Pharm 503 ch. 52 antiemetics

Which is the appropriate instruction for the nurse to follow to quickly relieve the patient's symptoms of nausea and vomiting when administering promethazine? "Administer promethazine through the intravenous route." "Administer promethazine through the intraarterial route." "Administer promethazine through the oral route." "Administer electrolytes to the patient to prevent dehydration caused by vomiting."

"Administer promethazine through the intravenous route." Promethazine should be administered intravenously because intraarterial injection leads to severe tissue damage, possibly requiring amputation. The oral and intramuscular routes are also used; however, the patient will experience the quickest relief from the intravenous route. Promethazine must be diluted when administered via the intravenous route. The nurse would assess for signs and symptoms of dehydration and electrolytic imbalance before administering promethazine but should not administer electrolytes to the patient. p. 820

Which statement by the patient indicates effective learning about how to administer scopolamine prescribed for motion sickness? "I should change the medication patch every week." "I should apply one medication patch on a hairless area behind the ear." "I should apply moisturizer to the skin before placing the medication patch." "I should place the medication patch on my skin at least 4 days before travel."

"I should apply one medication patch on a hairless area behind the ear." Scopolamine is an antiemetic medication that is available in a transdermal formulation. To increase absorption of the medication, the nurse would instruct the patient to apply the medication patch on a hairless area behind the ear. The medication patch should be changed every 3 days to provide effective treatment. Applying moisturizer on the skin may increase the risk of an allergy due to a drug interaction. The patient should apply the patch at least 4 hours, not 4 days, before travel. p. 819

Which statement regarding antiemetic medications made by the patient indicates the need for further patient teaching? "I will not drive while I am taking these medications because they may cause drowsiness." "I may take acetaminophen to treat the headache caused by ondansetron." "I will apply the scopolamine patches to rotating sites on my arms." "I should take my prescribed antiemetic before receiving my chemotherapy dose."

"I will apply the scopolamine patches to rotating sites on my arms." Transdermal scopolamine patches should be applied to nonirritated areas behind the ear, not on the arms. The other statements are accurate. p.824

Which information will the nurse include in the teaching plan for a patient who is prescribed promethazine? Select all that apply. One, some, or all responses may be correct. "You should avoid consuming alcohol." "You should increase your intake of tea and coffee." "You should take the medication 1 hour after meals." "You should discontinue taking the medication after 5 days." "You should avoid driving because the drug may cause drowsiness."

"You should avoid consuming alcohol." "You should avoid driving because the drug may cause drowsiness." The nurse would teach the patient to avoid driving—and other activities that require mental alertness or motor coordination—while taking promethazine because the drug may cause drowsiness. The consumption of alcohol must be avoided because the drug enhances depression of the central nervous system (CNS). The intake of tea or coffee should be limited because the drug interacts with caffeine and further depresses the CNS. The nurse would encourage the patient to take the medications per the prescription. For effective relief from the symptoms of nausea and vomiting, the patient should be advised to complete the dosage regimen, not to discontinue the medication after 5 days. Promethazine does not affect the gastrointestinal mucosa; therefore it can be taken before or after meals. Hence, the nurse would not advise the patient to take the medication 1 hour after a meal. p. 823, 824

Which advice would the nurse provide to a patient prescribed metoclopramide? "You should avoid long-term use of this medication." "You should take the medication without regard to meals." "You should use relaxation techniques while taking this medication." "You should take the medication with prochlorperazine for fast action."

"You should avoid long-term use of this medication." The nurse suggests the patient avoid long-term use of metoclopramide because it causes tardive dyskinesia, an involuntary neurologic movement. If the oral route of administration is preferred, the drug should be taken half an hour before meals. Use of complementary techniques such as relaxation is not required because central nervous system depression does not occur. Metoclopramide must not be administered with prochlorperazine, because prochlorperazine worsens the adverse effects of metoclopramide. p. 819

Which advice will the nurse give to the patient while administering diphenhydramine? "You should not consume alcohol." "You should not consume oral fluids." "You should consume coffee frequently." "You should not practice relaxation techniques."

"You should not consume alcohol." The nurse suggests that the patient avoid drinking alcohol because alcohol is a central nervous system depressant, and patients taking diphenhydramine may experience an exacerbation of central nervous system depression. The patient should consume oral fluids to prevent fluid volume deficits. The patient should not consume coffee frequently, because caffeine interacts with antiemetic drugs and causes central nervous system depression. The patient should practice relaxation techniques when this drug is coadministered with other central nervous system depressants. p. 824

Which neurotransmitter induces nausea and vomiting by triggering vestibular and labyrinthine pathways in the inner ear? Dopamine (D2) Acetylcholine Prostaglandins Serotonin (5-HT3)

