Unit2: Ch 59- Antiemetic Agents (Kach 7th Ed) Flashcards
A high school student starts vomiting and goes to see the school nurse. The student asks the nurse what
part of his brain makes him vomit. What area of the brain will the nurse tell the student must be
stimulated for vomiting to occur?
A) Chemoreceptor trigger zone (CTZ)
B) Forebrain
C) Hypothalamus
D) Thalamus
Ans: A
Feedback:
The CTZ has to be stimulated in order for vomiting to occur. The GI mucosa, hypothalamus, and
thalamus are not associated with eliciting vomiting. The forebrain, hypothalamus, and thalamus have
no part in vomiting.
A 25-pound child is in the clinic because of vomiting the last 24 hours. The nurse is to administer
trimethobenzamide (Tigan). What dose will the nurse administer by what route?
A) 0.25 mg IV
B) 1.1 mg/kg IM
C) 100 mg rectally
D) 200 mg orally
Ans: C
Feedback:
The nurse will administer 100 mg rectally. The other doses are inappropriate. A usual dose of
palonosetron for an adult is 0.25 mg IV. A usual dose of hydroxyzine for a child is 1.1 mg/kg IM, and a
usual dose of trimethobenzamide for a child weighing more than 30 pounds is 200 mg orally.
The clinic nurse is caring for a 55-year-old farmer who has been prescribed an antiemetic for an inner
ear problem. The patient states I need to get back to work. With this patient especially, what will the
nurse caution him about?
A) Weight gain
B) Suicidal ideation
C) Diarrhea
D) Photosensitivity
Ans: D
Feedback:
Photosensitivity is a common adverse reaction with many antiemetics. The nurse should advise the
patient to use sunscreen and wear protective garments if exposure cannot be avoided, which is unlikely
considering the patient’s occupation. Weight gain, suicidal ideation, and diarrhea have not been
identified as adverse effects of antiemetics.
A female college student with migraine headaches that cause nausea and vomiting has been prescribed
trimethobenzamide (Tigan). It is important for the nurse to caution the student to avoid using what?
A) St. John’s wort
B) Calcium channel blockers
C) Selective serotonin reuptake inhibitors (SSRIs)
D) Alcohol
Ans: D
Feedback:
Locally acting antiemetics depress areas of the CNS. If combined with other CNS depressants, such as
alcohol, patients could experience increasing CNS depression including dizziness and somnolence. St.
John’s wort, calcium channel blockers, and SSRIs are not CNS depressants.
A cancer patient is in the outpatient department to receive chemotherapy. The nurse administers
prochlorperazine (Compazine) prophylactically before the infusion. What will the nurse’s teaching for
this patient include?
A) Avoid driving or any dangerous activities if dizziness or drowsiness occurs.
B) Cover the head in extreme of temperatures.
C) Take extra precautions to avoid heat stroke.
D) Check blood pressure at home on a regular basis.
Ans: A
Feedback:
Prochlorperazine is an antiemetic that can cause dizziness and drowsiness. A patient who is taking it
should be advised not to drive or undertake dangerous activities if these adverse effects occur. The drug
does not cause heat loss or inability to sweat that may lead to heat stroke. This drug should not affect
blood pressure, so there is no need to test for it.
What is an appropriate nursing action for a hospitalized patient receiving aprepitant (Emend)? A) Elevate the head of the bed. B) Encourage fluids. C) Take the patient’s temperature. D) Place an NPO sign on the door.
Ans: B
Feedback:
Because dehydration is an adverse effect of aprepitant, the nurse will want to encourage the patient to
drink as much liquid as possible. Elevating the head of the bed would be unnecessary; the patient’s
temperature would not be affected by aprepitant; we are encouraging fluids so placing an NPO sign on
the door would not be appropriate for this patient.
The nurse is working in the medical station at a local amusement park. An adult is being seen
complaining of dizziness and feelings of seasickness after going on several rides. What would the nurse
suspect the patient may benefit from?
A) An anticholinergic
B) A histamine H2 blocker
C) Substance P/neurokinin 1 receptor antagonist
D) Cannabis
Ans: A
Feedback:
Nausea and vomiting associated with motion sickness is best treated with an anticholinergic that acts as
an antihistamine. Histamine H2 blockers affect gastric acid production. Substance P/neurokinin 1
receptor antagonists and cannabis are prescribed only as adjuncts to cancer chemotherapy drugs or
other therapy.
A women’s community group is attending the first-aid class the nurse is teaching. The nurse will
instruct the women to do what if a child ingests a possible overdose of medication or other potential
poison?
A) Call an ambulance.
