Ch34 Pharm

Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Clayton: Basic Pharmacology for Nurses, 15

th
Edition

Chapter 34: Drugs Used to Treat Nausea and Vomiting

Test Bank

MULTIPLE CHOICE

1. A patient is beginning the second round of high-dose cisplatin. Severe, chemotherapy-
induced nausea and vomiting (CINV) occurred following the first treatment, requiring 72
hours of continuous IV hydration. In addition to her chemotherapy regimen, which
medication would be best to administer?
A. Prochlorperazine (Compazine) suppository daily, the day of treatment, and the
next 3 days
B. Anticholinergic agents, such as diphenhydramine or meclizine
C. Parenteral ondansetron 1 hour before chemotherapy, with oral ondansetron to
continue for the next 4 days
D. Parenteral ondansetron during chemotherapy, with prochlorperazine suppositories
daily for 1 week

ANS: C

Feedback
A
Prochlorperazine is not indicated for the treatment of CINV.
B
Anticholinergic agents are not used for the treatment of CINV.
C
With the patients first treatment history and the emetogenic chemotherapy
agent, cisplatin, ondansetron has shown to be the most effective for prevention
of severe nausea and vomiting.
D
The ondansetron should be administered 1 hour before the chemotherapy and
continued for the next several days to prevent vomiting and dehydration
associated with chemotherapy administration. Prochlorperazine is not indicated
for the treatment of CINV.

DIF: Cognitive Level: Application REF: 542
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity

2. A patient expresses concerns about motion sickness. Which medication is most effective
in preventing motion sickness?
A. Serotonin antagonists
B. Phenothiazines
C. Corticosteroids
D. Anticholinergics

ANS: D

Feedback
Test Bank

34-2
A
Serotonin antagonists are used in the treatment of emesis associated with cancer
chemotherapy, radiation therapy, and postoperative nausea and vomiting.
B
Phenothiazines are used in the treatment of mild to moderate nausea and
vomiting associated with anesthesia and surgery, radiation therapy, and cancer
chemotherapy.
C
Corticosteroids are used in the treatment of nausea and vomiting related to
pregnancy, postsurgical state, chemotherapy, radiation, and bowel obstruction.
D
Anticholinergic agents are used to treat motion sickness by counterbalancing the
excessive amounts of acetylcholine present.

DIF: Cognitive Level: Knowledge REF: 551

3. What is the purpose for the nurse administering metoclopramide (Reglan) IV
postoperatively?
A. Prolong the effects of anesthesia.
B. Decrease the potential for thrombus formation.
C. Prevent postoperative nausea and vomiting.
D. Decrease postoperative pain.

ANS: C

Feedback
A
Metoclopramide does not affect anesthesia.
B
Metoclopramide does not affect the vascular system.
C
Metoclopramide (Reglan) is an antiemetic and antagonist of dopamine and
serotonin receptors. In addition to acting on receptor sites in the brain,
metoclopramide increases sphincter tone in the gastrointestinal tract, which
reduces nausea and vomiting.
D
Metoclopramide does not have analgesic effects.

DIF: Cognitive Level: Comprehension REF: 541
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

4. The nurse is assessing a patient with nausea and vomiting. Which additional autonomic
symptoms that often accompany vomiting will the nurse observe?
A. Bradycardia, diarrhea, and flushing
B. Pallor, sweating, and tachycardia
C. Urinary urgency, chills, and dizziness
D. Fever, hyperventilation, and bradycardia

ANS: B

Feedback
A
Bradycardia, diarrhea, and flushing are not autonomic symptoms associated with
Test Bank

34-3
vomiting.
B
Autonomic symptoms of pallor, sweating, and tachycardia cause additional
discomfort associated with vomiting.
C
Urinary urgency, chills, and dizziness are not autonomic symptoms associated
with vomiting.
D
Fever, hyperventilation, and bradycardia are not autonomic symptoms associated
with vomiting.

DIF: Cognitive Level: Knowledge REF: 538-539
TOP: Nursing Process Step: Assessment

5. The nurse would expect to administer which drug when treating hyperemesis
gravidarum?
A. THC (Marinol)
B. Haloperidol (Haldol)
C. Dexamethasone (Prednisone)
D. Metoclopramide (Reglan)

ANS: D

Feedback
A
THC is used in the treatment of nausea and vomiting associated with cancer and
cancer treatment.
B
Haloperidol is used in the treatment of nausea associated with chemotherapy.
C
Prednisone is used in the treatment of nausea associated with pregnancy,
postsurgical state, chemotherapy, radiation, and bowel obstruction.
D
Metoclopramide is the drug of choice when treating hyperemesis gravidarum
because no teratogenic effects have been reported with the use of this drug.


6. Why does the nurse monitor daily weights prior to the administration of antiemetic
medications to chemotherapy patients?
A. Antiemetics are calculated according to body surface area.
B. Antiemetics are toxic, and the minimal 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

Feedback
A
Antiemetics are not calculated according to body surface area.
Test Bank

34-4
B
Antiemetics are not toxic in recommended dosages.
C
Patients receiving chemotherapy are prone to weight loss secondary to nausea
and vomiting. As with any drug therapy, the safe dosage per weight parameters
should be assessed daily to avoid potential overmedication when patients are
losing significant weight.
D
Fluid overload is unrelated to antiemetic therapy.