Acetylcholine Acetylcholine induces nausea and vomiting by triggering vestibular and labyrinthine pathways in the inner ear. Dopamine (D2) stimulates receptors in the gastrointestinal (GI) tract and the chemoreceptor trigger zone (CTZ) in the brain. Serotonins (5-HT3) receive impulses from the GI tract and send them to the CTZ and vomiting center in the brain. Prostaglandins stimulate receptors in the GI tract. p. 816

Which condition would antidopaminergic drugs be used to treat? Select all that apply. One, some, or all responses may be correct. Anxiety Seizures Schizophrenia Intractable hiccups Bone marrow suppression

Anxiety Schizophrenia Intractable hiccups Antidopaminergic drugs are used to treat psychotic disorders such as mania and schizophrenia and their associated anxieties, intractable hiccups, and nausea and vomiting. Seizures and bone marrow suppression are contraindications to the use of antidopaminergic drugs. p. 817

Which antiemetic would the nurse expect to be prescribed in addition to ondansetron to enhance its effects for a patient receiving cisplatin intravenously to treat breast cancer? Select all that apply. One, some, or all responses may be correct. Aprepitant Scopolamine Promethazine Prochlorperazine

Aprepitant Aprepitant is an antagonist against substance P-neurokinin 1 receptors in the brain. It works to augment the effects of ondansetron. Scopolamine is a transdermal patch used to alleviate nausea due to motion sickness. Promethazine and prochlorperazine are used to manage postoperative nausea and vomiting. p. 820

Which antiemetic drug would the nurse anticipate for a patient who has been prescribed a high-dose regimen of cisplatin and develops severe nausea and vomiting? Aprepitant Ondansetron Lorazepam Metoclopramide

Aprepitant Cisplatin is a highly emetogenic anticancer drug. The primary health care provider may prescribe aprepitant, because it has high antiemetic activity due to direct selective blockade of neurokinin 1 receptors in the brain. Ondansetron is a moderately active antiemetogenic agent used in the treatment of chemotherapy-induced nausea and vomiting. Lorazepam is an anxiolytic that can be coadministered with antiemetic agents to blunt the memory of nausea and vomiting in patients undergoing chemotherapy. Metoclopramide is not effective for the treatment of severe nausea and vomiting associated with cisplatin use. p. 820

Which action will the nurse perform before administering dronabinol? Assess baseline vital signs and age Assess motor and cognitive abilities Assess nutritional wasting syndrome Assess imbalance between neurotransmitters

Assess motor and cognitive abilities Dronabinol is administered as a second-line antiemetic drug for the treatment of nausea and vomiting associated with chemotherapy when other antiemetics have failed to work. The nurse must assess motor and cognitive abilities before administration because of the drug's inhibitory action on the thalamus and cerebral cortex in the brain. Baseline vital signs and age must be assessed upon prescription of the serotonin blocker granisetron. Nutritional wasting syndrome is common in patients with cancer subjected to chemotherapy. Imbalance of electrolytes has to be assessed; imbalance between neurotransmitters is corrected by scopolamine. p. 823

Which recommendation would the US Food and Drug Administration (FDA) make for a medication initially effective in patients who have cancer and experience nausea and vomiting associated with chemotherapy that, during postmarketing surveillance, is found to produce ventricular dysrhythmias? Prescribe for the treatment of nausea and vomiting in geriatric patients. Avoid prescribing for patients who have been prescribed chemotherapy. Avoid prescribing for patients with hypertension and cardiac arrhythmia. Prescribe in low doses for the treatment of nausea associated with chemotherapy.

Avoid prescribing for patients who have been prescribed chemotherapy. Some drugs may be effective in the initial stages of treatment. However, they cause some adverse effects such as ventricular dysrhythmias if they are administered over the long term. According to the FDA, such medications cannot be prescribed for the treatment of nausea and vomiting associated with chemotherapy. Low doses of the antiemetic drug may not produce the desired antiemetic effect. Although the FDA recommends it be banned throughout the country, some institutions still use it. Geriatric patients and patients with hypertension and cardiac arrhythmias are not populations that fit with the use of this medication. p. 820

Which instruction would the nurse provide to a patient who has been prescribed metoclopramide? Avoid taking anticholinergics and opiates. Administer dolasetron in the first 24 to 48 hours of radiation therapy. Blurred vision is an adverse effect of radiation therapy. Avoid driving and other activities that require mental alertness.

