedation and dry mouth.

Which adverse effect of cannabinoids requires the healthcare provider to advise an older patient to not drive or operate heavy machinery? Blurred vision Dysphonic effects Enhanced sedation Orthostatic hypotension

Dysphonic effects Rationale The side effects of cannabinoids are not tolerated well by older adults; therefore older patients should be supervised and told to avoid driving or operating machinery while on drug therapy. These side effects include psychological dysphonic effects such as a depressed mood, hallucinations, distortion of perception, and paranoid reactions. Anticholinergic antiemetic drugs generally cause blurred vision. Enhanced sedation is a major side effect of many antiemetic drugs. Orthostatic hypotension is a side effect of promethazine (Phenergan).

For which adverse effect of trimethobenzamide does the nurse monitor in a patient undergoing surgery? Dystonia Infection Profuse sweating Abnormal dreams

Dystonia Rationale Trimethobenzamide is a butyrophenone that inhibits dopamine receptors that are part of the pathway to the vomiting center. These dopamine receptors in other parts of the brain are blocked, potentially producing extrapyramidal symptoms such as dystonia, parkinsonism, and tardive dyskinesia. Abnormal dreams, infection, and profuse sweating are not adverse effects of trimethobenzamide.

Which drug is a serotonin antagonist? Granisetron (Kytril) Meclizine Promethazine (Phenergan) Trimethobenzamide (Tigan)

Granisetron (Kytril) Rationale Granisetron (Kytril) is a serotonin antagonist. Meclizine is an anticholinergic agent. Promethazine (Phenergan) is a dopamine agonist. Trimethobenzamide (Tigan) is a butyrophenone.

Which drug is a dopamine antagonist? Aprepitant Meclizine Haloperidol Ondansetron

Haloperidol Rationale Haloperidol is a dopamine antagonist. Aprepitant is a neurokinin-1 (NK1) receptor antagonist. Meclizine is an anticholinergic agent. Ondansetron is a serotonin antagonist.

Which adverse effect may be experienced a by a patient taking aprepitant for prevention of acute chemotherapy-induced nausea and vomiting? Fever Hiccups Hallucinations Urinary retention

Hiccups Rationale Hiccups are an adverse effect of aprepitant. Fever, hallucinations, and urinary retention are not adverse effects of aprepitant.

Which is the potential for anticipated vomiting in a patient receiving cisplatin (Platinol-AQ)? Minimal Low Moderate High

High Rationale Cisplatin (Platinol-AQ) has high potential to cause emesis if it is administered via IV administration. Bleomycin has a minimal potential to cause emesis on administration. Paclitaxel (Taxol) has a low potential to cause emesis on administration. Carboplatin (Paraplatin) has a moderate potential to cause emesis on a administration.

Which is the reason a patient who received IV carboplatin and paclitaxel reports moderate vomiting 72 hours after initiating therapy? Induction of emesis by metabolic by-products of the drugs Stimulated response of the chemotherapeutic agents itself The conditioned response triggered by the knowledge that treatment is imminent Self-induced response of the patient to a situation he or she considers threatening

Induction of emesis by metabolic by-products of the drugs Rationale Delayed emesis occurs 24 to 120 hours after administration of chemotherapy. The mechanisms are unknown, however, delayed emesis in patients receiving chemotherapy may be induced by metabolic by-products of the chemotherapeutic agents or by destruction of the malignant cells. Acute chemotherapy-induced nausea and vomiting (CINV) may begin 1 to 6 hours after chemotherapy has been administered and may last for up to 24 hours. This type of emesis is stimulated directly by chemotherapeutic agents. The onset of anticipatory nausea and vomiting is usually 2 to 4 hours before treatment and is most severe at the time of chemotherapy administration. This type of CINV is a conditioned response triggered by the sight or smell of the clinic or hospital or by the knowledge that treatment is imminent. Psychogenic vomiting can be self-induced or it can occur involuntarily in response to situations that the person considers threatening or distasteful. Psychogenic vomiting iS not a type of CINV.

