Gi Nutrition>Supportive Care Practice Test

A 68-year-old man with a history of stroke and dysphagia is receiving continuous enteral nutrition via a PEG tube. Nursing reports the tube infuses slowly and then occludes completely after the patient received multiple crushed medications through the tube. He is hemodynamically stable and not in distress. The tube was recently functioning well, and there is no external kinking noted. The patient is on a fiber-containing polymeric formula at goal rate, and free-water flushes were performed infrequently overnight due to high nursing workload. The team requests pharmacist guidance on restoring tube patency quickly and safely at the bedside.

A 62-year-old man with stage III squamous cell carcinoma of the oropharynx is starting definitive chemoradiation. His regimen includes cisplatin 100 $mg/m^2$ on day 1 every 3 weeks, which his oncologist notes is highly emetogenic. He has hypertension and GERD controlled with amlodipine and omeprazole; baseline CMP and CBC are within normal limits and he is not on chronic steroids. He denies a history of motion sickness or prior severe postoperative nausea. He is anxious about nausea and vomiting because he is the primary caregiver for his spouse and wants to avoid hospitalizations. The team requests an antiemetic plan that covers both acute and delayed phases for cycle 1. The clinic stocks palonosetron, ondansetron, aprepitant, fosaprepitant, dexamethasone, and olanzapine. Which of the following is the most appropriate supportive care intervention?