Avoid taking anticholinergics and opiates. The nurse would instruct the patient to avoid taking anticholinergics and opiates because the action of metoclopramide will be decreased when it is taken along with those drugs. Blurred vision is an adverse effect of antiemetic therapy. Dolasetron is given in the first 24 to 48 hours of chemotherapy. The nurse would not instruct the patient to avoid driving. When the patient is being treated with suppository forms of promethazine, the patient should be instructed to avoid driving and other activities that require motor coordination or mental alertness. p. 822

Which information would the nurse include regarding adverse effects when providing education to a patient newly prescribed scopolamine for nausea prevention due to motion sickness? Select all that apply. One, some, or all responses may be correct. Monitor heart rate Change positions slowly Increase dietary fiber intake Report extrapyramidal effects Use hard candy for mouth dryness

Change positions slowly Increase dietary fiber intake Use hard candy for mouth dryness Adverse effects of scopolamine include dizziness, constipation, and dry mouth. Therefore, the nurse would instruct the patient to change positions slowly, increase dietary fiber, and use hard candy for mouth dryness. The nurse would instruct the patient to monitor the heart rate if taking neurokinin receptor antagonists. Antidopaminergic drugs can cause extrapyramidal effects. p. 818

Which laboratory report will the nurse review for a patient who is taking warfarin and is prescribed aprepitant? Red blood cell count Clotting time of blood White blood cell count Hemoglobin concentrations

Clotting time of blood The nurse would assess clotting time from the laboratory test reports, based on which the international normalized ratio is established. In this situation, aprepitant interacts with warfarin and increases the clotting time of blood. Red blood cell count and hemoglobin concentrations should be assessed in pregnant patients with anemia. White blood cell count is assessed in pregnant patients who are susceptible to infections. p. 820, 821

Which reason explains why combining antiemetic medications is preferred? The risk of constipation is decreased. Different vomiting pathways are blocked. Lower doses of medication are cost-effective. Increased sedation is achieved by higher doses of medication.

Different vomiting pathways are blocked. Combining antiemetic drugs from various categories allows blocking of the vomiting center and chemoreceptor trigger zone through different pathways, thus enhancing the antiemetic effect. Risk of constipation, cost-effectiveness, and increased sedation are not reasons for combination therapy when planning administration of antiemetic medications. p. 816

Which advice would the nurse provide to a pregnant woman who takes warfarin for venous thrombosis prophylaxis and states that she takes ginger daily for nausea? Discontinue taking ginger. Take ginger in large quantities. Continue administration of warfarin in low doses. Administer ginger with honey for immediate relief.

Discontinue taking ginger. The nurse would advise the patient to stop taking ginger, because it has abortifacient properties. It is effective for relieving symptoms of nausea and vomiting caused by chemotherapy. The nurse would not suggest that the patient administer ginger in large quantities, due to its abortifacient properties. Ginger with honey helps relieve the symptoms of nausea but cannot be suggested to the pregnant patient because it has abortifacient properties. Administering warfarin in low doses may not be effective in the prevention of venous thrombosis. p. 823

Which action would the nurse take when after administering an intravenous (IV) dose of promethazine the patient reports burning at the IV site? Select all that apply. Discontinue the infusion Dilute the drug with saline Slow the rate of administration Change the route to a suppository

Discontinue the infusion If the patient experiences burning at the IV site, the nurse would immediately discontinue the infusion and start a new IV. The nurse would dilute the medication prior to administration. Slowing the rate of infusion can damage the tissue if the medication was leaking out of the veins. The health care provider would change the route only if the patient did not have a working IV catheter. p. 820

Which condition might the patient with dehydration experience? Select all that apply. One, some, or all responses may be correct. Dizziness Dry mouth Bradycardia Hypertension Bronchospasm

Dizziness Dry mouth Dehydration is caused by the loss of water from the body, which leads to dry mouth, dizziness, and decreased urinary output. Tachycardia, not bradycardia, occurs during periods of stress and pain but not during dehydration. Hypotension, not hypertension, occurs with dehydration. Bronchospasm occurs because of constriction of bronchioles and is not related to hydration status. p. 823

The nurse is caring for a patient diagnosed with cancer who experiences nausea and vomiting and has now been prescribed ondansetron. After administering the medication, the nurse finds that the symptoms persist. Which medication will the primary health care provider prescribe for the patient with this condition? Dronabinol Dolasetron Granisetron Promethazine

Dronabinol Dronabinol is prescribed for patients with cancer because it has been approved by the US Food and Drug Administration as a second-line drug to treat nausea and vomiting related to chemotherapy when treatment with other antiemetics have failed. Dolasetron and granisetron are the first-line drugs used to treat nausea and vomiting associated with chemotherapy. Promethazine is not sufficient for the treatment of more severe nausea symptoms such as those associated with chemotherapy. p. 821

Which adverse effect would the nurse teach regarding anticholinergic drugs to treat nausea and vomiting? Diarrhea Dry mouth Bradycardia Lacrimation

Dry mouth Anticholinergic drugs block the parasympathetic nervous system, which causes the body to "rest and digest." Blocking of these effects leads to constipation, urinary retention, and decreased secretions (dry mouth). Diarrhea, bradycardia, and lacrimation are not expected adverse effects of this drug. p. 818

Which side effect would the nurse include in the teaching plan for a patient who is prescribed an anticholiergic drug for the treatment of nausea and vomiting? Select all that apply. One, some, or all responses may be correct. Diarrhea Sedation Dry mouth Bradycardia Constipation

