N/V Flashcards
- A 52-year-old man presents with chronic lower back pain that he has managed with ibuprofen 400 mg PO three times daily. He reinjured his back moving boxes and 2 days ago was started on hydrocodone 5 mg/acetaminophen 325 mg every 4 hours as needed for pain. He also has a
history of hypertension and asthma for which he takes lisinopril 20 mg daily,
hydrochlorothiazide 25 mg daily, fluticasone 250 mcg/salmeterol 50 mcg twice daily, and albuterol MDI two puffs as needed for shortness of breath. Today he complains of nausea with one episode of vomiting this morning. What is most likely to be causing his nausea and vomiting?
A. Lisinopril
B. Hydrochlorothiazide
C. Hydrocodone
D. Acetaminophen
E. Fluticasone
C
- All of the following are true regarding nausea except:
A. It is an objective finding
B. It is accompanied by tachycardia
C. It increases salivation
D. It is accompanied by diaphoresis
A
- The adverse effects of doxylamine include:
A. Salivation, diarrhea, insomnia
B. Drymouth, constipation, drowsiness
C. Salivation, constipation, insomnia
D. Drymouth, diarrhea, drowsiness
B
- Benzodiazepines are associated with all of the following adverse effects except:
A. Respiratory depression
B. Sedation
C. Dyskinesia
D. Amnesia
C
- A 57-year-old obese woman is scheduled to undergo lengthy abdominal surgery. She smokes one pack of cigarettes per day, does not drink alcohol, and has a history of motion sickness. Which set of risk factors predisposes this patient to postoperative nausea and vomiting (PONV)?
A. Female sex, smoking history, and alcohol history
B. Body habitus, history of motion sickness, and alcohol history
C. Female gender, history of motion sickness, and duration of surgery
D. Body habitus, smoking history, and alcohol history
E. Female gender, history of motion sickness, and smoking history
C
- Nonpharmacologic treatment options for motion sickness include:
A. Increasing exposure to movement to acclimate to it more quickly
B. Reading in a moving vehicle to distract from the motion
C. Restricting ventilation to prevent olfactory stimulation of motion sickness
D. Placing the head between the knees to reduce visual stimulation
E. Sitting in the center of a boat to reduce the magnitude of the movement
E
- Which of the following statements about aprepitant is true?
A. It is a 5-HT3 antagonist
B. It is ineffective for prevention of PONV
C. It is renally eliminated
D. It prevents acute and delayed CINV when used with standard antiemetics
D
- A 58-year-old man is undergoing surgical toe amputation. He does not have patient-specific risk factors for PONV, and his surgery will be short with minimal risks for PONV. He was not given PONV prophylaxis prior to the procedure but experiences nausea and vomiting in the post-anesthesia care unit. The nurse asks you for a treatment recommendation. Which of the following options is the best recommendation?
A. Diphenhydramine 25 mg orally
B. Ondansetron 8 mg orally
C. Scopolamine transdermal patch
D. Granisetron 0.1 mg IV
E. Dexamethasone 5 mg IV
D
- A 62-year-old woman with acute myeloid leukemia is in clinic to receive her first day of cytarabine 100 mg/m2 IV and daunorubicin 45 mg/m2 IV, which is a moderately emetogenic,
non-anthracycline/cyclophosphamide regimen. Which of the following prophylactic antiemetic regimens would be preferred for prevention of acute nausea and vomiting in this patient?
A. Palonosetron plus dexamethasone
B. Dolasetron plus lorazepam
C. Metoclopramide plus dexamethasone
D. Granisetron plus aprepitant
E. Prochlorperazine plus dexamethasone
A
- A 65-year-old woman is being treated for refractory chronic myelogenous leukemia (CML) with hydroxyurea. Which one of the following antiemetic regimens would be the most appropriate to administer prior to the hydroxyurea dose for preventing CINV?
A. Granisetron plus dexamethasone plus aprepitant
B. Palonosetron plus dexamethasone
C. Dexamethasone
D. Metoclopramide
E. No prophylaxis is required
E
- A 69-year-old woman with non–small-cell lung cancer is scheduled to receive her first cycle of cisplatin 100 mg/m2
plus gemcitabine 1000 mg/m2. Which of the following oral regimens would be most appropriate for preventing acute and delayed nausea and vomiting?
