Pharm Chapter 33 PDF

Pharm chapter 33 1. A patient is beginning thesecond round of high-dose cisplatin. Severe, chemotherapy-induced nausea and vomiting (CINV) occurred following thefirst treatment, requiring 72 hours of continuous IV hydration. Which medication would be best to administer in addition to thechemotherap...

Pharm chapter 33 1. A patient is beginning thesecond round of high-dose cisplatin. Severe, chemotherapy-induced nausea and vomiting (CINV) occurred following thefirst treatment, requiring 72 hours of continuous IV hydration. Which medication would be best to administer in addition to thechemotherapy regimen? a. Prochlorperazine (Compazine) suppository daily, on theday of treatment and thenext 3 days b. Anticholinergic agents, such as diphenhydramine or meclizine c. Parenteral ondansetron 1 hour before chemotherapy, with oral ondansetron to continue for thenext 4 days d. Parenteral ondansetron during chemotherapy, with prochlorperazine suppositories daily for 1 week ANS: C With thepatient‘s first treatment history and theemetogenic chemotherapy agent, cisplatin, ondansetron has shown to be themost effective for prevention of severe nausea and vomiting. Prochlorperazine and anticholinergic agents are not used for thetreatment of CINV. theondansetron should be administered 1 hour before thechemotherapy and continued for thenext several days to prevent vomiting and dehydration associated with chemotherapy administration. 2. Which medication is most effective in preventing motion sickness? a. Serotonin antagonists b. Phenothiazines c. Corticosteroids d. Anticholinergics ANS: D Anticholinergic agents are used to treat motion sickness by counterbalancing theexcessive amounts of acetylcholine present. Serotonin antagonists are used in thetreatment of emesis associated with cancer chemotherapy, radiation therapy, and postoperative nausea and vomiting. Phenothiazines are used in thetreatment of mild to moderate nausea and vomiting associated with anesthesia and surgery, radiation therapy, and cancer chemotherapy. Corticosteroids are used in thetreatment of nausea and vomiting related to pregnancy, postsurgical state, chemotherapy, radiation, and bowel obstruction. 3)Which rationale explains thepurpose for thenurse administering metoclopramide (Reglan) IV postoperatively? a. Prolong theeffects of anesthesia. b. Decrease thepotential for thrombus formation. c. Prevent postoperative nausea and vomiting. d. Decrease postoperative pain. ANS: C Metoclopramide (Reglan) is an antiemetic and antagonist of dopamine and serotonin receptors. In addition to acting on receptor sites in thebrain, metoclopramide increases sphincter tone in thegastrointestinal tract, which reduces nausea and vomiting. Metoclopramide does not affect anesthesia or thevascular system and does not have analgesic effects. 4. The nurse is assessing a patient with nausea and vomiting. Which additional autonomic symptoms that often accompany vomiting will thenurse observe? a. Bradycardia, diarrhea, and flushing b. Pallor, sweating, and tachycardia c. Urinary urgency, chills, and dizziness d. Fever, hyperventilation, and bradycardia ANS: B Autonomic symptoms of pallor, sweating, and tachycardia cause additional discomfort associated with vomiting. Bradycardia, diarrhea, flushing, urinary urgency, chills, dizziness, fever, and hyperventilation are not autonomic symptoms associated with vomiting. 5. Which drug would thenurse expect to administer when treating hyperemesis gravidarum? a. THC (Marinol) b. Haloperidol (Haldol) c. Dexamethasone (Prednisone) d. Metoclopramide (Reglan) ANS: D Metoclopramide is thedrug of choice when treating hyperemesis gravidarum because no teratogenic effects have been reported with theuse of this drug. THC is used in thetreatment of nausea and vomiting associated with cancer and cancer treatment. Haloperidol is used in thetreatment of nausea associated with chemotherapy. Prednisone is used in thetreatment of nausea associated with pregnancy, postsurgical state, chemotherapy, radiation, and bowel obstruction. 6. Which reason explains why thenurse monitors daily weights prior to theadministration of antiemetic medications to chemotherapy patients? a. Antiemetics are calculated according to body surface area. b. Antiemetics are toxic, and theminimal dosage should be administered. c. Weight loss is a common adverse effect associated with chemotherapy, and dosages may need to be readjusted. d. Fluid overload is common, and antiemetic dosages are increased as treatment progresses. ANS: C Patients receiving chemotherapy are prone to weight loss resulting from nausea and vomiting. As with any drug therapy, thesafe dosage per weight parameters should be assessed daily to avoid potential overmedication when patients are losing significant weight. Antiemetics are not calculated according to body surface area. Antiemetics are not toxic in recommended dosages. Fluid overload is unrelated to antiemetic therapy. 7. Which advantage explains thereason for using benzodiazepines as an adjunctive treatment for nausea and vomiting associated with chemotherapy? a. The long half-life will prolong theeffectiveness of other drugs b. They increase a sense of euphoria. c. The patient will not develop tolerance to themedications as quickly. d. The antianxiety effect helps, in addition to reducing thefrequency of nausea and vomiting. ANS: D Benzodiazepines (e.g., diazepam, lorazepam, midazolam) are effective in reducing not only thefrequency of nausea and vomiting but also theanxiety often associated with chemotherapy. Benzodiazepines do not affect theeffectiveness of other drugs. Although distraction can be an effective intervention, using benzodiazepines is not a method to achieve this goal. Tolerance to benzodiazepines can develop quickly; they do not affect thedevelopment of tolerance to other drugs. 