Which parameter should be monitored to prevent complications in a patient concurrently taking warfarin (Coumadin) and aprepitant (Emend)? Vision Urine output Consciousness International normalized ratio (INR)

International normalized ratio (INR) Rationale Aprepitant (Emend) increases the metabolism of warfarin (Coumadin) and causes a reduced INR. Anticholinergic agents cause blurred vision and urinary retention. Therefore vision and urine output should be monitored in patients using anticholinergic drugs. Serotonin antagonists such as granisetron (Kytril) and ondansetron (Zofran) cause profound hypotension and loss of consciousness when taken with apomorphine.

Which parameter should be monitored to prevent complications in a patient concurrently taking warfarin (Coumadin) and aprepitant (Emend)? Vision Urine output Consciousness International normalized ratio (INR)

International normalized ratio (INR) Rationale Aprepitant (Emend) increases the metabolism of warfarin (Coumadin) and causes a reduced INR. Anticholinergic agents cause blurred vision and urinary retention. Therefore vision and urine output should be monitored in patients using anticholinergic drugs. Serotonin antagonists such as granisetron (Kytril) and ondansetron (Zofran) cause profound hypotension and loss of consciousness when taken with apomorphine.

Which action is the priority to alleviate postoperative nausea and vomiting (PONV) in a patient with a nasogastric (NG) tube? Moving the NG tube Irrigating the NG tube Checking the patency of the NG tube Administration of as-needed (PRN) antiemetics

Irrigating the NG tube Rationale Irrigation of a blocked NG tube will alleviate the symptoms of nausea and vomiting in a postoperative patient. Moving an NG tube that was inserted during surgery should be avoided because it may penetrate the suture line. The NG tube should be checked for patency and placement to prevent abdominal distention; however, this action will not help relieve nausea and vomiting. PRN antiemetics should be administered, but this iS not the most priority action.

Which action is the priority to alleviate postoperative nausea and vomiting (PONV) in a patient with a nasogastric (NG) tube? Moving the NG tube Irrigating the NG tube Checking the patency of the NG tube Administration of as-needed (PRN) antiemetics

Irrigating the NG tube Rationale Irrigation of a blocked NG tube will alleviate the symptoms of nausea and vomiting in a postoperative patient. Moving an NG tube that was inserted during surgery should be avoided because it may penetrate the suture line. The NG tube should be checked for patency and placement to prevent abdominal distention; however, this action will not help relieve nausea and vomiting. PRN antiemetics should be administered, but this is not the most priority action.

Which surgery may have a lesser incidence of postoperative nausea and vomiting (PONV)? Middle ear surgery Abdominal surgery Knee replacement surgery Testicular traction surgery

Knee replacement surgery Rationale Knee replacement surgery has a lesser incidence of PONV when compared with surgical procedures that involve extraocular muscle and middle ear surgery, abdominal surgery, and testicular traction surgery.

Which surgery may have a lesser incidence of postoperative nausea and vomiting (PONV)? Middle ear surgery Abdominal surgery Knee replacement surgery Testicular traction surgery

Knee replacement surgery Rationale Knee replacement surgery has lesser incidence of PONV when compared with surgical procedures that involve extraocular muscle and middle ear surgery, abdominal surgery, and testicular traction surgery.

Which type of vomiting may a patient with hyperemesis gravidarum experience? Motion sickness Morning sickness Psychogenic vomiting Postoperative vomiting

Morning sickness

Which type of vomiting may a patient with hyperemesis gravidarum experience? Motion sickness Morning sickness Psychogenic vomiting Postoperative vomiting

Morning sickness Rationale Hyperemesis gravidarum is a condition in which starvation, dehydration, and acidosis are superimposed on the vomiting syndrome. This condition occurs in pregnant women when severe persistent vomiting (described as morning sickness) interferes with nutrition, fluid, and electrolyte balance. Motion sickness is nausea and vomiting associated with motion; it is thought to result from stimulation of the ear's labyrinth system. Psychogenic vomiting can either be self-induced or occur involuntarily in response to situations that the person considers threatening or distasteful. Postoperative vomiting is a relatively common complication that occurs after surgery.

Which type of vomiting is treated with antihistamines? Motion sickness Psychogenic vomiting Anticipatory nausea and vomiting Chemotherapy-induced nausea and vomiting (CINV)

Motion sickness Rationale Motion sickness occurs when the chemoreceptor trigger zone is activated; this effect is relieved by the anticholinergic properties of antihistamines. Antianxiety drugs are used to treat psychogenic vomiting. Benzodiazepines are prescribed to treat anticipatory nausea and vomiting. A combination of antiemetics such as ondansetron (Zofran), aprepitant (Emend), and dexamethasone (Decadron) are given to treat CINV.

Which type of vomiting is best treated by the anticholinergic properties of antihistamine drugs? Delayed emesis Motion sickness Morning sickness Anticipatory nausea and vomiting

Motion sickness Rationale The effectiveness of antihistamines in treating motion sickness results from their anticholinergic properties, not from their ability to block histamines. A combination of prochlorperazine (Compazine), lorazepam (Ativan), and diphenhydramine (Benadryl) successfully controls delayed emesis. Drugs generally used to treat morning sickness include vitamin B 6 and phenothiazines. Antihistamines may also be used but they are more effective in treating motion sickness. Drugs used to treat anticipatory nausea and vomiting includes benzodiazepines.

Which statement made by the nursing student indicates a need for further education about factors associated with obesity that can contribute to increased and postoperative nausea and vomiting (PONV)? Obese patients have a larger residual gastric volume that contributes to PONV. Obese patients have higher risk of PONV when treated with general anesthetics. Obese patients have a decreased esophageal reflux, which may contribute to PONV. Obese patients have greater risk for gallbladder diseases, which contributes to PONV.

Obese patients have a decreased esophageal reflux, which may contribute to PONV. Rationale Increased, not decreased, esophageal reflux is a factor associated with obesity, which may cause a higher incidence of nausea and vomiting. Larger residual gastric volume in obese patients is a major factor that contributes to PONV. General anesthetics are fat-soluble; these chemicals may accumulate in adipose tissue and continue to be released long after anesthesia is discontinued. This action causes a greater incidence of PONV. The risk of gallbladder and gastrointestinal diseases is a major factor that contributes to PONV in obese patients.

Which condition may be a cause of nausea and vomiting during pregnancy? Obesity Diabetes Thyroid disease Gall bladder disease

Obesity Rationale Nausea and vomiting in pregnancy is commonly known as morning sickness. Vomiting is much more common among obese women. Diabetes, thyroid disease, and gall bladder disease do not have an effect on morning sickness.

Which condition may be a cause of nausea and vomiting during pregnancy? Obesity Diabetes Thyroid disease Gall bladder disease

Obesity Rationale Nausea and vomiting in pregnancy is commonly known as morning sickness. Vomiting is much more common among obese women. Diabetes, thyroid disease, and gall bladder disease do not have an effect on morning sickness.

What are the priority assessments involved in the basic assessment of nausea and vomiting? Select all that apply. Obtain baseline vital signs. Assess and record signs of hydration. Observe the size and shape of the abdomen. Assess bowel habits before nausea and vomiting. Analyze bowel sounds in all four quadrants of the abdomen. Assess liver enzymes at presentation of nausea and vomiting.

Obtain baseline vital signs. Assess and record signs of hydration. Observe the size and shape of the abdomen. Analyze bowel sounds in all four quadrants of the abdomen. Rationale After determining the underlying cause of nausea and vomiting, baseline vital signs should be obtained. Then bowel sounds should be analyzed in all four quadrants of the abdomen. The nurse should then observe the size and shape of the abdomen and note any distention, ascites, or masses. Finally, the nurse should assess and record any signs of hydration such as skin turgor, thirst, and urine output. Assessing bowel habits before nausea and vomiting and assessing liver enzymes at presentation of nausea and vomiting are not priority assessments.

