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
Explanation
Choice A rationale
Nystagmus, an involuntary rhythmic eye movement, is not a recognized or common adverse effect of oral albuterol. Albuterol is a beta-2 adrenergic agonist primarily acting on bronchial smooth muscle to cause bronchodilation. Its side effects are typically related to sympathetic nervous system stimulation, not oculomotor dysfunction.
Choice B rationale
Tachycardia is a common adverse effect of oral albuterol due to its systemic absorption and stimulation of beta-1 adrenergic receptors in the heart, in addition to its primary beta-2 effects on the lungs. This leads to an increased heart rate (normal range 60-100 bpm) and can cause palpitations, especially in sensitive individuals or with higher doses.
Choice C rationale
Drowsiness is not a typical adverse effect of oral albuterol. In fact, due to its stimulant properties, albuterol is more likely to cause central nervous system excitation, leading to insomnia, nervousness, or tremors rather than sedation. Its action is to activate adrenergic pathways, which generally promote alertness.
Choice D rationale
Oral fungal infections, such as oral candidiasis (thrush), are commonly associated with inhaled corticosteroids, not oral albuterol. Inhaled corticosteroids suppress the local immune response in the oral cavity, allowing opportunistic fungal growth. Oral albuterol does not have immunosuppressive effects on the oral mucosa.
Correct Answer is B
Explanation
Choice A rationale
Insulin lispro is a rapid-acting insulin used to manage hyperglycemia in clients with diabetes mellitus. Its primary mechanism involves facilitating glucose uptake into cells and inhibiting hepatic glucose production. It does not directly mitigate the adverse effects, such as myelosuppression and gastrointestinal issues, associated with topotecan, a topoisomerase I inhibitor used in chemotherapy.
Choice B rationale
Granisetron is a serotonin 5-HT3 receptor antagonist, primarily used to prevent nausea and vomiting induced by chemotherapy. It works by blocking serotonin's action on vagal nerve terminals and in the chemoreceptor trigger zone in the brainstem. This action effectively controls a common and distressing adverse effect of topotecan, thereby improving client comfort and compliance.
Choice C rationale
Magnesium sulfate is an electrolyte replacement and smooth muscle relaxant. It is used in conditions like pre-eclampsia, eclampsia, and hypomagnesemia. Its physiological effects involve stabilizing neuronal excitability and reducing uterine contractions. It is not indicated for the management of topotecan's adverse effects, which predominantly involve myelosuppression and gastrointestinal toxicity.
Choice D rationale
Prednisone is a corticosteroid with potent anti-inflammatory and immunosuppressive properties. It is used to treat various conditions, including autoimmune disorders, allergic reactions, and some cancers. While it can reduce inflammation, it does not specifically target the common adverse effects of topotecan, such as myelosuppression and gastrointestinal disturbances.
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