8. Which condition is occurring when a patient experiences nausea immediately on entering theclinic to receive another course of chemotherapy? a. Psychogenic b. Chemotherapy induced c. Hyperemesis gravidarum d. Anticipatory nausea and vomiting ANS: D Anticipatory nausea and vomiting is a conditioned response triggered by thesight or smell of theclinic or hospital or by theknowledge that treatment is imminent. Delayed reaction from a previous treatment would have occurred in a shorter interval after theother treatment. Delayed emesis occurs 24 to 120 hours after theadministration of chemotherapy. Although smells can trigger nausea, this is not likely thecause of this patient‘s sickness. Hyperemesis gravidarum is excessive vomiting and nausea associated with pregnancy. 9. Which herb has been used in many cultures to provide relief of nausea associated with pregnancy? a. Mint b. Hyssop c. Echinacea d. Ginger ANS: D Ginger is an herb used in many cultures to treat pregnancy-induced nausea and vomiting. Mint is often used to treat mild dyspepsia. Hyssop is used as an expectorant and anticatarrhal. Echinacea is used to boost theimmune system. 10. Which consideration will thenurse take into account when caring for a 27-year-old patient taking a cannabinoid during chemotherapy? a. Antihistamines may potentiate theeffects. b. Monitor thepatient for fluid volume excess. c. Previous use of marijuana requires increased dosage. d. Inform thepatient to avoid theintake of potassium. ANS: A Antihistamines, alcohol, analgesics, benzodiazepines, barbiturates, antidepressants, muscle relaxants, and sedative hypnotics increase toxic effects. Fluid volume excess is not an adverse effect of cannabinoids. Previous use does not necessarily require increased dosage. There are no dietary restrictions with theuse of cannabinoids. 11. The recovery room nurse is preparing to assist with thecare of several postoperative patients. Which patient would thenurse prioritize care for regarding thepotential for postoperative nausea and vomiting (PONV)? a. A 5-year-old child undergoing a closed reduction procedure with regional anesthesia b. A 50-year-old woman undergoing a total hysterectomy with general anesthesia c. A 27-year-old man undergoing a middle ear manipulation with general anesthesia d. An 80-year-old man undergoing a total hip replacement with spinal anesthesia ANS: B Women have a higher incidence of PONV, possibly because of hormonal differences. Patients who have had general anesthesia have a higher incidence of PONV than those who have had regional anesthesia. Children ages 11 to 14 years have thehighest incidence of PONV based on age-group. Spinal anesthesia is generally least emetogenic. 12. Which medication puts a patient at thelowest risk of having an adverse reaction? a. Ondansetron b. Scopolamine c. Promethazine d. Dexamethasone ANS: D Dexamethasone is a corticosteroid. A particular advantage of thesteroids, apart from their efficacy, is their relative lack of adverse effects. Ondansetron, scopolamine, and promethazine have more associated side effects than dexamethasone. MULTIPLE RESPONSE 1. Which role(s) apply(ies) to thechemoreceptor trigger zone (CTZ) in vomiting? (Select all that apply.) a. Initiates or induces vomiting. b. Coordinates thevomiting reflex. c. Activates thevomit center (VC) to induce vomiting. d. Samples blood and spinal fluid for potentially toxic substances. ANS: C, D The CTZ stimulates theVC to induce vomiting as well as samples blood and spinal fluid for potentially toxic substances. theCTZ does not initiate vomiting or coordinate thevomiting reflex. 2. Which explanation(s) describe(s) why drug therapy is important for selected causes of nausea and vomiting? (Select all that apply.) a. Relieves thedistress associated with nausea and vomiting. b. Prevents aspiration of gastric contents into thelung. c. Prevents dehydration. d. Prevents electrolyte imbalances. e. Increases intracranial pressure. ANS: A, B, C, D Promoting comfort is a goal of treating nausea and vomiting. Aspiration can lead to severe respiratory complications. Dehydration is a common consequence of vomiting and can cause disturbances in electrolyte balances. Electrolytes are salts that thebody needs to function well and stay healthy. Drugs that control nausea and vomiting do not increase intracranial pressure. 3. A patient going on vacation asks thenurse what can given to a 3-year-old child who becomes car sick. Which response(s) would be accurate? (Select all that apply.) a. ―Positioning techniques such as placing thechild facing forward and blocking out scenery through theside windows can be helpful.‖ b. ―There is no such thing as car sickness.‖ c. ―If your child does vomit, give over-the-counter Benadryl.‖ d. ―I would check with thepharmacist regarding over-the-counter products available for young children.‖ ANS: A, D Positioning techniques that help block out therapid peripheral movement assist young children who suffer from motion sickness. Over-the-counter products are available to medicate a young child. A healthcare provider should recommend dosages and evaluate other medications being currently given. Motion sickness is very real, and dismissing a patient‘s complaints is unprofessional. Benadryl is not effective for treating nausea or vomiting. 4. A prepared childbirth nurse educator is discussing potential discomforts during pregnancy with a group of women. Which statement(s) will be included when relaying information about nausea and vomiting? (Select all that apply.) a. The majority of pregnant women experience nausea and vomiting. b. Severe, persistent vomiting during pregnancy is known as anticipatory vomiting. c. Vomiting during pregnancy is more common among primigravidas. d. Prior fetal loss puts a woman at higher risk. e. Nausea and vomiting during pregnancy can occur at any time of theday. ANS: C, E Vomiting during pregnancy is more common among primigravidas. Nausea and vomiting during pregnancy can occur at any time of theday. thepercentage of women reporting vomiting during thefirst 16 weeks of gestation is relatively constant at about 40%, decreasing to 20% from 17 to 20 weeks. Only 9% of women report vomiting after 20 weeks of pregnancy. Severe, persistent vomiting during pregnancy is known as hyperemesis gravidarum. Contrary to commonly held beliefs, vomiting is not more common in women who have experienced prior fetal losses