Dry mouth Constipation Anticholinergic drugs act by binding and blocking acetylcholine receptors in the gastrointestinal tract, thereby reducing secretions and causing dry mouth as a side effect. Constipation occurs due to the administration of anticholinergic agents. Diarrhea and sedation result from the administration of prokinetic agents. Tachycardia is an adverse effect of anticholinergics. p. 818

Which condition would cause the nurse to request an alternate prescription to scopolamine? Glaucoma Gastroenteritis Hyperthyroidism Rheumatoid arthritis

Glaucoma Anticholinergic drugs are contraindicated in patients with glaucoma. These drugs can cause pupillary dilation, which can obstruct the flow of aqueous humor and increase intraocular pressure. Gastroenteritis, hyperthyroidism, and rheumatoid arthritis are not contraindications for anticholinergic drugs. p. 820

A patient preparing to travel asks about the use of scopolamine for motion sickness. Which finding in the patient's health history would make this drug contraindicated for use? Glaucoma Neutropenia Seizure disorder Atrial fibrillation

Glaucoma Patients with glaucoma should avoid the use of scopolamine as it is an anticholinergic drug that can affect fluid levels in the aqueous humor. Prochlorperazine is contraindicated in patients with bone marrow suppression such as neutropenia and seizure disorders. Antidopaminergics such as prochlorperazine and promethazine can widen the QT interval and cause dysrhythmias. Therefore, patients with dysrhythmias should use other antiemetics. p. 820

Which is the correct procedure to administer diphenhydramine to the patient? Intramuscularly in the deltoid In a single dose at a rate of 25 mg/min In an undiluted form while the patient is sleeping By adding metoclopramide for synergistic action

In a single dose at a rate of 25 mg/min Diphenhydramine should be administered via the intravenous route at a rate of 25 mg/min. Diphenhydramine is a commonly used antihistamine antiemetic and is administered in an undiluted form for effective treatment and faster action; however, an older adult may be hypersensitive to the drug, which can lead to oversedation. The nurse would administer this medication while the patient is awake to assess for level of consciousness before giving it. It is recommended to administer this medication into a large muscle if giving intramuscularly. Administering in combination with other medications such as metoclopramide can cause side effects, including sedation and gastrointestinal upset. p. 823

Which adverse condition is likely to be found in a patient taking scopolamine for the last 2 weeks? Increased blood glucose levels Increased intraocular pressure Increased nausea and vomiting Increased serum creatinine levels

Increased intraocular pressure Scopolamine is an anticholinergic medication that inhibits the binding of acetylcholine (ACh) with cholinergic receptors. It causes an imbalance of ACh and norepinephrine and increases the lachrymal secretions, resulting in increased intraocular pressure. Therefore scopolamine is contraindicated in a patient with narrow-angle glaucoma. Scopolamine does not impair insulin production and does not cause an increase in blood glucose levels. Scopolamine is an antiemetic medication and does not cause nausea and vomiting. Scopolamine does not impair renal function, as indicated by increased serum creatinine levels. p. 820

Which medication would the nurse anticipate may be added to the treatment plan for a patient who has been prescribed ondansetron for the prevention of chemotherapy-induced nausea and vomiting? Select all that apply. One, some, or all responses may be correct. Atenolol Morphine Lorazepam Dronabinol Dexamethasone

Lorazepam Dronabinol Dexamethasone Nausea and vomiting are common side effects of anticancer drugs. Antiemetic drugs are prescribed to prevent these side effects. Ondansetron, which is a serotonin receptor blocker, can be prescribed in combination with lorazepam, dronabinol, and dexamethasone. It produces a synergistic effect and prevents the symptoms of nausea and vomiting. Atenolol is an antihypertensive drug and is not prescribed in combination with serotonin receptor blockers because it may cause hypotension. Morphine is prescribed for the relief of cancer pain but not to prevent symptoms of nausea and vomiting. p. 819

Which antiemetic drug would the nurse anticipate to be ordered for a pregnant patient? Select all that apply. One, some, or all responses may be correct. Warfarin Meclizine Aprepitant Propranolol Metoclopramide

Meclizine Metoclopramide The primary health care provider prescribes meclizine and metoclopramide because they are used to treat nausea and vomiting associated with pregnancy. Warfarin should not be prescribed, because it increases the risk of bleeding. Aprepitant should not be prescribed, because it reduces the effectiveness of oral contraceptives. Propranolol is a beta blocker, and it is prescribed for the treatment of hypertension, not to reduce the symptoms of nausea and vomiting. p. 819

The nurse is reviewing the assessment data of a patient who requests an antiemetic due to nausea and vomiting. Based on the findings, which drug would be contraindicated? Assessment Data Temperature 97.5° F (36.4° C) Heart rate 74 beats/min Respirations 13 breaths/min Blood pressure 112/66 mmHg Oxygen saturation 95% 2 L O2 nasal cannula Alert and oriented x 4 Breath sounds diminished bases Absent bowel sounds Peripheral pulses 1+ bilaterally Lorazepam Ondansetron Metoclopramide Prochlorperazine