Which intervention would be the most appropriate a before starting a patient on droperidol (Inapsine)? Collecting data regarding emesis Obtaining baseline data about the patient's degree of alertness Obtaining an electrocardiogram before and after administration of the drug Having a check of the international normalized unit (INR) after 7 to 10 days of initiation of therapy

Obtaining an electrocardiogram before and after administration of the drug Rationale Droperidol (Inapsine) causes prolongation of the Q-T interval. Therefore an electrocardiogram should be obtained before and after administration of the drug. Collecting data regarding emesis and obtaining baseline data about the patient's degree of alertness are performed before initiating any antiemetic therapy. The INR should be checked 7 to 10 days after initiating aprepitant in a patient also taking warfarin.

Which drug is approved to treat chemotherapy-induced nausea and vomiting (CINV), postoperative nausea and vomiting (PONV), and radiotherapy-induced nausea and vomiting (RINV)? Granisetron (Kytril) Palonosetron (Aloxi) Ondansetron (Zofran) Lorazepam

Ondansetron (Zofran) Rationale Ondansetron is used to treat CINV, PONV, and RINV. Granisetron is used in the treatment of CINV and RINV. Palonosetron (Aloxi) is approved to treat CINV and PONV. Lorazepam is used to treat CINV.

Which antiemetic agents can be used by a pregnant woman with severe dehydration as a result of persistent vomiting? Select all that apply. Lorazepam (Ativan) Ondansetron (Zofran) Metoclopramide (Reglan) Promethazine (Phenergan) Diphenhydramine (Benadryl)

Ondansetron (Zofran) Metoclopramide (Reglan) Rationale A pregnant woman with severe persistent vomiting that interferes with nutrition, fluid, and electrolyte balance may be experiencing hyperemesis gravidarum. This is a condition in which starvation, dehydration, and acidosis are superimposed on the vomiting syndrome. Ondansetron (Zofran) and metoclopramide (Reglan) are the most effective antiemetics at treating hyperemesis gravidarum. Lorazepam (Ativan) is recommended to treat chemotherapy-induced nausea and vomiting (CINV). Promethazine (Phenergan) is used to treat motion sickness and nausea and vomiting associated with pregnancy. Diphenhydramine (Benadryl) is used to treat CINV, motion sickness, and nausea and vomiting associated with pregnancy.

Which patient would the nurse anticipate to have the least emetogenic effects? General Spinal Peripheral regional Isoflurane

Peripheral regional Rationale Patient C, who received peripheral regional anesthesia, has the least emetogenic effects because this type of anesthesia is least likely to induce nausea and vomiting. General, spinal, and isoflurane anesthesia are all more likely to cause nausea and vomiting than peripheral regional anesthesia.

Which drug is least likely to be prescribed to a patient with a seizure disorder? Aprepitant (Emend) Meclizine Dolasetron (Anzemet) Prochlorperazine (Compazine)

Prochlorperazine (Compazine) Rationale Prochlorperazine (Compazine) should be used with caution in patients with seizure disorder. Aprepitant (Emend), meclizine, and dolasetron (Anzemet) can be used to treat nausea and vomiting in this patient because they do not cause complications.

Which actions of lorazepam (Ativan) will benefit a patient with chemotherapy-induced nausea and vomiting (CINV)? Select all that apply. Providing an amnesic effect Antagonizing dopamine receptors Reducing anxiety associated with CINV Counterbalancing excessive amounts of acetylcholine Inhibiting pathways to the vomiting center (VC) using several mechanisms

Providing an amnesic effect Reducing anxiety associated with CINV Rationale The amnesic effect appears to be most important in treating cancer patients; thus lorazepam (Ativan) would be prescribed. In addition, lorazepam (Ativan) reduces anxiety often associated with chemotherapy. Dopamine antagonists act by antagonizing dopamine receptors. Anticholinergic drugs act by counterbalancing excessive amounts of acetylcholine. Cannabinoids act through several mechanisms to inhibit pathways to the VC.

For which reason would a patient diagnosed with self-induced vomiting be prescribed an antianxiety drug? Pregnancy Chemotherapy Radiation therapy Psychological problem

Psychological problem Rationale Psychogenic vomiting can be self-induced or it can occur involuntarily in response to a situation that the person considers threatening or distasteful. This type of vomiting is generally a result of a psychological problem and is treated with an antianxiety drug and proper counseling. Nausea and vomiting associated with pregnancy is generally treated with vitamin B 6, antihistamines, and phenothiazines. Combinations of serotonin antagonists with dexamethasone, aprepitant, rolapitant, and possibly lorazepam are often used to treat chemotherapy-induced nausea and vomiting. Serotonin antagonists are used to treat radiation-induced nausea and vomiting.

