Nokea
A patient is on a chemotherapy regimen in an outpatient clinic and is receiving a chemotherapy drug that is known to be highly emetogenic. The nurse will implement which interventions regarding the pharmacologic management of nausea and vomiting? (Select all that apply.)
- A. Giving antinausea drugs at the beginning of the chemotherapy infusion
- B. Administering antinausea drugs 30 to 60 minutes before chemotherapy is started
- C. For best therapeutic effects, medicating for nausea once the symptoms begin
- D. Observing carefully for the adverse effects of restlessness and anxiety
- E. Instructing the patient that the antinausea drugs may cause extreme drowsiness
- F. Instructing the patient to rise slowly from a sitting or lying position because of possible orthostatic hypotension
Correct Answer: B,E,F
Rationale: Antiemetics should be given before any chemotherapy drug is administered, often 30 to 60 minutes before treatment, but not immediately before chemotherapy is administered. Do not wait until the nausea begins. Most antiemetics cause drowsiness, not restlessness and anxiety. Orthostatic hypotension is a possible adverse effect that may lead to injury.
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A woman who is in the first trimester of pregnancy has been experiencing severe morning sickness. She asks, 'I've heard that ginger tablets may be a natural way to ease the nausea and vomiting. Is it okay to try them?' What is the nurse's best response?
- A. They are a safe and natural remedy for nausea when you are pregnant.
- B. Go ahead and try them, but stop taking them once the nausea is relieved.
- C. Some health care providers do not recommend ginger during pregnancy. Let's check with your provider.
- D. You will need to wait until after the first trimester to try them.
Correct Answer: C
Rationale: There is some anecdotal evidence that ginger may have abortifacient properties, and for this reason some providers do not recommend its use during pregnancy.
A patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates an order for which antinausea drug to stimulate his appetite?
- A. Metoclopramide, a prokinetic drug
- B. Dronabinol, a tetrahydrocannabinoid
- C. Ondansetron, a serotonin blocker
- D. Aprepitant, a substance P/NK1 receptor antagonist
Correct Answer: B
Rationale: Dronabinol is used for the treatment of nausea and vomiting associated with cancer chemotherapy, generally as a second-line drug after treatment with other antiemetics has failed. It is also used to stimulate appetite and weight gain in patients with AIDS and in patients undergoing chemotherapy.
The nurse is reviewing new postoperative orders and notes that the order reads, 'Give hydroxyzine 50 mg IV PRN nausea or vomiting.' The patient states that he has slight nausea. Which action by the nurse is correct at this time?
- A. Hold the dose until the patient states that the nausea is severe.
- B. Give the dose orally instead of intravenously.
- C. Give the patient the IV dose of hydroxyzine as ordered.
- D. Call the prescriber to question the route that is ordered.
Correct Answer: D
Rationale: The nurse needs to question the route. Hydroxyzine is an antihistamine-class antiemetic that is only to be given either by oral or intramuscular routes. Intravenous, intra-arterial, or subcutaneous administration of hydroxyzine may result in significant tissue damage, thrombosis, and gangrene. Antiemetic drugs are best given before the patient's nausea becomes severe.
A patient on chemotherapy is using ondansetron for treatment of nausea. The nurse will instruct the patient to watch for which adverse effect of this drug?
- A. Dizziness
- B. Diarrhea
- C. Dry mouth
- D. Blurred vision
Correct Answer: B
Rationale: Diarrhea is an adverse effect of the serotonin blockers. The other adverse effects listed may occur with anticholinergic drugs.
A patient who has been newly diagnosed with vertigo will be taking an antihistamine antiemetic drug. The nurse will include which information when teaching the patient about this drug?
- A. The patient may skip doses if the patient is feeling well.
- B. The patient will need to avoid driving because of possible drowsiness.
- C. The patient may experience occasional problems with taste.
- D. It is safe to take the medication with a glass of wine in the evening to help settle the stomach.
Correct Answer: B
Rationale: Drowsiness may occur because of central nervous system (CNS) depression, and patients should avoid driving or working with heavy machinery because of possible sedation. These drugs must not be taken with alcohol or other CNS depressants because of possible additive depressant effects. The medication should be taken as instructed and not skipped unless instructed to do so.