Metoclopramide Metoclopramide is a prokinetic drug that increases gastrointestinal motility. If the nurse administered this drug to a patient with absent bowel sounds, this could cause a bowel rupture. It would be safe to administer lorazepam, ondansetron, and prochlorperazine to this patient. p. 821

Which drug can cause tardive dyskinesia as an adverse effect? Ondansetron Promethazine Metoclopramide Prochlorperazine

Metoclopramide The long-term use of metoclopramide produces an adverse effect of involuntary neurologic movements called tardive dyskinesia. Promethazine induces sedation in users. Long-term use of ondansetron and prochlorperazine has not been known to cause tardive dyskinesia. p. 821

The nurse is preparing to administer a dose of ondansetron to a patient who has been vomiting. Based on the patient's history below, which action would the nurse take after administering the dose? Health History Hypertension DyslipidemiaAtrial fibrillation Depression Ovarian cancer Evaluate pain rating Obtain blood pressure Monitor cardiac rhythm Assess for extrapyramidal effects

Monitor cardiac rhythm Ondansetron and the other serotonin blockers can prolong the QT interval. Since the patient has a history of a dysrhythmia, the nurse would monitor the patient's cardiac rhythm. The nurse would assess the patient's pain rating after giving an analgesic. Blood pressures would be assessed after giving an antihypertensive. The nurse would assess for extrapyramidal effects in patients taking antidopaminergic antiemetics. p. 821

Which nursing intervention helps prevent complications in a patient who is scheduled for a tonsillectomy and has been prescribed metoclopramide? Providing a fiber-rich diet to the patient Monitoring the patient's blood pressure Providing a potassium-rich diet to the patient Monitoring the patient's thyroid hormone levels

Monitoring the patient's blood pressure Metoclopramide is a prokinetic that acts as a dopamine antagonist and helps prevent postoperative nausea and vomiting. Metoclopramide decreases dopamine levels and causes hypotension. Therefore the nurse should monitor the patient's blood pressure to prevent complications from the adverse effects of the medication. p. 818

Which condition will cause concern for a patient taking scopolamine for motion sickness? Narrow-angle glaucoma Color and turgor of skin Longitudinal furrows on tongue Dryness of mucous membranes

Narrow-angle glaucoma The nurse must assess the patient's medical history for narrow-angle glaucoma, because the drug is contraindicated in this situation. Color and turgidity of the skin and longitudinal furrows on the tongue have to be assessed when a patient is prescribed promethazine. Dryness of mucous membranes must be assessed with the administration of serotonin blockers such as ondansetron. p. 820

Which site is appropriate for the application of a scopolamine patch? On the chest On the shoulder On the irritated skin On a hairless area behind the ear

On a hairless area behind the ear The scopolamine transdermal patch should be applied on an area of intact skin on the head behind the ear after cleaning and drying the area to reduce secretions. The patch may be dislodged if applied to irritated skin, the shoulder, or the chest. If the patch becomes dislodged, residual drug must be washed off and a fresh patch must be placed to produce the desired effect. p. 819

Which drug will the nurse expect to be added to the treatment plan along with the chemotherapeutic agent for a patient who has developed nausea and vomiting? Ondansetron Scopolamine Promethazine Diphenhydramine

Ondansetron Ondansetron blocks serotonin receptors in the gastrointestinal tract, chemoreceptor trigger zone (CTZ), and vomiting center of the brain, thereby preventing chemotherapy-associated nausea and vomiting. Diphenhydramine, which blocks H1 receptors, thereby preventing acetylcholine from binding to receptors in the vestibular nuclei, is used in the treatment of motion sickness-associated nausea and vomiting. Promethazine, which blocks dopamine in the CTZ and may also block acetylcholine, is used to treat nausea and vomiting associated with psychotic disorders. Scopolamine, which blocks acetylcholine receptors in the vestibular nuclei and reticular formation, is used to treat nausea and vomiting associated with motion sickness. p. 821

Which drug works by blocking serotonin in the gastrointestinal tract, vomiting center, and chemoreceptor trigger zone? Metoclopramide Meclizine Droperidol Ondansetron

Ondansetron Ondansetron is a serotonin blocker. Metoclopramide is a prokinetic drug, meclizine is an antihistamine, and droperidol is an antidopaminergic drug.Test-Taking Tip: Read the question carefully before looking at the answers: (1) determine what the question is really asking and look for key words, (2) read each answer thoroughly to see whether it completely covers the material asked by the question, and (3) narrow the choices by immediately eliminating answers you know are incorrect. p. 817

Which drug acts by blocking serotonin receptors in the gastrointestinal (GI) tract, vomiting center of the brain, and chemoreceptor trigger zone (CTZ)? Meclizine Droperidol Ondansetron Metoclopramide