A. Ondansetron, dexamethasone, and aprepitant on days 1–4
B. Ondansetron, dexamethasone, and aprepitant on day 1
C. Ondansetron and dexamethasone on day 1, and aprepitant on days 1–4
D. Ondansetron day 1, dexamethasone days 1–4, and aprepitant day 1
E. Ondansetron day 1, dexamethasone days 1–4, and aprepitant days 1–3
E
- A 50-year-old woman had a hysterectomy and now presents with an abdominal abscess. She has a history of diabetes, gastroparesis, hypertension, and dyslipidemia. Her home medications
are metformin, glipizide, erythromycin, ramipril, and simvastatin. Which one of the patient’s medications makes droperidol contraindicated for PONV?
A. Simvastatin
B. Erythromycin
C. Metformin
D. Ramipril
E. Glipizide
B
- A 30-year-old woman is going deep-sea fishing this weekend. The last time she went on a similar excursion, she got seasick about an hour after leaving port and shortly after drinking three margaritas and eating several tacos. She asks you to recommend something to help prevent seasickness. What is the best recommendation?
A. Apply a transdermal scopolamine patch 1 hour before the trip
B. Take granisetron one mg orally 4 hours before the trip
C. Take aprepitant 40 mg orally 3 hours before the trip
D. Take meclizine 50 mg orally if nausea or vomiting occurs
E. Take methylprednisolone 8 mg orally if nausea or vomiting occurs
A
- A 26-year-old woman in her first trimester of pregnancy (week 9) is experiencing severe nausea and vomiting that is interfering with her ability to maintain an acceptable level of
nutrition. Which one of the following antiemetic regimens would be the most appropriate?
A. Methylprednisolone 12 mg orally twice daily as needed
B. Droperidol 0.625 mg orally every 12 hours as needed
C. Doxylamine 10 mg/pyridoxine 10mg, two tablets at bedtime
D. Dolasetron 100 mg orally every 8 hours as needed
E. Dronabinol 5–15 mg/m2
every 2–4 hours as needed
C
- The vestibular system is replete with which types of receptors?
A. Histaminic
B. Dopaminergic
C. Neurokinin-1
D. Serotonergic
E. Adrenergic
A
- Which of the following is a true statement regarding nausea and vomiting?
A. Patients with nausea and vomiting experience flushing, bradycardia, and dry mouth
B. Stimulation of serotonin receptors found in the vestibular apparatus causes nausea and vomiting
C. The chemoreceptor trigger zone is protected from blood-borne toxins by the blood/brain barrier making chemotherapy-induced nausea and vomiting rare
D. Visceral vagal nerve fibers are rich in serotonin receptors and respond to GI distention and mucosal irritation, which contribute to nausea and vomiting
D
Option D: Correct. Visceral vagal nerve fibers are rich in serotonin receptors and result in nausea and vomiting in response to GI distention and mucosal irritation.
- The adverse effects of scopolamine include:
A. Salivation, diarrhea, insomnia
B. Dry mouth, constipation, drowsiness
C. Salivation, constipation, insomnia
D. Dry mouth, diarrhea, drowsiness
B
- Which of the following adverse effects is associated with promethazine administered intra-arterially?
A. Limb gangrene
B. Insomnia
C. Loss of muscle tone
D. Acute hypertension
A
Option A: Correct. Promethazine is associated with limb gangrene if inadvertently administered
intra-arterially.
- A 57-year-old obese woman is scheduled to undergo lengthy abdominal surgery. She smokes one pack of cigarettes per day, does not drink alcohol, and has a history of motion sickness. Which set of risk factors predisposes this patient to postoperative nausea and vomiting (PONV)?
A. Female sex, smoking history, and alcohol history
B. Body habitus, history of motion sickness, and alcohol history
C. Female sex, history of motion sickness, and duration of surgery
D. Body habitus, smoking history, and alcohol history
C
Option C: Correct. Females are at higher risk than males of developing PONV. History of PONV or motion sickness is also a risk factor, as is longer surgery duration, general anesthesia, use of volatile anesthetics, and use of intra- or postoperative opioids.
- Which one of the following is an appropriate nonpharmacologic treatment option for motion sickness?
A. Increasing exposure to movement to acclimate to it more quickly
B. Reading in a moving vehicle to distract from the motion
C. Placing the head between the knees to reduce visual stimulation
D. Sitting in the center of a boat to reduce the magnitude of the movement
D
- Which of the following statements about netupitant is true?
