Chapter 14, Drugs for Gastrointestinal Problems: Overview of Nausea and Vomiting—Sherpath

Question 1 of 12

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Which patient statement indicates an understanding regarding the administration of antiemetic drugs?

• • “It’s important that I add herbal supplements to my daily routine.”This indicates the patient needs further teaching. Herbal drugs can increase the risk of drug interactions while taking antiemetics.
• • “I enjoy sitting in the warm summer sun to get my vitamin D.”This statement indicates the patient needs further teaching. The nurse should remind the patient to avoid direct sunlight without sunscreen and protective clothing because many antiemetic drugs increase sun sensitivity.
• Correct
  • “I should report any coffee ground emesis to my healthcare provider.”Coffee ground emesis is indicative of bleeding in the gastrointestinal tract and should be reported to the healthcare provider immediately.
• • “It’s essential that I take my drugs prior to driving to work.”The nurse should tell the patient not to drive or operate heavy machinery while taking any antiemetic drug.

Question 2 of 12

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Which drug class is commonly used to treat nausea and vomiting? Select all that apply. One, some, or all responses may be correct.

• • AntacidsAntacids neutralize stomach acids to help relieve heartburn and indigestion.
• Correct
  • CannabinoidsCannabinoids are natural forms of tetrahydrocannabinol used to treat nausea and vomiting caused by cancer drug.
• • Histamine H₂-receptor BlockersHistamine H₂-receptor blockers are a common drug class used to treat peptic ulcer disease and gastroesophageal reflux disease by binding to the H₂ receptors in stomach cells, which decreases production of basal and nighttime gastric acid. They are not typically used to treat nausea and vomiting.
• Correct
  • PhenothiazinesPhenothiazines alleviate nausea and vomiting by blocking dopamine receptors in the chemoreceptor trigger zone (CTZ).
• Correct
  • Promotility drugsPromotility drugs reduce the incidence of nausea and vomiting.

Question 3 of 12

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Which finding would the nurse monitor in a patient experiencing nausea and vomiting?

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  • Cracked lipsThe nurse should monitor the patient for dehydration such as cracked skin or lips. Cracked lips is an indication that there is a deficiency in fluid balance due to nausea and vomiting.
• • Weight gainWeight gain is a therapeutic finding and should not be alarming for a patient experiencing nausea and vomiting.
• • Potassium level 4.5 mEq/LA potassium level of 4.5 mEq/L is a normal finding.
• • Magnesium level 2.0 mEq/LA magnesium level of 2.0 mEq/L is a normal finding.

Question 4 of 12

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Which expected side effect is associated with aprepitant (Emend-oral)? Select all that apply. One, some, or all responses may be correct.

• Correct
  • FatigueThe patient taking aprepitant (Emend-oral) may experience fatigue, which is an expected side effect associated with substance P/NK₁ receptor antagonists.
• • Cardiac damageCardiac damage is not an expected side effect of aprepitant (Emend-oral).
• • TremorsTremors are not an expected side effect of aprepitant (Emend-oral).
• Correct
  • HeadacheHeadache is an expected side effect associated with aprepitant (Emend-oral).
• Correct
  • DizzinessSubstance P/NK₁ receptor antagonists block the substance P/NK₁ receptor, which could also cause the common side effect dizziness.

Question 5 of 12

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Which observation indicates that a patient prescribed rolapitant (Varubi) 180 mg orally once daily has developed angioedema? Select all that apply. One, some, or all responses may be correct.

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  • BronchospasmAngioedema is swelling under the skin triggered by a reaction to substance P/neurokinin 1 receptor antagonists. Bronchospasm is a sign associated with angioedema.
• • AnemiaBlood abnormalities such as anemia should be monitored with a patient prescribed rolapitant (Varubi). However, it is not a symptom of angioedema.
• • ThrombocytopeniaThe nurse should monitor laboratory values carefully for thrombocytopenia with a patient prescribed rolapitant (Varubi). However, it is not a symptom of angioedema.
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  • UrticariaAngioedema is swelling under the skin triggered by a reaction to substance P/neurokinin 1 receptor antagonists. Hives or urticaria may accompany angioedema.
• Correct
  • Lip swellingAngioedema is swelling under the skin triggered by a reaction to substance P/neurokinin 1 receptor antagonists. Lip swelling is a hallmark sign of angioedema.

Question 6 of 12

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Which drug interaction with ondansetron (Zofran) poses the greatest risk for developing cardiac dysrhythmias?

• • Metoclopramide (Reglan)Metoclopramide (Reglan) is a promotility drug which increases contraction of the upper gastrointestinal tract. However, it does not cause cardiac dysrhythmias when combined with ondansetron.
• Correct
  • Prochlorperazine (Compazine)Patients may experience cardiac dysrhythmias when serotonin (5-HT₃) receptor antagonists are combined with phenothiazine drugs.
• • Dronabinol (Marinol)Dronabinol (Marinol) is a cannabinoid that reduces nausea and vomiting by binding to cannabinoid receptors in the chemoreceptor trigger zone (CTZ) and by preventing serotonin 5-HT₃ from binding to its receptors in the CTZ. However, it does not cause cardiac dysrhythmias when combined with ondansetron.
• • Nabilone (Cesamet)Nabilone (Cesamet) is a cannabinoid that reduces nausea and vomiting by binding to cannabinoid receptors in the chemoreceptor trigger zone (CTZ) and by preventing serotonin 5-HT₃ from binding to its receptors in the CTZ. However, it does not cause cardiac dysrhythmias when combined with ondansetron.