Ondansetron Ondansetron is an antiserotonergic agent that acts by blocking serotonin receptors in the GI tract, vomiting center of the brain, and CTZ. Meclizine is an antihistamine and anticholinergic agent that blocks histamine H1 receptors. Droperidol is an antidopaminergic agent that acts by blocking dopamine receptors. Metoclopramide is a prokinetic agent and acts by blocking dopamine receptors (it is a dopamine antagonist). p. 816, 817

Which antinausea drug would the nurse expect to be prescribed for a patient who is pregnant and experiencing morning sickness? Dolasetron Palonosetron Promethazine Ondansetron

Ondansetron The patient should be administered ondansetron to relieve nausea associated with morning sickness during pregnancy. Palonosetron and dolasetron are prescribed to treat nausea and vomiting in patients with cancer and postoperative patients. Promethazine is a pregnancy category C drug and is not prescribed for pregnant patients because it has teratogenic effects. p. 821

Which medication can be prescribed for the treatment of hyperemesis gravidarum? Ondansetron Dronabinol Dimenhydrinate Diphenhydramine

Ondansetron Vomiting and nausea during pregnancy is called hyperemesis gravidarum. Ondansetron is a serotonin blocker that blocks serotonin receptors in the vomiting center in the medulla and prevents emesis. It is prescribed for the treatment of hyperemesis gravidarum. Dronabinol, a tetrahydrocannabinoid class of drug, inhibits the activity of the reticular formation in the thalamus and cerebral cortex. It is prescribed for the treatment of nausea and vomiting induced by anticancer drugs. Diphenhydramine and dimenhydrinate are H1 receptor blockers that prevent acetylcholine from binding to receptors in the vestibular nuclei. They are not generally prescribed to treat hyperemesis gravidarum. p. 821

Which drug will the nurse expect to be added to the treatment plan to enhance the antiemetic effect of aprepitant? Select all that apply. One, some, or all responses may be correct. Warfarin Verapamil Ondansetron Dexamethasone Methylprednisolone

Ondansetron Dexamethasone Methylprednisolone Ondansetron can be added to the treatment plan because it augments the antiemetic effect of aprepitant. Dexamethasone and methylprednisolone are corticosteroids, which interact with aprepitant and increase its bioavailability, so they can be added. Warfarin induces the metabolism of aprepitant, thereby increasing the international normalized ratio, leading to increased risk of bleeding. Therefore it should not be added to the treatment plan. Verapamil is metabolized through the cytochrome P450 enzyme, which is inhibited by aprepitant. As a result, the plasma concentrations of these drugs increase, leading to decreased efficacy of the antiemetic aprepitant. Therefore it should not be added to the treatment plan. p. 820

Which route would be correct for administering hydroxyzine? Select all that apply. One, some, or all responses may be correct. Oral route Intraarterial route Intramuscular route Intravenous route Subcutaneous route

Oral route Intramuscular route Hydroxyzine belongs to the antihistamine class of antiemetic drugs. This drug should be cautiously administered by oral and intramuscular routes only. If hydroxyzine is administered by intraarterial, intravenous, or subcutaneous routes, it can cause tissue damage, thrombosis, and gangrene. p. 820

A patient informs the nurse of uncontrolled facial and tongue movements over the past 48 hours. After reviewing the medication administration record, which medication is most likely the cause of these symptoms? Medication Administration Record Cisplatin 100 mg IV every 4 weeks Lisinopril 10 mg PO dailyMegestrol 125 mg PO daily Prochlorperazine 5 mg PO Q 6 hours PRN Cisplatin Lisinopril Megestrol Prochlorperazine

Prochlorperazine The patient is experiencing extrapyramidal effects, which is an adverse effect of prochlorperazine. Cisplatin is a chemotherapy drug that causes pancytopenia. Lisinopril is an antihypertensive medication. Megestrol is used to increase the appetite in patients undergoing chemotherapy. Cisplatin, lisinopril, and megestrol do not cause extrapyramidal reactions. p. 818

Which drug does the nurse anticipate will be prescribed for a patient who has narrow-angle glaucoma and reports nausea and vomiting? Meclizine Promethazine Dimenhydrinate Diphenhydramine

Promethazine The antidopaminergic drug promethazine is prescribed for patients with narrow-angle glaucoma who are suffering from nausea and vomiting. The drugs meclizine, diphenhydramine, and dimenhydrinate are antihistamines and are not used in patients with narrow-angle glaucoma. p. 822

Which action of metoclopramide results in a reduction of postoperative nausea and vomiting? Promotes motility in the small intestine Decreases chemoreceptor stimulation Improves the body's response to analgesia Decreases motility in the gastrointestinal (GI) tract

Promotes motility in the small intestine minimizing gastric distention and accompanying stimulation of the vomiting center. Metoclopramide does not work by decreasing chemoreceptor stimulation, improving the body's response to analgesia, or decreasing motility in the GI tract. p. 821

