NURS 317 Unit 2 Chapter 59 Pharm Point Questions

Question 1

Which medication is most likely to block 5-HT3 receptors locally and in the chemoreceptor trigger zone (CTZ)?

A) Chlorpromazine

B) Nabilone

C) Aprepitant

D) Granisetron

Answer 1

D) Granisetron

Rationale:Granisetron blocks the 5-HT3 receptors associated with nausea and vomiting locally and in the CTZ. Chlorpromazine acts centrally at the CTZ to change its responsiveness or stimulation. Aprepitant acts directly in the CNS to block receptors associated with nausea and vomiting with little or no effect on serotonin, dopamine, or corticosteroid receptors. Nabilone contains the active ingredient of cannabis (marijuana).

Question 2

A client receiving antiemetics is at risk for increased sedation if he ingests alcohol.

A) FALSE

B) TRUE

Answer 2

B) TRUE

Rationale:There is a risk of increased sedation if antiemetics are combined with any other CNS depressant, including alcohol.

Question 3

Which instruction would be most appropriate for the nurse to give to a client who is experiencing photosensitivity related to antiemetic therapy?

A) Avoid crowds of people.

B) Wear cotton short-sleeved shirts.

C) Drink plenty of fluids when outside.

D) Use protective sunscreen when outside.

Answer 3

D) Use protective sunscreen when outside.

Rationale:Photosensitivity is an increased sensitivity to sunlight and ultraviolet light, so protective clothing and sunscreen are important. Drinking more fluids will not protect the skin from increased sensitivity to the sun. All of the skin should be covered; therefore, short-sleeved shirts would not provide sufficient protection from the sun. Photosensitivity refers to increased sensitivity to the sun leading to increased chance of skin inflammation. Avoiding crowds of people will have no effect on photosensitivity.

Question 4

Chlorpromazine is the only antiemetic available in the nonphenothiazine category.

A) FALSE

B) TRUE

Answer 4

A) FALSE

Rationale:Metoclopramide is the only antiemetic available in the nonphenothiazine category.

Question 5

A nurse is teaching a group of parents about measures to prevent accidental poisonings in children. The nurse recognizes that further instruction is needed if a parent makes which statement?

A) “I know that many poisons have antidotes, but these must be specific.”

B) “I will make sure that the childproof caps are on all medication before I put the medication away.”

C) “I will make sure to tell my child he is taking candy instead of medicine so he will finish all of the medicine.”

D) “I have the Poison Control number posted right next to the telephone.”

Answer 5

C) “I will make sure to tell my child he is taking candy instead of medicine so he will finish all of the medicine.”

Rationale:Parents should never refer to medication as candy or a treat. Parents should return all childproof caps to the locked position after they are used. The number for the Poison Control center is posted near the phone. Antidotes must be specific to the poison ingested.

Question 6

Antiemetics work to relieve nausea and vomiting either locally or centrally.

A) FALSE

B) TRUE

Answer 6

B) TRUE

Rationale:Antiemetics are used to decrease or prevent nausea and vomiting. Antiemetic agents can be centrally or locally acting, and they have varying degrees of effectiveness.

Question 7

A client develops significant nausea and vomiting related to antineoplastic chemotherapy. What agents would be appropriate to use in this situation? Select all that apply.

A) Nabilone

B) Hydroxyzine

C) Aprepitant

D) Dolasetron

E) Granisetron

Answer 7

A) Nabilone
C) Aprepitant
D) Dolasetron
E) Granisetron

Rationale:While dolasetron, granisetron, aprepitant, and nabilone are 5-HT3 receptor blockers indicated for use with cancer chemotherapy, hydroxyzine is typically used to treat prepartum, postpartum, and postoperative nausea and vomiting

Question 8

The antiemetics dronabinol and nabilone contain the active ingredient of morphine.

A) FALSE

B) TRUE

Answer 8

A) FALSE

Rationale:Dronabinol and nabilone contain the active ingredient of cannabis (marijuana), not morphine.

Question 9

The nurse has just administered prochlorperazine to a client who is experiencing nausea. What instruction is most important for the nurse to give to this client?

A) “You can expect your urine to be bright red.”

B) “Please call for assistance before you get up to go to the bathroom.”

C) “Don’t be worried if you begin to salivate excessively.”

D) “Be sure to drink plenty of water to make this drug work faster.”

Answer 9

B) “Please call for assistance before you get up to go to the bathroom.”

Rationale:Prochlorperazine and other phenothiazines may cause dizziness; therefore, the client should receive assistance before getting out of bed. Drinking large quantities of water will only increase a client’s nausea. Phenothiazines may cause urine to be tinged pink or red-brown, not bright red. Phenothiazines may cause dry mouth, not excessive salivation.

Question 10

What would increase the risk of sedation in a client receiving prochlorperazine? Select all that apply.

A) Hydrocodone

B) Alcohol

C) Caffeine

D) Codeine

E) Diazepam

Answer 10

A) Hydrocodone
B) Alcohol
D) Codeine
E) Diazepam

Rationale:A client receiving prochlorperazine has an increased risk of sedation if the client combines the drug with alcohol or other drugs that cause CNS depression, such as diazepam, codeine, or hydrocodone.

Question 11

Trimethobenzamide is associated with greater sedation and CNS depression than other antiemetics.

A) FALSE

B) TRUE

Answer 11

A) FALSE

Rationale:Trimethobenzamide is not associated with as much sedation and CNS depression as other antiemetics.

Question 12

A nurse is caring for a client receiving a 5-HT3 receptor blocker. Which 5-HT3 receptor blocker is available only in parenteral form?

A) Granisetron

B) Dolasetron

C) Ondansetron

D) Palonosetron

Answer 12

D) Palonosetron

Rationale:Palonosetron is available only in IV form. The other listed drugs can also be given orally.

Question 13

Aprepitant is reserved for the treatment of nausea that results from chemotherapy.

A) FALSE

B) TRUE

Answer 13

B) TRUE

Rationale:Aprepitant is reserved for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic cancer chemotherapy.

Question 14

The nurse is preparing to administer nabilone to a client prior to cancer chemotherapy. The nurse understands that this agent is classified as which category of controlled substance?

A) III

B) II

C) I

D) IV

Answer 14

B) II

Rationale:Nabilone is classified as a category II controlled substance.

Question 15

Parents with young children are encouraged to keep a supply of syrup of ipecac on hand to induce vomiting in a child who has ingested a poison.

A) FALSE

B) TRUE

Answer 15

A) FALSE

Rationale:In November 2003, the American Academy of Pediatrics (AAP) revised its long-standing recommendation that parents be advised to keep and use ipecac for ingestion of toxic substances. Study findings showed that ipecac did not fully empty the stomach, that inducing vomiting in many cases was more toxic than what was ingested, and that the poison that was ingested needed to be carefully evaluated before the proper treatment was recommended.

Question 16

A client is prescribed prochlorperazine. The nurse would teach the client about what possible adverse effects? Select all that apply.

A) Irritability

B) Photosensitivity

C) Urine color change

D) Drowsiness

E) Dry mouth

Answer 16

B) Photosensitivity
C) Urine color change
D) Drowsiness
E) Dry mouth

Rationale:Dry mouth can occur with prochlorperazine. The client may experience a change in the color of urine to pink or red-brown. Photosensitivity is associated with prochlorperazine. Drowsiness can occur with prochlorperazine. Irritability is not typically associated with prochlorperazine

Question 17

Which action by the nurse would be most important when administering a phenothiazine antiemetic to a client?

A) Maintain NPO status.

B) Institute safety precautions.

C) Insert an indwelling urinary catheter.

D) Assess respiratory status.

Answer 17

B) Institute safety precautions.

