CHAPTER 17: Stimulants

Which is a priority nursing action when assessing for side effects expected in a patient taking analeptics? A. Auscultating heart rate for bradycardia B. Assessing for decreased mental alertness C. Observing patient for nervousness D. Checking blood pressure for hypotension

C. Observing patient for nervousness Analeptics are CNS stimulants, which cause nervousness as a side effect. The stimulation effect can result in increased heart rate, increased mental alertness, and hypertension as well.

The nurse is caring for a child taking methylphenidate (Ritalin). Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's priority action? A. Hold the next dose of the medication. B. Assess for over-the-counter medication use. C. Administer an antianxiety agent. D. Stay with the child and use relaxation techniques.

B. Assess for over-the-counter medication use. Methylphenidate interacts with over-the-counter cold medication. The nurse should assess for the use of over-the-counter medication use.

The nurse expects that a newborn who is experiencing apnea is most likely to be ordered treatment with which medication? A. Benzphetamine HCl B. Caffeine citrate C. Diethylpropion HCl D. Diphenhydramine

B. Caffeine citrate Caffeine citrate can be used as a respiratory stimulant for newborns experiencing apnea.

Which of the following conditions would meet the medically approved criteria for use of CNS stimulants? (Select all that apply.) A. Attention-deficit/hyperactivity disorder in children B. Weight loss in the morbidly obese C. Promotion of wakefulness in narcolepsy D. Reversal of respiratory distress E. Severe depressive states

A. Attention-deficit/hyperactivity disorder in children C. Promotion of wakefulness in narcolepsy D. Reversal of respiratory distress Medically approved use of CNS stimulants is limited to the treatment of attention-deficit/hyperactivity disorder in children, narcolepsy, and the reversal of respiratory distress. Although the drug has anorexiant properties, this is not its medically approved indication. It is not indicated for depression.

5. The nurse is monitoring a patient who is taking phentermine. Which is important for the nurse to observe? (Select all that apply.) a. Euphoria b. Dry mouth c. Insomnia d. Hypotension e. Bradycardia f. Palpitations

A. Euphoria C. Insomnia F. Palpitations

5. The parent of a child who is taking amphetamine to treat attention-deficit/hyperactivity disorder (ADHD) asks the provider to recommend an over-the-counter medication to treat a cold. What will the nurse tell the parent? a. "Avoid any products containing pseudoephedrine or caffeine." b. "Never give over-the-counter medications with amphetamine." c. "Sudafed (pseudoephedrine) is a safe and effective decongestant for my child." d. "Use any over-the-counter medication from the local pharmacy."

ANS: A Amphetamine is a stimulant, so other stimulants, such as caffeine and pseudoephedrine, should be avoided to avoid additive stimulation.

3. A patient has been using methylphenidate to treat ADHD for several weeks. the patient is having difficulty sleeping and takes the medication twice daily before breakfast and dinner. the nurse will explain to the patient that methylphenidate a. can cause insomnia and recommend taking the medication before breakfast and lunch. b. does not often cause insomnia. c. can cause insomnia and recommend a medication to help with sleep. d. usually causes drowsiness.

ANS: A Amphetamines such as methylphenidate are CNS stimulants and can contribute to insomnia. For patients taking methylphenidate twice daily, it is recommended to take the medication 30-45 minutes before breakfast and lunch. Recommending a shift in administration time would be the best first option before staring a medication for insomnia.

11. A college-age student is brought to the emergency department by friends after consuming caffeine tablets along with several cups of coffee and a few energy drinks. the patient is complaining of nausea and diarrhea and appears restless. the nurse understands that a. arrhythmias and convulsions may occur. b. psychological dependence to caffeine does not occur. c. effects of the caffeine will wear off shortly due to its 1-hour half-life. d. severe adverse effects do not occur.

ANS: A Caffeine and other stimulants can cause cardiac arrhythmias and seizures. Psychological dependence to caffeine may occur. the half-life of caffeine is approximately 4 hours.