Which would be a possible reaction in a patient after administration of dronabinol? Reduced symptoms of vertigo Reduced symptoms of rhinitis Reduced symptoms of sedation Reduced symptoms of glaucoma

Reduced symptoms of glaucoma The drug dronabinol benefits patients with cancer who are experiencing nausea and vomiting. It reduces the symptoms of glaucoma by decreasing the intraocular pressure in the eye. Antihistamines are used in the treatment of vertigo, rhinitis, and sedation. p. 818

Which anticholinergic drug is commonly used to prevent motion sickness? Droperidol Scopolamine Prochlorperazine Metoclopramide

Scopolamine Scopolamine blocks the binding of acetylcholine with cholinergic receptors in the inner ear, an imbalance of which is a common cause of motion sickness. Droperidol and prochlorperazine are antidopaminergics. Metoclopramide is a prokinetic drug. p. 817

Which combination of drugs does the nurse suspect is causing dry mouth, constipation, and urinary retention in a patient who is receiving medication to control nausea and vomiting? Scopolamine with meclizine Meclizine with benzodiazepines Dronabinol with metoclopramide Ondansetron with tetrahydrocannabinol

Scopolamine with meclizine Anticholinergics such as scopolamine block the binding of acetylcholine to the receptors and cause dry mouth, constipation, and urinary retention. Anticholinergics interact with antihistamines such as meclizine and cause an additive, drying effect. Therefore taking a combination of scopolamine and meclizine increases the severity of dry mouth, constipation, and urinary retention. Antihistamines such as meclizine and benzodiazepines used concomitantly have central nervous system depressant actions. Serotonin blockers such as ondansetron, when used in combination with tetrahydrocannabinoids, do not cause dryness of mouth, constipation, and urinary retention. Tetrahydrocannabinoids such as dronabinol and prokinetics such as metoclopramide do not have anticholinergic effects. p. 818

Which class of drugs is helpful for nausea and vomiting associated with chemotherapy? Antihistamines Anticholinergics Antidopaminergics Serotonin blockers

Serotonin blockers Serotonin blockers are useful in the treatment of nausea and vomiting associated with chemotherapy. Antihistamines are used in the treatment of motion sickness, nonproductive cough, sedation, rhinitis, and allergy symptoms. Anticholinergics are used in the treatment of motion sickness and secretion. Antidopaminergics are used in the treatment of psychotic disorders. p. 817

Which class of drug is used along with commonly prescribed antiemetics to prevent nausea and vomiting associated with chemotherapy? Select all that apply. One, some, or all responses may be correct. Anxiolytics Corticosteroids Serotonin blockers Tetrahydrocannabinoids Phosphorated carbohydrate solutions

Serotonin blockers Tetrahydrocannabinoids Serotonin blockers and tetrahydrocannabinoids are commonly used antiemetics that prevent nausea and vomiting associated with chemotherapy. Phosphorated carbohydrate solutions are used for minor nausea and vomiting, not severe nausea and vomiting associated with chemotherapy. Anxiolytics such as lorazepam are used to blunt the memory of the nausea and vomiting experienced by patients undergoing chemotherapy. Corticosteroids such as dexamethasone prevent immune reactions such as bone marrow suppression associated with chemotherapy. p. 817

The nurse is preparing to administer dronabinol to a patient with nausea and vomiting related to chemotherapy. Prior to giving the dose, which laboratory parameter would the nurse assess? Select all that apply Lipid panel Serum electrolytes Liver function tests Complete blood count

Serum electrolytes The nurse would assess fluid and electrolyte status prior to beginning treatment. Therefore, serum electrolytes would be assessed. The nurse would assess lipid panels for patients with dyslipidemia. Liver function tests would be monitored in patients receiving hepatotoxic medications. A complete blood count would be monitored in patients receiving chemotherapeutic drugs, not antiemetics. p. 823

Which class of drugs is used to treat the patient with acquired immunodeficiency syndrome (AIDS) who reports anorexia associated with weight loss? Antihistamines Anticholinergics Antidopaminergics Tetrahydrocannabinoids

Tetrahydrocannabinoids Tetrahydrocannabinoids are useful in the treatment of anorexia associated with weight loss because they alter mood and stimulate the appetite. Antihistamines and anticholinergics are used in the treatment of nausea and vomiting associated with motion sickness, rhinitis, and allergic symptoms. Antidopaminergics are used in the treatment of nausea, vomiting, and intractable hiccups. p. 818

Which side effect would the nurse teach to a patient prescribed dronabinol? The patient may lose weight The patient may gain weight The patient may have amnesia The patient may have glaucoma

The patient may gain weight The patient who has been prescribed dronabinol may gain weight, because the drug stimulates the appetite and avoidance from wasting syndrome. Lorazepam often is used in the treatment and prevention of chemotherapy-induced nausea and vomiting. Dronabinol does not cause amnesia or loss of memory. The drug also demonstrates some benefit in controlling the symptoms of glaucoma. p. 818