Which action describes the function of the chemoreceptor trigger zone (CTZ)? Select all that apply. Initiating vomiting Coordinating the vomiting reflex Receiving stimuli from the cerebral cortex Responding to stimuli originating in the inner ear Evaluating the spinal fluid for potentially toxic substances

Receiving stimuli from the cerebral cortex Evaluating the spinal fluid for potentially toxic substances Rationale Stimuli from the cerebral cortex, vestibular apparatus of the inner ear, and blood travel first to the CTZ, which then activates the vomiting center (VC) to induce vomiting. An important function of the CTZ is to sample blood and spinal fluid for potentially toxic substances. The CTZ cannot initiate vomiting independently. The VC's function is to coordinate the vomiting reflex and respond to stimuli originating in tissues such as the cerebral cortex, vestibular apparatus of the inner ear, and blood.

Which action describes the function of the chemoreceptor trigger zone (CTZ)? Select all that apply. Initiating vomiting Coordinating the vomiting reflex Receiving stimuli from the cerebral cortex Responding to stimuli originating in the inner ear Evaluating the spinal fluid for potentially toxic substances

Receiving stimuli from the cerebral cortex Evaluating the spinal fluid for potentially toxic substances Rationale Stimuli from the cerebral cortex, vestibular apparatus of the inner ear, and blood travel first to the CTZ, which then activates the vomiting center (VC) to induce vomiting. An important function of the CTZ is to sample blood and spinal fluid for potentially toxic substances. The CTZ cannot initiate vomiting independently. The VC's function is to coordinate the vomiting reflex and respond to stimuli originating in tissues such as the cerebral cortex, vestibular apparatus of the inner ear, and blood.

Which condition is also known as dry heaves? Nausea Retching Vomiting Regurgitation

Retching Rationale Dry heaves, or retching, is the involuntary labored, spasmodic contraction of the abdominal and respiratory muscles without emesis. Nausea is the sensation of abdominal discomfort that is intermittently accompanied by a desire to vomit. Vomiting is the forceful expulsion of gastric contents up the esophagus and out the mouth. Regurgitation occurs when gastric or esophageal contents rise to the pharynx because of pressure.

Which condition is also known as dry heaves? Nausea Retching Vomiting Regurgitation

Retching Rationale Dry heaves, or retching, is the involuntary labored, spasmodic contraction of the abdominal and respiratory muscles without emesis. Nausea is a sensation of abdominal discomfort that is intermittently accompanied by desire to vomit. Vomiting is the forceful expulsion of gastric contents up the esophagus and out the mouth. Regurgitation occurs when gastric or esophageal contents rise to the pharynx because of pressure.

Which treatment would prevent vomiting in a patient with severe motion sickness who has to travel by car? Aprepitant and granisetron Diphenhydramine and cyclizine Scopolamine and ephedrine Dexamethasone and metoclopramide

Scopolamine and ephedrine Rationale Anticholinergic drugs are used to treat motion sickness. Scopolamine is an anticholinergic drug used to treat severe motion sickness; this drug is given along with ephedrine. A combination of aprepitant and granisetron is used to treat nausea and vomiting associated with chemotherapy with high emetic potential. Diphenhydramine has a long duration but causes excessive sedation; cyclizine is less effective in treating severe motion sickness. Dexamethasone and metoclopramide therapy are used to treat nausea and vomiting caused by chemotherapy with a low emetic a potential.