DIF: Cognitive Level: Application REF: 544
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

7. What is an advantage of using benzodiazepines as an adjunctive treatment for nausea and
vomiting associated with chemotherapy?
A. The long half-life will prolong the effectiveness of other drugs.
B. They increase a sense of euphoria.
C. The patient will not develop tolerance to the medications as quickly.
D. The antianxiety effect helps, in addition to reducing the frequency of nausea and
vomiting.

ANS: D

Feedback
A
Benzodiazepines do not affect the effectiveness of other drugs.
B
Although distraction can be an effective intervention, using benzodiazepines is
not a method to achieve this goal.
C
Tolerance to benzodiazepines can develop quickly; they do not affect the
development of tolerance to other drugs.
D
Benzodiazepines (e.g., diazepam, lorazepam, midazolam) are effective in
reducing not only the frequency of nausea and vomiting, but also the anxiety
often associated with chemotherapy.


8. What condition is occurring when a patient experiences nausea immediately on entering
the clinic to receive another course of chemotherapy?
A. Psychogenic
B. Chemotherapy-induced
C. Hyperemesis gravidarum
D. Anticipatory nausea and vomiting

ANS: D

Feedback
A
Delayed reaction from a previous treatment would have occurred in a shorter
interval after the other treatment. Delayed emesis occurs 24 to 120 hours after
Test Bank

34-5
the administration of chemotherapy.
B
Although smells can trigger nausea, this is not likely the cause of this patients
sickness.
C
Hyperemesis gravidarum is excessive vomiting and nausea associated with
pregnancy.
D
Anticipatory nausea and vomiting is a conditioned response triggered by the
sight or smell of the clinic or hospital or by the knowledge that treatment is
imminent.


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

Feedback
A
Mint is often used to treat mild dyspepsia.
B
Hyssop is used as an expectorant and anticatarrhal.
C
Echinacea is used to boost the immune system.
D
Ginger is an herb used in many cultures to treat pregnancy-induced nausea and
vomiting.


10. The nurse is caring for a 27-year-old patient taking a cannabinoid during chemotherapy.
Which consideration will the nurse take into account?
A. Antihistamines may potentiate the effects.
B. Monitor the patient for fluid volume excess.
C. Previous use of marijuana requires increased dosage.
D. Inform the patient to avoid the intake of potassium.

ANS: A

Feedback
A
Antihistamines, alcohol, analgesics, benzodiazepines, barbiturates,
antidepressants, muscle relaxants, and sedative-hypnotics increase toxic effects.
B
Fluid volume excess is not an adverse effect of cannabinoids.
C
Previous use does not necessarily require increased dosage.
Test Bank

34-6
D
There are no dietary restrictions with the use of cannabinoids.


MULTIPLE RESPONSE

1. What is the role of the chemoreceptor trigger zone (CTZ) in vomiting? (Select all that
apply.)
A. Initiates or induce vomiting
B. Coordinates the vomiting reflex
C. Activates the vomit center (VC) to induce vomiting
D. Samples blood and spinal fluid for potentially toxic substances

ANS: C, D

Feedback
Correct
The CTZ stimulates the VC to produce vomiting.
The CTZ samples blood and spinal fluid for potentially toxic substances.
Incorrect
Vomiting is induced by the VC.
The VC coordinates the vomiting reflex.


2. Why is drug therapy important for selected causes of nausea and vomiting? (Select all
that apply.)
A. Relieves the distress associated with nausea and vomiting
B. Prevents aspiration of gastric contents into the lung
C. Prevents dehydration
D. Prevents electrolyte imbalances
E. Increases intracranial pressure

ANS: A, B, C, D

Feedback
Correct
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 the body needs to function well and stay healthy.
Incorrect
Drugs that control nausea and vomiting do not increase intracranial
pressure.

Test Bank

34-7

3. Which are important nursing assessments for monitoring the hydration status of infants?
(Select all that apply.)
A. Monitor oral mucous membranes, vital signs, and skin turgor twice each shift.
B. Monitor intake and output every shift.
C. Weigh every other day.
D. Monitor electrolyte and specific gravity laboratory values.
E. Provide diversional activities during hospitalization.

ANS: A, B, D

Feedback
Correct
Assessment of hydration in the infant includes monitoring mucous
membranes, vital signs, skin turgor, and fontanels at least every 4 hours.
Assessment of hydration in the infant includes monitoring intake and
output.
Significant laboratory values to monitor include electrolytes, RBC, HCT,
HGB, and specific gravity.
Incorrect
Weight should be evaluated daily.
Diversional activities do not promote hydration in the sick child.

DIF: Cognitive Level: Application REF: 533-534

4. A patient going on vacation asks the nurse what she can give to her 3-year-old child who
becomes car sick. Which responses are accurate? (Select all that apply.)
A. Positioning techniques such as placing the child facing forward and blocking out
scenery through the side windows can be helpful.
B. There is no such thing as car sickness.
C. If your child does vomit, there is some over-the-counter Benadryl you can
administer.
D. I would check with the pharmacist regarding over-the-counter products available
for young children.

ANS: A, D

Feedback
Correct
Positioning techniques that help block out the rapid peripheral movement
assist young children who suffer from motion sickness.
Over-the-counter products are available to medicate a young child. A
health care provider should recommend dosages and evaluate other
medications being currently given.
Incorrect
Motion sickness is very real, and dismissing a patients complaints is
Test Bank

34-8
unprofessional.
Benadryl is not effective for treating nausea or vomiting.

DIF: Cognitive Level: Analysis REF: 544

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Mosby items and derived items 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Clayton: Basic Pharmacology for Nurses, 15

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