Question

Which of the following orders should the nurse question for chemotherapy induced nausea and vomiting? ? A. Ondansetron (Zofran) 8 mg every eight hours ? B. Dolasetron (Anzemet) 1.8 mg per kg ? C. Prochlorperazine maleate (Compazine) 50 mg four times daily ? D. Metoclopramide (Reglan) 20 mg four times daily

Short answer

Answer: Option C (Prochlorperazine maleate 50 mg four times daily) should be questioned the most by the nurse, as it greatly exceeds the recommended daily dosage for treating chemotherapy-induced nausea and vomiting.

Step-by-step solution

Analyze Option A: Ondansetron (Zofran) 8 mg every eight hours

For Ondansetron, the recommended dosage for CINV is 8 mg to 24 mg daily, divided into 2-3 doses. With an order of 8 mg every eight hours, the patient would receive a total of 24 mg per day, which is within the recommended dosage range. This option appears to be appropriate for treating CINV.

Analyze Option B: Dolasetron (Anzemet) 1.8 mg per kg

For Dolasetron, the recommended dosage for CINV is a single intravenous dose of 1.8 mg per kg or a fixed dose of 100 mg administered 30 minutes before the start of chemotherapy. Since the given order is within the recommended dosage range and does not exceed the maximum recommended dose, this option also appears to be appropriate for treating CINV.

Analyze Option C: Prochlorperazine maleate (Compazine) 50 mg four times daily

For Prochlorperazine maleate, the usual adult dosage for CINV is 5 mg to 10 mg, administered three to four times daily. However, the given order suggests a dose of 50 mg four times daily, which results in a total daily dosage of 200 mg. This greatly exceeds the recommended daily dosage and may cause harm to the patient. This option should be questioned.

Analyze Option D: Metoclopramide (Reglan) 20 mg four times daily

For Metoclopramide, the recommended dosage for CINV is 10 mg to 15 mg, administered four times daily, with a maximum dose of 60 mg per day. The given order of 20 mg four times daily results in a total daily dosage of 80 mg, which exceeds the maximum recommended daily dosage. This order should also be questioned.

Determine the most inappropriate order

Based on our analysis, both Option C (Prochlorperazine maleate) and Option D (Metoclopramide) exceed the recommended daily dosage for treating CINV. However, the Prochlorperazine maleate order (Option C) has a more significant deviation from the recommended dosage than Option D. Therefore, Option C should be the order that is questioned the most by the nurse for chemotherapy-induced nausea and vomiting.