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 ["B","E"]
Explanation
Choice A rationale
Blood glucose levels are not directly impacted by epoetin alfa. Epoetin alfa stimulates erythropoiesis, the production of red blood cells, and its effectiveness is assessed by parameters related to red blood cell mass and oxygen-carrying capacity, not glucose metabolism.
Choice B rationale
Iron levels are crucial to monitor when a client is receiving epoetin alfa. Epoetin alfa stimulates red blood cell production, which requires adequate iron stores for hemoglobin synthesis. Insufficient iron can limit the therapeutic response to epoetin alfa.
Choice C rationale
Alanine aminotransferase (ALT) levels are indicators of liver function. Epoetin alfa does not have a direct hepatotoxic effect, and therefore, monitoring ALT is not a primary method to assess its effectiveness. Liver enzyme levels are not directly related to erythropoiesis.
Choice D rationale
Thyroid-stimulating hormone (TSH) levels are indicators of thyroid function. Epoetin alfa does not directly influence thyroid hormone production or regulation, and monitoring TSH would not provide information about the medication's effectiveness in stimulating red blood cell production.
Choice E rationale
Hemoglobin levels are the primary laboratory test to monitor the effectiveness of epoetin alfa. The medication's purpose is to stimulate erythropoiesis, leading to an increase in red blood cell mass and subsequently, a rise in hemoglobin concentration (normal range for adult males: 13.5–17.5 grams/dL; for adult females: 12.0–15.5 grams/dL).
Correct Answer is B
Explanation
Choice A rationale
Gingival hyperplasia is an overgrowth of gum tissue, often associated with certain medications like phenytoin or cyclosporine. It is caused by an increase in the number of fibroblasts and collagen deposition in the gingiva. Haloperidol, an antipsychotic, primarily affects dopamine receptors in the brain and does not cause gingival hyperplasia.
Choice B rationale
Haloperidol is a first-generation antipsychotic that blocks D2 dopamine receptors in the brain. This blockade, particularly in the nigrostriatal pathway, can lead to extrapyramidal symptoms (EPS) such as acute dystonia, parkinsonism (including muscle rigidity, bradykinesia, and tremor), and akathisia. Muscle rigidity is a common manifestation of drug-induced parkinsonism.
Choice C rationale
Polyuria is the excessive production of urine, often a symptom of diabetes mellitus or insipidus. It results from impaired water reabsorption in the kidneys. While some medications can affect fluid balance, haloperidol's primary pharmacological action on dopamine receptors does not directly induce polyuria as a typical adverse effect.
Choice D rationale
Bruising, or ecchymosis, results from bleeding under the skin, often due to trauma or coagulation disorders. It is caused by extravasation of blood from capillaries into surrounding tissues. Haloperidol does not affect coagulation factors or platelet function and is not associated with increased bruising as a direct adverse effect.
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