A. It is renally eliminated
B. It is free of CYP 450–mediated drug interactions
C. It is only available as a combination product with palonosetron
D. It is ineffective for CINV prophylaxis when used with standard antiemetics
C
Option A: Incorrect. Netupitant is primarily eliminated via hepatic and biliary clearance.
Option B: Incorrect. Like the NK-1 receptor antagonist aprepitant, netupitant interacts with substrates of the CYP P450 system. Rolapitant is the NK-1 receptor antagonist free from CYP 450–mediated drug interactions.
Option C: Correct. Netupitant is only available as a combination product with the 5-HT 3 receptor antagonist palonosetron.
Option D: Incorrect. Netupitant and the other NK-1 receptor antagonists are effective and recommended for preventing acute and delayed CINV when used with other antiemetics.
- A 40-year-old man is experiencing acute nausea and vomiting due to gastroenteritis. He has had these symptoms for approximately 12 hours and has not been able to keep any food or drink down during that time. You classify his symptoms as simple nausea and vomiting. Which monitoring parameters are the most appropriate for this patient’s symptoms?
A. Check blood urea nitrogen (BUN) and serum creatinine (SCr) to evaluate hydration status
B. Weigh the patient to determine whether he has lost weight due to his symptoms
C. Assess for dry mucous membranes or skin tenting to assess hydration status
D. Check serum electrolyte concentrations to evaluate and correct electrolyte imbalances
C
Option C: Correct. This patient’s nausea and vomiting is simple, acute nausea and vomiting and will likely resolve without significant interventions. It is reasonable to ask the patient about number and volume of vomiting episodes and assess for dehydration using simple physical assessments such as dry mucous membranes and skin tenting.
- A 73-year-old woman is going on a 7-day cruise. She has a history of car sickness on long trips. Her past medical history is significant for overactive bladder for which she takes oxybutynin 10 mg XR once daily. She is worried about motion sickness ruining her trip and asks what you recommend. Which one of the following options is the best recommendation?
A. Apply a transdermal scopolamine patch 1 hour before the trip
B. Apply acupressure wrist bands for the duration of the cruise
C. Take aprepitant 40 mg orally if nausea or vomiting occurs
D. Take meclizine 50 mg orally if nausea or vomiting occurs
B
Option A: Incorrect. Although anticholinergics and antihistamines are generally first-line therapy
for motion sickness, this patient’s age and history of anticholinergic therapy for overactive bladder make the anticholinergic side effects associated with these therapies undesirable.
Option B: Correct. Initiating a nonpharmacologic approach such as acupressure wrist bands is
effective and safer than pharmacologic therapy with anticholinergic adverse effects for this patient.
Option C: Incorrect. If aprepitant is used, it should be provided prior to exposure to motion to prevent motion sickness.
Option D: Incorrect. Meclizine has anticholinergic adverse effects.
- A 26-year-old woman in her first trimester of pregnancy (week 9) is experiencing severe nausea and vomiting that is interfering with her ability to maintain an acceptable level of nutrition. Which one of the following antiemetic regimens would be the most appropriate?
A. Dronabinol 5 to 15 mg/m 2 every 2 to 4 hours as needed
B. Droperidol 0.625 mg orally every 12 hours as needed
C. Doxylamine 10 mg/pyridoxine 10 mg, 2 tablets at bedtime
D. Dolasetron 100 mg orally every 8 hours as needed
C
Option A: Incorrect. Dronabinol is mainly used as an adjunctive agent for treating CINV and not routinely used to treat NVP.
Option B: Incorrect. Droperidol is primarily used to prevent or treat PONV and not NVP.
Option C: Correct. Doxylamine and pyridoxine are considered first line for moderate to severe NVP.
Option D: Incorrect. The 5HT 3 antagonists may be considered for treating NVP after patients have failed initial therapy with first-line agents such as doxylamine and pyridoxine.
- The vestibular system is replete with which types of receptors?
A. Histaminic
B. Dopaminergic
C. Neurokinin-1
D. Serotonergic
A
- A 20-year-old woman presents seeking your advice. She has a history of asthma for which she takes fluticasone 250 mcg/salmeterol 50 mcg twice daily, and albuterol MDI two puffs as needed for shortness of breath. She states that she also recently started Yaz (ethinyl estradiol and drospirenone) once daily for adult acne. She reports nausea with one episode of vomiting this morning. What is most likely to be causing her nausea and vomiting?