Which nursing assessment should be performed before administering promethazine for nausea and vomiting? The patient's vital signs Alterations in the patient's mood The patient's motor and cognitive abilities The patient's international normalized ratio (INR)

The patient's vital signs The adverse effects of promethazine are orthostatic hypotension and tachycardia. Therefore, to prevent these adverse effects, the nurse would assess vital signs such as blood pressure and pulse rate. Altered mood and motor and cognitive abilities should be monitored when dronabinol is prescribed. The patient's international normalized ratio (INR) should be monitored when aprepitant is prescribed. p. 822

At which time would the nurse administer metoclopramide? In combination with opiates In combination with phenothiazines Thirty minutes before meals and at bedtime After meals to decrease gastrointestinal upset

Thirty minutes before meals and at bedtime Metoclopramide is a prokinetic antiemetic drug and should be administered 30 minutes before meals to increase intestinal motility. It distends the stomach and delays gastric emptying, thereby reducing nausea and vomiting. It should not be administered in combination with opiates, because its activity is decreased. It should not be given in combination with phenothiazines, because it could lead to the exacerbation of extrapyramidal reactions. The medication must be given before meals for better absorption and efficacy. p. 819

Which is the correct administration procedure for metoclopramide? Every 6 hours around the clock With food to decrease gastrointestinal upset Thirty minutes before meals and at bedtime With a full glass of water, first thing in the morning

Thirty minutes before meals and at bedtime Metoclopramide should be administered 30 minutes before meals and at bedtime. Administering the medication before meals allows time for onset to increase gastrointestinal motility before food ingestion, thus decreasing stomach distention and the resulting nausea and vomiting. It is not administered every 6 hours or first thing in the morning. It is given 30 minutes before meals, not with meals. p. 824

Which reason explains why the nurse performs a skin turgor assessment before administering promethazine? To assess for signs and symptoms of dehydration To assess for adverse effects of tachycardia and urinary retention To assess for drug interactions between anticholinergics and promethazine To assess for adverse effects of orthostatic hypotension and tardive dyskinesia

To assess for signs and symptoms of dehydration Antidopaminergic drugs such as promethazine are to be used only after cautious assessment for signs and symptoms of dehydration and electrolyte imbalance by evaluating skin turgor. Skin turgor is a sign commonly used to assess the degree of fluid loss or dehydration. The nurse must monitor vital signs such as blood pressure and pulse rate to assess for the adverse effects of tachycardia and orthostatic hypotension. The drug interactions between anticholinergics and prokinetic drugs should be assessed before administering prokinetic drugs, because the action of a drug may be decreased. The nurse would monitor fluid intake and the frequency of urination to assess the adverse effects of urinary retention. The nurse would monitor muscle movements to assess for the adverse effects of tardive dyskinesia. p. 822

Which procedure will the nurse use to administer diphenhydramine intravenously? Undiluted over 1 minute Undiluted over 2 minutes Diluted in 100 mL D5W over 20 minutes Diluted in 50 mL normal saline over 30 minutes

Undiluted over 2 minutes Diphenhydramine is recommended to be administered undiluted at a rate of 25 mg/min. Any other method of administration is incorrect. p. 823

Which laboratory test would the nurse expect to be ordered for a patient prescribed dronabinol twice a day? Electrolyte levels Blood urea nitrogen levels Blood hemoglobin levels Urinalysis with specific gravity

Urinalysis with specific gravity A patient with cancer who has been prescribed dronabinol twice a day may experience low urine output. The drug prevents the recurrence of chemotherapy-induced nausea and vomiting. The nurse may evaluate urinalysis with a specific gravity laboratory test report to check the frequency of urine output. Electrolyte levels may be evaluated if additional medications are administered along with antiemetic and antinausea drugs to prevent dehydration. Blood urea nitrogen levels and blood hemoglobin levels need not be evaluated with the administration of this drug. p. 824

Which clinical condition is an indication for meclizine? Select all that apply. One, some, or all responses may be correct. Vertigo Secretion Motion sickness Delayed gastric emptying Gastroesophageal reflux

Vertigo Motion sickness The antihistaminic drug meclizine is used in the treatment of vertigo and motion sickness. Metoclopramide is used in the treatment of delayed gastric emptying and gastroesophageal reflux. Scopolamine is used to reduce secretion before surgery. p. 819

Which is the correct administration procedure for promethazine in suppository form? With meals Via the oral route Via the rectal route By moistening it with petrolatum

Via the rectal route The nurse administers the medication promethazine via the rectal route because it is prescribed in suppository form. Because the drug is administered by the rectal route, its absorption is not altered by food. Therefore the nurse can administer the medication to the patient before or after meals. After unwrapping the foil, the suppository should be moistened with water before insertion into the rectum. Saline or a water-insoluble base must not be used because it can degrade the medication and can cause allergy in the patient. Because the primary health care provider prescribed the suppository form of the drug, it cannot be administered via the oral route. p.823