Which mechanism of emesis would be anticipated in a patient who frequently travels by aircraft? Stimulation of the labyrinth Self-induced response to the situation Detecting potentially toxic substances in the blood Conditioned response triggered by the sight or smell

Stimulation of the labyrinth Rationale Nausea and vomiting associated with motion is a result of stimulation of the labyrinth system of the ear. This type of stimulation commonly occurs in patients who travel via airplane frequently. Psychogenic vomiting can be self- induced or it can occur involuntarily in response to situations that the person considers threatening or distasteful. Acute chemotherapy-induced nausea and vomiting may be stimulated directly by chemotherapeutic agents or their metabolic products in the blood. Anticipatory nausea and vomiting is a conditioned response triggered by the sight or smell of the clinic or hospital; it can also be triggered by the knowledge that treatment is imminent.

Which mechanism of emesis would be anticipated in patient who frequently travels by aircraft? Stimulation of the labyrinth Self-induced response to the situation Detecting potentially toxic substances in the blood Conditioned response triggered by the sight or smell

Stimulation of the labyrinth Rationale Nausea and vomiting associated with motion is a result of stimulation of the labyrinth system of the ear. This type of stimulation commonly occurs in patients who travel via airplane frequently. Psychogenic vomiting can be self-induced or it can occur involuntarily in response to situations that the person considers threatening or distasteful. Acute chemotherapy-induced nausea and vomiting may be stimulated directly by chemotherapeutic agents or their metabolic products in the blood. Anticipatory nausea and vomiting is a conditioned response triggered by the sight or smell of the clinic or hospital; it can also be triggered by the knowledge that treatment is imminent.

Which statement best describes the action of phenothiazines? They are dopamine antagonists that inhibit dopamine receptors. They are serotonin (5-HT 3) antagonists that block receptors known to induce nausea and vomiting. They are anticholinergic agents used to counterbalance the excessive amounts of acetylcholine present. They are potent, selective neurokinin-1 receptor antagonists that block the effects of substance P in the central nervous system.

They are dopamine antagonists that inhibit dopamine receptors. Rationale Phenothiazines are dopamine antagonists that inhibit the dopamine receptors that are part of the pathway to the vomiting center. Phenothiazines are not serotonin (5-HT 3) antagonists, anticholinergic agents, or selective neurokinin-1 receptor antagonists.

Which statement is true about cannabinoids? They more effective than metoclopramide. They serve as antiemetics only in patients receiving chemotherapy. They are less effective in younger patients who are refractory to other antiemetic agents. They are more effective than prochlorperazine in patients receiving moderately emetogenic chemotherapy.

They serve as antiemetics only in patients receiving chemotherapy. Rationale Cannabinoids serve as antiemetics only in patients receiving chemotherapy because they have mind-altering effects and relatively high potential for abuse. These drugs are less effective than metoclopramide and are effective in younger patients who are refractory to other antiemetic agents. Cannabinoids are equally as effective as prochlorperazine in patients receiving moderately emetogenic chemotherapy.

Which statement is true about cannabinoids? They more effective than metoclopramide. They serve as antiemetics only in patients receiving chemotherapy. They are less effective in younger patients who are refractory to other antiemetic agents. They are more effective than prochlorperazine in patients receiving moderately emetogenic chemotherapy.

They serve as antiemetics only in patients receiving chemotherapy. Rationale Cannabinoids serve as antiemetics only in patients receiving chemotherapy because they have mind-altering effects and a relatively high potential for abuse. These drugs are less effective than metoclopramide and are effective in younger patients who are refractory to other antiemetic agents. Cannabinoids are equally as effective as prochlorperazine in patients receiving moderately emetogenic chemotherapy.

Which interventions help reduce the incidence of postoperative nausea and vomiting (PONV) in a patient undergoing abdominal surgery? Premedication the patient with morphine Using the analgesic alfentanil with regional anesthetics Using general anesthesia over regional anesthesia Using enflurane anesthesia over nitrous oxide anesthesia

Using enflurane anesthesia over nitrous oxide anesthesia Rationale Patients under nitrous oxide anesthesia have a higher incidence of nausea and vomiting than those under enflurane or isoflurane anesthesia. Premedicating patients with analgesics such as morphine may increase the frequency of nausea and vomiting. Coadministration of analgesics, such as alfentanil, with regional anesthetics frequently induces nausea and vomiting. Regional anesthesia is associated with less PONV compared with general anesthesia.