Question 7 of 12

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Which question is important for the nurse to ask a patient receiving trimethobenzamide (Tigan)?

• • “Are you having trouble sleeping at night?”Insomnia is a common side effect for a patient receiving trimethobenzamide (Tigan).
• • “Do you suffer from restlessness?”Restlessness is a common side effect for a patient receiving trimethobenzamide (Tigan).
• • “Have you experienced any visual impairment?”Visual impairment is a common side effect for a patient receiving trimethobenzamide (Tigan).
• Correct
  • “Have you ever thought about killing yourself?”The nurse should observe the patient for depression and suicidal ideation following receiving promotility drugs such as trimethobenzamide (Tigan) due to impacting the neurotransmitter dopamine.

Question 8 of 12

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Which adverse effect is important for the nurse monitor in a patient receiving phenothiazines? Select all that apply. One, some, or all responses may be correct.

• • TremorsTremors are neither an adverse reaction nor an expected side effect for phenothiazines.
• Correct
  • DystoniaThe nurse should watch carefully for any Parkinson’s disease–like adverse reaction related to patient receiving phenothiazines drugs due to their effect on dopamine. Dystonia is involuntary muscle contractions that cause repetitive or twisting movements.
• Correct
  • AkathisiaThe nurse should watch carefully for any Parkinson’s disease–like adverse reaction related to patient receiving phenothiazines drugs due to their effect on dopamine. Akathisia is the feeling of muscle quivering and restlessness.
• Correct
  • BradykinesiaThe nurse should watch carefully for any Parkinson’s disease–like adverse reaction related to patient receiving phenothiazines drugs due to their effect on dopamine. Bradykinesia is the slowness of movement.
• Correct
  • Tardive dyskinesiaThe nurse should watch carefully for any Parkinson’s disease–like adverse reaction related to patient receiving phenothiazines drugs due to their effect on dopamine. Tardive dyskinesia is the involuntary movement of the jaw and face.

Question 9 of 12

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Which finding supports an occurrence of neuroleptic malignant syndrome in a patient prescribed promethazine (Phenergean)?

• • BradycardiaTypically, a fast heart rate is a warning sign for neuroleptic malignant syndrome.
• • Flaccid muscleMuscle stiffness is mainly associated with neuroleptic malignant syndrome.
• Correct
  • Elevated temperatureThe nurse would monitor the patient for any sudden increase in temperature, which is a cardinal sign of neuroleptic malignant syndrome. This is a rare but life-threatening adverse reaction with phenothiazines.
• • BradypneaRapid breathing or tachypnea is associated with neuroleptic malignant syndrome.

Question 10 of 12

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Which response indicates further teaching is required for a patient who is prescribed the drug dronabinol (Marinol)?

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  • “I usually have grapefruit juice with breakfast every morning.”Grapefruit juice can cause dangerous adverse reactions with dronabinol (Marinol). The nurse should reinforce to the patient to avoid grapefruit because its juices can significantly increase the amount of the drug that enters the bloodstream.
• • “I can have a cup of orange juice a day.”Orange juice does not interact with the drug dronabinol (Marinol).
• • “It’s okay to add lemons to my water for flavor.”Lemons do not interact with the drug dronabinol (Marinol).
• • “It’s safe to eat strawberries.”Strawberries can be eaten with the drug dronabinol (Marinol).

Question 11 of 12

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Which finding would indicate that a patient is experiencing an adverse reaction to cannabinoid therapy?

• • LaughingLaughing is a common side effect related to the actions of cannabinoids due to its effects on the central nervous system. However, it is not an adverse reaction.
• Correct
  • Acute confusionAcute confusion is an immediate adverse reaction associated with cannabinoid therapy due to its effects on the central nervous system.
• • Increased awarenessSome patients have a “high” feeling when consuming cannabinoids. The nurse may notice the patient having an increased awareness in seeking to inform and educate people about a topic or issue. However, it is not an adverse reaction.
• • ElationMany patients feel a great sense of happiness and exhilaration when receiving cannabinoids due to its effects on the central nervous system. However, it is not an adverse reaction.

Question 12 of 12

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Which information would the nurse include when teaching a patient about the administration of nabilone (Cesamet)?

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  • “The drug helps control side effects associated with chemotherapy.”Nabilone (Cesamet) is a synthetic form of tetrahydrocannabinol (THC) that reduces nausea and vomiting associated with chemotherapy by binding to cannabinoid receptors in the chemoreceptor trigger zone (CTZ) and by preventing serotonin 5-HT₃ from binding to its receptors in the CTZ.
• • “This drug may not be the best option if you have a history of substance abuse.”Cannabinoids should be used with caution in patients who have a history of substance abuse (including alcohol) because of the increased risk of abuse of the drug.
• • “The drug you are taking is a common street drug approved in most states.”Marijuana is a common street drug approved in some states. However, nabilone (Cesamet) is for used medicinal treatment to help suppress nausea and vomiting associated with cancer chemotherapy.
• • “The drug you are taking will be used for research.”Nabilone (Cesamet) has proven to have medical benefits. Typically, cannabinoids are prescribed in severe cases due to their medicinal properties in aiding with controlling nausea and vomiting associated with cancer chemotherapy.