B) Make an appointment to see the health care provider.
C) Induce vomiting by sticking a finger down the child’s throat.
D) Call the local poison control center and follow their directions.
Ans: D
Feedback:
New guidelines suggest that potential ingestion with poison should prompt an immediate call to the
local poison control center and then follow their directions. An ambulance may not be needed and it
may take too long to get an appointment with a health care provider. Induction of vomiting could be
harmful and does not represent the best treatment.
The nurse is caring for a child who has been vomiting intermittently for 24 hours. What is the drug of
choice for children who need an antiemetic?
A) Dronabinol (Marinol)
B) Metoclopramide (Reglan)
C) Meclizine (Antivert)
D) Prochlorperazine (Compazine)
Ans: D
Feedback:
Prochlorperazine is often the drug of choice with children because it has established oral, rectal, and parenteral doses. The other three options are not recommended for children.
The nurse is caring for a patient who has begun vomiting after undergoing bariatric surgery. When
including this complication in the plan of care, what would be an appropriate nursing diagnosis related
to the adverse effects of drowsiness and weakness associated with an antiemetic?
A) Acute pain related to central nervous system (CNS), skin, and gastrointestinal (GI) effects
B) Risk for injury related to CNS effects
C) Decreased cardiac output related to cardiac effects
D) Deficient knowledge regarding drug therapy
Ans: B
Feedback:
Because the patient is experiencing CNS effects, the nurse will be concerned about the patient’s safety.
The appropriate nursing diagnosis would be risk for injury related to CNS effect. Acute pain related to
CNS, skin, and GI effects; decreased cardiac output related to cardiac effects; and deficient knowledge
regarding drug therapy would not be appropriate because no evidence is provided in the question to
support any of these diagnoses.
What medication, given with aprepitant (Emend), is used to effectively manage chemotherapy-induced emesis? A) Bonamine B) Dexamethasone C) Phenergan D) Ativan
Ans: B
Feedback:
Aprepitant acts directly in the central nervous system to block receptors associated with nausea and
vomiting with little to no effect on serotonin and dopamine levels, nor corticosteroid receptors. It is
approved for use in treating nausea and vomiting associated with highly emetogenic antineoplastic
chemotherapy, including cisplatin therapy. It is given orally, in combination with dexamethasone.
Bonamine, Phenergan, and Ativan are not used in conjunction with Emend.
What symptom may be related to the use of dronabinol (Marinol)? A) Bradycardia B) Hypertension C) Rash D) Anxiety
Ans: D
Feedback:
Dronabinol and nabilone are only approved for use in managing nausea and vomiting associated with
cancer chemotherapy in patients who have not responded to other treatment. The exact mechanisms of
action of dronabinol and nabilone are not understood. They are readily absorbed and metabolized in the
liver, with excretion through bile and urine. They are controlled substances. Dronabinol is a category
C-III controlled substance and nabilone is a category C-II substance. They must be used under close
supervision because of the possibility of altered mental status. Dronabinol does not cause bradycardia,
hypertension, or a rash.
People taking phenothiazines need to be assessed for extrapyramidal symptoms. What effects are
considered adverse effects of the phenothiazines?
A) Dysphoria, anxiety, and dizziness
B) Drowsiness, dystonia, and blurred vision
C) Dry mouth, blurred vision, and urinary retention
D) Hypertension, confusion, and shuffling gait
Ans: B
Feedback:
Adverse effects include drowsiness, dystonia, photophobia, blurred vision, and discolored pink to redbrown
urine. Adverse effects of the phenothiazines do not include dysphoria, urinary retention, or
confusion.
A 57-year-old patient is to receive metoclopramide (Reglan) for nausea. What statement by the patient
leads the nurse to believe that the patient has understood the nurse’s teaching?
A) During episodes of nausea, I will drink clear liquids.
B) I may be drowsy as a result of taking this medication.
C) This medication should be taken on a full stomach.
D) I will need to take supplemental potassium while I am taking this medication
Ans: B
Feedback:
Adverse effects include drowsiness, fatigue, restlessness, extrapyramidal symptoms, and diarrhea. The
other statements are incorrect and would tell the nurse that this patient does not understand the teaching
about this drug.
Prochlorperazine (Compazine) is contraindicated in which population? A) Children under the age of 12 years B) Preoperative patients C) Pregnant women D) People weighing <100 pounds
Ans: C
Feedback:
Caution should be used in individuals with renal dysfunction, moderate liver impairment, active peptic
ulcer, or during pregnancy and lactation. Compazine can be used in children under the age of 12,
preoperative patients, and people weighing <100 pounds.
