A nurse is providing teaching to a client who is scheduled to receive chemotherapy and has a prescription for ondansetron to control nausea and vomiting.
Which of the following information should the nurse include in the teaching?
Restlessness is an expected adverse effect of the medication.
Take the medication 30 minutes after chemotherapy.
Acute nausea resolves within 12 hours of chemotherapy administration.
Additional medications can be required if nausea persists.
The Correct Answer is D
Choice A rationale
Restlessness, also known as akathisia, is not a typical expected adverse effect of ondansetron. Ondansetron primarily acts as a selective 5-HT3 receptor antagonist, blocking serotonin's emetogenic effects in the chemoreceptor trigger zone and gastrointestinal tract. Common adverse effects are generally mild, including headache, constipation, or diarrhea, with neurological effects like restlessness being rare and atypical for this drug's primary mechanism.
Choice B rationale
Ondansetron should be administered prophylactically, typically 30 minutes *before* chemotherapy, to achieve optimal antiemetic effect. Its mechanism involves blocking serotonin receptors that, when activated by chemotherapy, trigger nausea and vomiting. Pre-emptive administration ensures therapeutic drug levels are present to counteract the emetogenic stimuli effectively before their onset.
Choice C rationale
Acute nausea and vomiting associated with chemotherapy can persist for significantly longer than 12 hours, often lasting for 24 to 48 hours or even longer depending on the specific chemotherapeutic agent and its emetogenic potential. The duration of emesis is highly variable and directly related to the drug's pharmacokinetic profile and the extent of serotonin release.
Choice D rationale
If nausea persists despite ondansetron administration, it indicates an inadequate antiemetic response, likely due to the complex neurochemical pathways involved in chemotherapy-induced nausea and vomiting. This often necessitates a multi-modal approach, involving the addition of other antiemetic agents like corticosteroids (e.g., dexamethasone) or neurokinin-1 receptor antagonists (e.g., aprepitant) to target different emetogenic pathways for more complete symptom control.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
A prothrombin time (PT) of 15.5 seconds, while slightly above the normal range of 11 to 12.5 seconds, indicates a mild prolongation of clotting time. For a client on warfarin, a slight elevation in PT is often expected as it reflects the anticoagulant effect. This value alone may not necessitate immediate reporting.
Choice B rationale
An activated partial thromboplastin time (aPTT) of 45 seconds, slightly above the normal range of 30 to 40 seconds, indicates a minor prolongation in the intrinsic and common pathways of coagulation. While relevant for heparin therapy, its direct significance for warfarin's primary monitoring is less critical.
Choice C rationale
An International Normalized Ratio (INR) of 5.2 is significantly elevated above the therapeutic range for most conditions, which is typically 2.0 to 3.0 for clients on warfarin. An INR of 5.2 indicates a high risk of bleeding complications due to excessive anticoagulation, requiring immediate provider notification. Normal range is 0.8 to 1.1.
Choice D rationale
A platelet count of 90,000/mcL is below the normal range of 150,000 to 400,000/mcL, indicating thrombocytopenia. While important for hemostasis, warfarin primarily affects clotting factors, not platelet production. However, a low platelet count combined with high INR further increases bleeding risk, necessitating reporting.
Correct Answer is A
Explanation
Choice A rationale
Laryngeal edema is a severe manifestation of an immediate hypersensitivity (Type I anaphylactic) reaction to penicillin. It involves swelling of the larynx, leading to airway obstruction, stridor, and difficulty breathing. This life-threatening condition requires immediate medical intervention, including epinephrine and airway management, making it the priority to monitor.
Choice B rationale
Urticaria, or hives, is a common cutaneous manifestation of a hypersensitivity reaction to penicillin. It involves transient, itchy wheals on the skin due to histamine release. While uncomfortable and requiring attention, it is typically not life-threatening unless accompanied by systemic symptoms like laryngeal edema or bronchospasm.
Choice C rationale
Epigastric distress, such as stomach upset or pain, is a common gastrointestinal adverse effect of oral penicillin V, often due to direct irritation of the gastric mucosa or altered gut flora. While it can cause discomfort, it is generally not a life-threatening condition and can often be managed with food or dose adjustment.
Choice D rationale
Maculopapular rash is a delayed hypersensitivity reaction to penicillin, usually appearing several days after initiation of therapy. It presents as flat, red areas with small raised bumps. While it indicates a drug allergy, it is generally not immediately life-threatening compared to acute airway compromise and resolves upon discontinuation of the medication.
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