Rationale:Adverse effects associated with phenothiazines are linked to their interference with normal CNS stimulation. The client’s risk for injury is high. Withholding food and fluids would not be necessary unless the client’s vomiting was not controlled and food or fluid intake exacerbated his vomiting. Respiratory adverse effects are not associated with the use of phenothiazines. Although urinary retention may occur, catheterization would be a last resort.

Question 18

A client receives prochlorperazine by IM injection. The nurse would expect the drug to begin acting in what amount of time?

A) 10 to 20 minutes

B) 40 to 50 minutes

C) 30 to 40 minutes

D) 20 to 30 minutes

Answer 18

A) 10 to 20 minutes

Rationale:Prochlorperazine, when given by IM injection, has an onset of action of 10 to 20 minutes.

Question 19

A client is experiencing intractable hiccoughs. Which agent would the nurse expect the healthcare provider to prescribe?

A) 5-HT3 receptor blocker

B) Phenothiazine

C) Substance P/neurokinin 1 receptor antagonist

D) Anticholinergic/antihistamine

Answer 19

B) Phenothiazine

Rationale:Phenothiazines are indicated for the treatment of intractable hiccoughs. Anticholinergics/antihistamines are commonly indicated for the treatment of motion sickness. 5-HT3 receptor blockers are commonly used for nausea and vomiting associated with cancer chemotherapy. Substance P/neurokinin 1 receptor antagonists are commonly used to treat nausea and vomiting associated with cancer chemotherapy.

Question 20

When developing the plan of care for a client who is receiving an antiemetic, what would the nurse include? Select all that apply.

A) Providing frequent mouth care

B) Offering warm liquids such as coffee

C) Ensuring a quiet environment

D) Ensuring ready access to bathroom facilities

E) Offering noncarbonated fluids

F) Encouraging slow, deep breaths

Answer 20

A) Providing frequent mouth care
C) Ensuring a quiet environment
D) Ensuring ready access to bathroom facilities
F) Encouraging slow, deep breaths

Rationale:Slow, deep breaths help to promote client comfort and relaxation. Frequent mouth care promotes client comfort. A quiet environment promotes comfort and rest. Readily available access to bathroom facilities promotes comfort and reassurance. Carbonated fluids most likely would be better tolerated. Cool liquids or ice chips most likely would be better tolerated.

Question 21

The nurse has administered metoclopramide to a client with nausea. To what category does this drug belong?

A) Substance P/neurokinin 1 receptor antagonist

B) Phenothiazine

C) 5-HT3 receptor blocker

D) Nonphenothiazine

Answer 21

D) Nonphenothiazine

Rationale:The only nonphenothiazine currently available for use as an antiemetic is metoclopramide.

Question 22

The nurse is reviewing the drug trimethobenzamide in preparation for administration. The nurse understands that this drug can be administered by which route? Select all that apply.

A) Intravenous

B) Intramuscular

C) Subcutaneous

D) Oral

E) Rectal

Answer 22

B) Intramuscular
D) Oral

Rationale:Trimethobenzamide is administered orally or as an IM injection.

Question 23

The nurse has administered a phenothiazine to a client with nausea. What medication may the nurse have given?

A) Granisetron

B) Ondansetron

C) Metoclopramide

D) Perphenazine

Answer 23

D) Perphenazine

Rationale:Perphenazine is a phenothiazine antiemetic. Granisetron and ondansetron are classified as 5-HT3 receptor blockers. Metoclopramide is a nonphenothiazine antiemetic.

Question 24

The nurse is caring for an 88-year-old client who is experiencing postoperative nausea. The nurse can anticipate that the healthcare provider will make which modification in prescribing an antiemetic for this client?

A) The dosage of the medication will be decreased.

B) The frequency of administration will be increased.

C) The dosage of the medication will be increased.

The frequency of administration will be decreased.

Answer 24

A) The dosage of the medication will be decreased.

Rationale:The dose for older adults should be started at a lower level than that recommended for young adults. The dosage of medication will be reduced, not the frequency of administration