A nursing student is discussing with a nurse the plan of care for ...

[cherise1989]

A nursing student is discussing with a nurse the plan of care for a patient about to undergo a third round of chemotherapy with cisplatin. Which statement by the nursing student about the treatment of CINV is correct?
 
  a. Aprepitant Emend will be necessary to treat CINV caused by cisplatin.
  b. Antiemetics are most effective if given just as the chemotherapy is finished.
  c. Lorazepam probably would not be help-ful for this patient.
  d. This patient will need intravenous anti-emetics for best effects.

Question 2

A patient has been taking fluoxetine Prozac for 2 years and reports feeling cured of depression. The nurse learns that the patient is sleeping well, participates in usual activities, and feels upbeat and energetic most of the time.
 
  The patient's weight has returned to normal. The patient reports last having symptoms of depression at least 9 months ago. What will the nurse tell this patient? a. Indefinite drug therapy is necessary to maintain remission.
  b. Discuss gradual withdrawal of the medi-cation with the provider.
  c. Stop the drug while remaining alert for the return of symptoms.
  d. Take a drug holiday to see whether symptoms recur.

[Ptupou85]

Answer to Question 1

A
CINV caused by cisplatin is maximal 48 to 72 hours after dosing and can persist for 6 to 7 days, so an antiemetic such as aprepitant, which treats delayed emesis, is an important part of anti-emetic therapy. Antiemetics should be started 30 minutes before initiation of chemotherapy. Lo-razepam should be given to this patient, because the patient has had some experience with che-motherapy and is likely to have anticipatory emesis. There is no benefit to IV over oral dosing unless the patient has ongoing emesis.

Answer to Question 2

B
Abrupt discontinuation of selective serotonin reuptake inhibitors (SSRIs) can cause a withdrawal syndrome, so these drugs should be withdrawn gradually. After symptoms are in remission, treatment should continue for 4 to 9 months to prevent relapse; these drugs are not taken indefi-nitely. It is incorrect to counsel the patient to stop taking the drug without tapering it. Drug holi-days are used to minimize sexual dysfunction side effects, not to monitor symptoms.

[cherise1989]

Excellent

[Sarahjh]

TYSM