Question 1

A woman is in her first trimester of pregnancy.She tells the primary care nurse practitioner (NP)that she continues to have severe morning sickness on a daily basis.The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior.The NP should consult an obstetrician and prescribe:

Accepted Answer

No antiemetic drugs should be used for nausea and vomiting during pregnancy unless approved by an obstetrician.Ondansetron has been shown to be safe and effective (off-label)for hyperemesis gravidum.

Question 2

A primary care NP sees a patient 2 days after an outpatient surgical procedure.The patient reports using ondansetron for nausea.The NP notes a blood pressure of 88/56 mm Hg,and the patient reports feeling faint.The NP should suspect:

Accepted Answer

Hypotension and faintness are signs of overdose of ondansetron,and drug toxicity is the more likely cause of this patient's decrease in blood pressure.

Question 3

A primary care NP sees a 3-year-old patient who has been vomiting for several days.The child has had fewer episodes of vomiting the past day and is now able to take sips of fluids without vomiting.The child has dry oral mucous membranes,2-second capillary refill,and pale but warm skin.The child's blood pressure is 88/46 mm Hg,the heart rate is 110 beats per minute,and the temperature is 37.2° C.The NP should:

Accepted Answer

The use of antiemetics in children is discouraged for cases of uncomplicated vomiting.The child has compensated,mild dehydration and is now able to tolerate fluids,so oral rehydration is indicated.

Question 4

A primary care NP sees a patient who is about to take a cruise and reports having had motion sickness with nausea on a previous cruise.The NP prescribes the scopolamine transdermal patch and should instruct the patient to apply the patch:

Accepted Answer

The transdermal system allows steady-state plasma levels of scopolamine to be reached rapidly and maintained for 3 days.The onset of action is approximately 4 hours.The patch should be changed every 3 days and left on at all times,not as needed.

Question 5

A patient is in the clinic complaining of nausea and vomiting that has lasted 2 to 3 days.The patient has dry oral mucous membranes,a blood pressure of 90/56 mm Hg,a pulse of 96 beats per minute,and a temperature of 38.8° C.The primary care NP notes a capillary refill of greater than 3 seconds.The NP should:

Accepted Answer

If vomiting is not controlled,dehydration may occur.Patients who are dehydrated,as this patient is,must be treated with IV fluids in a hospital or emergency department setting.

Question 6

A patient who is about to begin chemotherapy expresses concern to the primary care NP about gastrointestinal side effects of the treatments.The NP should reassure the patient that:

Accepted Answer

In many situations,nausea and vomiting may be anticipated.These situations may involve motion sickness or chemotherapy.Premedicating the patient with an antiemetic may be necessary in order for the patient to receive full therapy; this is the current standard of care.Although most chemotherapeutic agents have emetogenic potential,the use of premedication with 5-HT₃ receptor antagonists significantly decreases the nausea and vomiting experienced during and after administration The most common agent in this class,ondansetron,is now available as a generic.

Question 7

A patient reports having episodes of dizziness,nausea,and lightheadedness and describes a sensation of the room spinning when these occur.The primary care NP will refer the patient to a specialist who,after diagnostic testing,is likely to prescribe:

Accepted Answer

Patients with vertigo may experience whirling or a feeling of the room spinning around.In true vertigo,the patient can identify the direction in which the room is spinning.Anticholinergics are the most effective agents in cases of motion sickness or vertigo.Meclizine has a specific indication to treat vertigo.

Quiz 30: Antiemetics

A woman is in her first trimester of pregnancy.She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis.The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior.The NP should consult an obstetrician and prescribe:

A primary care NP sees a patient 2 days after an outpatient surgical procedure.The patient reports using ondansetron for nausea.The NP notes a blood pressure of 88/56 mm Hg,and the patient reports feeling faint.The NP should suspect:

A primary care NP sees a patient who is about to take a cruise and reports having had motion sickness with nausea on a previous cruise.The NP prescribes the scopolamine transdermal patch and should instruct the patient to apply the patch:

A patient who is about to begin chemotherapy expresses concern to the primary care NP about gastrointestinal side effects of the treatments.The NP should reassure the patient that:

A patient reports having episodes of dizziness,nausea,and lightheadedness and describes a sensation of the room spinning when these occur.The primary care NP will refer the patient to a specialist who,after diagnostic testing,is likely to prescribe: