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WorksheetsN/V and Complex N/V
Total questions: 60
Worksheet time: 30mins
Which of the following agents is OTC-approved for the prevention of motion-related nausea and vomiting?
Scopolamine transdermal patch
Promethazine
Meclizine
Tradipitant
Which OTC antihistamine is described as less sedating and longer-acting than dimenhydrinate?
Diphenhydramine
Doxylamine
Meclizine
Cetirizine
Which of the following is NOT effective for treating motion sickness–related nausea?
Dimenhydrinate
Diphenhydramine
Meclizine
Loratadine
Which patient should NOT be managed with OTC antiemetics?
Adult with mild nausea after overeating
Adult with nausea and dark urine and yellow sclera
Adult with motion sickness during travel
Adult with nausea relieved by crackers
Which OTC product contains phosphorated carbohydrates and works by direct local action on the GI tract?
Pepto-Bismol
Emetrol
Sea-Band
Meclizine
Which patient should avoid phosphorated carbohydrate solutions such as Emetrol without physician advice?
Patient with GERD
Patient with uncontrolled diabetes
Patient with motion sickness
Patient with mild indigestion
Which statement regarding bismuth subsalicylate (Pepto-Bismol) is correct?
Approved for children under 12
Safe during pregnancy
Can cause black tongue and stool
Contains calcium carbonate
Which agent is a transdermal prescription medication effective for prolonged motion exposure?
Dimenhydrinate
Scopolamine
Meclizine
Diphenhydramine
Which population is at highest risk for scopolamine-associated hyperthermia?
Adults aged 30–50
Adolescents 12–17
Children <17 and adults >60
Pregnant women
Which is the most appropriate initial recommendation for nausea during pregnancy?
OTC antihistamines
Bismuth subsalicylate
Nonpharmacologic measures
Phosphorated carbohydrate solution
When should OTC antihistamines be taken for motion sickness prevention?
At symptom onset only
Immediately after exposure begins
30–60 minutes before exposure
Only at bedtime before exposure
Which duration of vomiting in adults requires referral, even if symptoms seem mild?
> 12 hours
> 24 hours
> 48 hours
> 72 hours
Which patient should avoid acupressure or nerve-stimulating wristbands?
Patient with GERD
Patient with asthma
Patient with pacemaker
Patient with diabetes
Why are antacids generally poor choices for nausea management?
Delayed onset
Limited efficacy for N/V
Significant CNS effects
Risk of addiction
Which physiologic change commonly occurs before vomiting?
Increased GI motility
Decreased heart rate
Sweating and pallor
Bronchodilation
Overeating-induced nausea is primarily caused by:
Increased gastric acid secretion
Dopamine receptor stimulation
Distention activating mechanoreceptors
Serotonin release in the vestibular system
Which etiology of nausea does NOT originate from the GI tract or vestibular system?
Viral gastroenteritis
Motion sickness
Anxiety and anticipation
NSAID irritation
An adult with nausea, vomiting, dehydration, and urine ketones should be:
Given OTC antiemetics
Advised oral rehydration
Referred immediately for medical care
Treated with bismuth subsalicylate
Which OTC antiemetic class may be misused for psychiatric effects?
Antacids
Phosphorated carbohydrate solutions
Antihistamines
Oral rehydration solutions
Which activity may reduce motion sickness symptoms?
Sitting in the back seat
Reading during travel
Driving the vehicle
Using a phone screen
Where should Sea-Band pressure be applied?
Over the radial artery
Two fingers above the elbow
Over the P6 (Nei-Kuan) point
On the dorsum of the wrist
Which medication causes nausea and vomiting due to toxic drug levels, requiring referral rather than OTC treatment?
Ibuprofen
Digoxin
Acetaminophen
Loperamide
Which condition increases risk when using antihistamine antiemetics?
Seasonal allergies
Chronic bronchitis
Hypothyroidism
Iron deficiency anemia
Severe right upper quadrant pain after a fatty meal suggests:
Appendicitis
Cholecystitis
IBS
GERD
What is the maximum duration phosphorated carbohydrate solutions (e.g., Emetrol) should be used?
24 hours
6 hours
1 hour
48 hours
Which withdrawal state may cause nausea and vomiting?
Beta-blockers
Benzodiazepines
Antihistamines
Proton pump inhibitors
Which medication may have increased seizure risk when combined with antihistamine antiemetics?
Metformin
Bupropion
Omeprazole
Warfarin
Concurrent use of antihistamine antiemetics with ipratropium increases risk of:
Hypotension
QT prolongation
Anticholinergic toxicity
Hepatotoxicity
For motion sickness, promethazine should be administered via which routes only?
Oral and IV
Oral and rectal
IM and rectal
IV only
Promethazine is contraindicated in patients with:
Hypertension
GERD
Asthma
Diabetes
Which group of neurotransmitter receptors is involved in nausea and vomiting?
GABA, NMDA, AMPA
Cholinergic, histaminic, dopaminergic, serotonergic, neurokinin
Adrenergic, opioid only
Prostaglandin and leukotriene
Which symptom duration defines chronic nausea and vomiting?
>2 weeks
>3 weeks
>1 month
>6 months
Which condition is classified as an intraperitoneal cause of nausea and vomiting?
Vestibular disorder
Diabetic ketoacidosis
Cannabinoid hyperemesis syndrome
Anxiety disorder
Complex nausea and vomiting typically requires:
Single-agent therapy
Non-pharmacologic treatment only
Combination therapy using different mechanisms
Avoidance of prescription medications
Which antacid is MOST associated with diarrhea?
Aluminum hydroxide
Calcium carbonate
Magnesium hydroxide
Sodium bicarbonate
Which medication is MOST useful for motion sickness?
Famotidine
Meclizine
Ondansetron
Metoclopramide
Which adverse effect is associated with phenothiazines?
Hyperglycemia
QT prolongation
Diarrhea
Renal failure
Which phenothiazine has a BBW for severe tissue injury?
Prochlorperazine
Chlorpromazine
Promethazine
Haloperidol
Which 5-HT3 antagonist dosing is NO LONGER recommended due to QT risk?
Ondansetron 4 mg PO
Ondansetron 8 mg IV
Ondansetron 16 mg IV
Granisetron PO
Which antiemetic requires EKG prior to administration?
Haloperidol
Droperidol
Metoclopramide
Dexamethasone
Which medications carry a BBW for increased mortality in elderly patients with dementia-related psychosis?
Ondansetron and metoclopramide
Haloperidol and olanzapine
Dexamethasone and aprepitant
Scopolamine and meclizine
Which condition is metoclopramide MOST useful for?
Motion sickness
GERD only
Diabetic gastroparesis
Vestibular neuritis
What is the maximum recommended duration of metoclopramide therapy?
4 weeks
8 weeks
12 weeks
No limit
A patient with ≥3 PONV risk factors should receive:
Ondansetron alone
Two agents from the same class
3–4 agents from different classes
Rescue therapy only
When should a scopolamine patch be applied for PONV prophylaxis?
End of surgery
During induction
At least 2 hours before surgery
Post-op only
First-line pharmacologic therapy for nausea and vomiting of pregnancy is:
Ondansetron
Promethazine
Pyridoxine ± doxylamine
Metoclopramide
Which finding BEST suggests cannabinoid hyperemesis syndrome?
One episode of vomiting daily
Weekly cannabis use
Relief with hot showers
Positive pregnancy test
Administering 10 mEq of potassium chloride is expected to increase serum potassium by approximately:
0.05 mmol/L
0.1 mmol/L
0.5 mmol/L
1.0 mmol/L
Which medication is a common offender for drug-induced nausea?
Metformin
Lubiprostone
Amlodipine
Warfarin
Which medication mainly used in PONV prolongs QT AND increases prolactin levels?
Metoclopramide
Amisulpride
Haloperidol
Droperidol
Which antiemetic blocks dopamine, serotonin, adrenergic, and histamine receptors?
Prochlorperazine
Haloperidol
Olanzapine
Droperidol
Which class is MOST associated with extrapyramidal symptoms?
5-HT3 antagonists
Antacids
Dopamine antagonists
NK-1 antagonists
NK-1 receptor antagonists primarily augments the activity of:
Antihistamines and Antacids
Dopamine antagonists and Phenothiazines
5-HT3 antagonists and corticosteroids
Benzodiazepines and opioids
Which NK-1 antagonist is sometimes administered IV prior to anesthesia for PONV?
Netupitant
Rolapitant
Aprepitant
Fosnetupitant
Cannabinoids are NOT first-line antiemetics due to:
Lack of efficacy
Risk of QT prolongation
Risk of cyclic nausea and vomiting with chronic use
Lack of oral formulations
Which acid-base disturbance is commonly associated with prolonged vomiting?
Metabolic acidosis
Respiratory alkalosis
Metabolic alkalosis
Respiratory acidosis
Which complication of nausea and vomiting can independently worsen QT-related arrhythmia risk?
Dehydration
Hypokalemia
Metabolic alkalosis
Hyperglycemia
Which complication may require hospitalization in pregnancy?
Mild nausea
Morning-only vomiting
Hyperemesis gravidarum
Food aversion
Which condition requires avoidance of amisulpride?
Hepatic impairment
Severe renal impairment
Diabetes mellitus
GERD
Which factor MOST strongly favors use of non-oral antiemetics?
High cost
Mild nausea
Active vomiting
Young age