A. Albuterol
B. Salmeterol
C. Ethinyl estradiol and drospirenone
D. Fluticasone
C
Option C: Correct. Of the medications this patient is taking, the hormonal contraception for adult acne is most likely to cause nausea and vomiting.
- A 58-year-old man is undergoing toe amputation. He does not have patient-specific risk factors for PONV, and his surgery will be short with minimal risks for PONV. He was not given PONV prophylaxis prior to the procedure but experiences nausea and vomiting in the post-anesthesia care unit. The nurse asks you for a treatment recommendation. Which of the following options is the best recommendation?
A. Dexamethasone 5 mg IV
B. Ondansetron 8 mg orally
C. Scopolamine transdermal patch
D. Granisetron 0.1 mg IV
D
Option A: Incorrect. Dexamethasone is most often recommended as a preventive measure for PONV.
Option B: Incorrect. A low-dose 5HT 3 antagonist should be used prior to using higher doses when treating PONV in this patient.
Option C: Incorrect. A scopolamine patch would not allow for a rapid onset of action and would not be effective for treating acute nausea and vomiting.
Option D: Correct. If a patient is not at high risk of developing PONV, prophylactic antiemetics are not required. If a patient did not receive a prophylactic antiemetic regimen, a low-dose 5HT 3 antagonist, such as granisetron 0.1 mg IV, is the preferred treatment for any PONV that occurs.
- A patient undergoing chemotherapy with a highly emetogenic, nonanthracycline regimen receives rolapitant, ondansetron, dexamethasone, and olanzapine on day 1 of her chemotherapy regimen. What
agents should she take on day 2?
A. None, the CINV prophylaxis regimen she received concludes after 1 day of therapy
B. Ondansetron only
C. Olanzapine and dexamethasone
D. Rolapitant, dexamethasone, and ondansetron
C
Option A: Incorrect. Highly emetogenic chemotherapy regimens are at risk for delayed CINV. Continuation of specific agents in the CINV regimen help prevent delayed CINV.
Option B: Incorrect. A 5-HT 3 antagonist alone is insufficient for the prevention of CINV following highly emetogenic chemotherapy.
Option C: Correct. Olanzapine and dexamethasone should be continued for days 2 to 4 to prevent delayed CINV.
Option D: Incorrect. Dexamethasone should be continued for days 2 to 4; however, rolapitant and ondansetron are not necessary after day 1 of therapy.
- A 32-year-old woman is 19 weeks pregnant and continues to experience nausea and vomiting daily. She began experiencing nausea and vomiting when she was 3 weeks pregnant. She has been treating her nausea and vomiting with oral doxylamine and pyridoxine daily. She reports vomiting between one and three times each day and says she has difficulty keeping food or drink down even though she is consistently thirsty. She currently weighs 5 lb (2.3 kg) less than her
prepregnancy weight. Her PUQE score is 13. How should this patient’s nausea and vomiting be classified and addressed?
A. Simple nausea and vomiting; provide counseling for dietary interventions
B. Simple nausea and vomiting; change pyridoxine and doxylamine to methylprednisolone as needed for symptoms
C. Complex nausea and vomiting; evaluate hydration and electrolyte status and correct intravenously and add oral ondansetron as needed for severe symptoms
D. Complex nausea and vomiting; evaluate hydration and electrolyte status and correct intravenously
C
Option C: Correct. This patient has been experiencing ongoing nausea and vomiting despite treatment. She has experienced weight loss despite being 19 weeks pregnant and reports thirst
that may indicate dehydration. In addition, her PUQE score indicates that she has severe NVP. These findings support classification as complex nausea and vomiting. Because she reports
inability to keep food and drink down, hydration status and any electrolyte abnormalities should be corrected intravenously.
- According to the Apfel simplified risk score for PONV, the addition of which of the following combinations of patient characteristic would result in a high risk for PONV?
A. Male patient, no history of PONV, smokes 1 PPD, postoperative pain management orders for morphine and ketorolac
B. Female patient, history of NVP but not PONV or motion sickness, nonsmoker, opioid-free postoperative orders
C. Female patient, no history of PONV, smokes 1.5 PPD, postoperative pain management orders for hydromorphone
D. Male patient, history of motion sickness, postoperative pain management orders for
hydromorphone, nonsmoker
D
