Test 1

Question 1

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

Answer 1

D

Question 2

The adverse effects of scopolamine include:

Answer 2

Dry mouth, constipation, drowsiness

Example: Salivation, diarrhea, insomnia

Question 3

Which of the following adverse effects is associated with promethazine administered intra-arterially?

Answer 3

Limb gangrene

Question 4

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)?

Answer 4

Female sex, history of motion sickness, and duration of surgery

Question 5

Which one of the following is an appropriate nonpharmacologic treatment option for motion sickness?

Answer 5

Placing the head between the knees to reduce visual stimulation

Question 6

Which of the following statements about netupitant is true?

Answer 6

It is free of CYP 450–mediated drug interactions

Question 7

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?

Answer 7

Check serum electrolyte concentrations to evaluate and correct electrolyte imbalances

Question 8

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?

Answer 8

Apply a transdermal scopolamine patch 1 hour before the trip

Question 9

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?

Answer 9

Doxylamine 10 mg/pyridoxine 10 mg, 2 tablets at bedtime

Question 10

The vestibular system is replete with which types of receptors?

Answer 10

Serotonergic

Question 11

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?

Answer 11

Ethinyl estradiol and drospirenone

Question 12

What is most likely to be causing her nausea and vomiting?

Answer 12

C. Ethinyl estradiol and drospirenone

Example sentence: She also recently started Yaz (ethinyl estradiol and drospirenone) once daily for adult acne.

Question 13

Which of the following options is the best recommendation?

Answer 13

A. Dexamethasone 5 mg IV

Example sentence: He does not have patient-specific risk factors for PONV, and his surgery will be short with minimal risks for PONV.

Question 14

What agents should she take on day 2?

Answer 14

A. None, the CINV prophylaxis regimen she received concludes after 1 day of therapy

Example sentence: A patient undergoing chemotherapy with a highly emetogenic, nonanthracycline regimen receives rolapitant, ondansetron, dexamethasone, and olanzapine on day 1 of her chemotherapy regimen.

Question 15

How should this patient’s nausea and vomiting be classified and addressed?

Answer 15

C. Complex nausea and vomiting; evaluate hydration and electrolyte status and correct intravenously and add oral ondansetron as needed for severe symptoms

Example sentence: A 32-year-old woman is 19 weeks pregnant and continues to experience nausea and vomiting daily.

Question 16

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?

Answer 16

D. Male patient, history of motion sickness, postoperative pain management orders for hydromorphone, nonsmoker

Example sentence: The addition of which of the following combinations of patient characteristic would result in a high risk for PONV?