Author Question: A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron ... (Read 88 times)

tingc95 · **on:** Jul 23, 2018

A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron (Zofran) and dexamethasone.

The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do?
a. Contact the provider to discuss increasing the dose of ondansetron.
b. Suggest giving prolonged doses of dexamethasone.
c. Suggest adding aprepitant (Emend) to the medication regimen.
d. Tell the patient to ask the provider about changing the ondansetron to aprepitant.

Question 2

A patient is receiving intravenous promethazine (Phenergan) 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug?

a. Giving the dose as an IV push over 3 to 5 minutes
b. Infusing the dose with microbore tubing and an infusion pump
c. Observing the IV insertion site frequently for patency
d. Telling the patient to report dry mouth and sedation

bob · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: C
The current regimen of choice for patients taking highly emetogenic drugs consists of three agents: aprepitant plus dexamethasone plus a 5-HT3 antagonist, such as ondansetron. Aprepitant has a prolonged duration of action and can prevent delayed CINV as well as acute CINV. Increasing the dose of ondansetron will not help treat the delayed CINV. Glucocorticoids should be given intermittently and for short periods to avoid side effects. Changing the ondansetron to aprepitant is not recommended.

Answer to Question 2

ANS: C
If IV administration must be done with this drug, it should be given through a large-bore, freely flowing line. The site should be monitored closely for local burning or pain or any sign of extravasation, which can cause abscess formation, tissue necrosis, and gangrene requiring amputation. Giving the medication as a rapid IV push or through microbore tubing does not adequately slow the infusion or dilute the drug. Dry mouth and sedation are expected side effects of this drug and are not dangerous.