7. The parent of an adolescent who has taken methylphenidate 20 mg/day for 6 months for attention-deficit/hyperactivity disorder (ADHD) brings the child to clinic for evaluation of a recent onset of nausea, vomiting, and headaches. the parent expresses concern that the child seems less focused and more hyperactive than before. What will the nurse do next? a. Ask the child whether the drug is being taken as prescribed. b. Contact the provider to discuss increasing the dose to 30 mg/day. c. Recommend taking the drug with meals to reduce gastrointestinal side effects. d. Report signs of drug toxicity to the patient's provider.

ANS: A Nausea, vomiting, and headaches can occur with drug withdrawal, along with a recurrence of symptoms. thenurse should ask thechild about how they are taking themedication. Methylphenidate should be taken 30 to 45 minutes before meals, not with meals.

8. The nurse is teaching a parent about methylphenidate to treat attention-deficit/hyperactivity disorder (ADHD). Which statement by theparent indicates understanding of theteaching? a. "I should consult a pharmacist when giving my child OTC medications." b. "I will only give my child diet soft drinks while administering this medication." c. "Medication therapy means that behavioral therapy will not be necessary." d. "Weight gain is a common side effect of this medication."

ANS: A Since many OTC medications contain stimulants, parents should consult a pharmacist or the provider before giving them in combination with methylphenidate. Diet soft drinks often contain caffeine, a stimulant, and should be avoided with methylphenidate use. Behavioral therapy remains an essential part of the treatment for ADHD. Weight loss is common.

10. The nurse is working in a neonatal intensive care unit and is caring for an infant who is experiencing multiple periods of apnea and bradycardia. Which of the following drugs could be used to treat neonatal apnea? a. Albuterol b. Caffeine citrate c. Doxapram d. Methylphenidate

ANS: B Caffeine citrate is indicated for use in newborns with respiratory distress. the other drugs listed are not used for this purpose.

4. The nurse is teaching a child and a parent about taking methylphenidate to treat attentiondeficit/ hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. "I should give this drug to my child at bedtime." b. "My child should avoid products containing caffeine." c. "The drug should be stopped immediately if my child develops aggression." d. "We should monitor my child's weight since weight gain is common."

ANS: B Methylphenidate is a stimulant, so other stimulants such as caffeine should be avoided. the medication should be taken in the morning. Patients should be taught not to stop the drug abruptly to avoid withdrawal symptoms. Weight loss is common.

6. The nurse is checking an 8-year-old child who has attention-deficit/hyperactivity disorder (ADHD) into a clinic for an annual well-child visit. the child takes methylphenidate HCl. Which assessments are especially important for this child? a. Respiratory rate and oxygen saturation b. Height, weight, and blood pressure c. Measures of fine- and gross-motor development d. Blood glucose

ANS: B Methylphenidate may cause growth suppression, so the child's height and weight should be assessed. Methylphenidate may also increase blood pressure, so the nurse should pay careful attention to changes in blood pressure.

2. The nurse is caring for a 7-year-old child who has difficulty concentrating and completing tasks and who cannot seem to sit still. Which diagnostic test may be ordered to assist with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) in this child? a. Computerized tomography (CT) of thehead b. Electrocardiogram (ECG) c. Electroencephalogram (EEG) d. Magnetic resonance imaging (MRI) of thebrain

ANS: C A child with ADHD may have abnormal EEG findings. CT, MRI, and ECG tests are not diagnostic for ADHD.

9. The parent of an obese 10-year-old child asks the nurse about medications to aid in weight loss. Which response by the nurse is correct? a. "Anorexiants are often used to 'jump start' a weight loss regimen in children." b. "Children are able to use over-the-counter anorexiants on a long-term basis." c. "Children under 12 years of age should not use weight loss drugs." d. "Side effects of anorexiants occur less often in children."

ANS: C Anorexiants should not be given to children under age 12 years.

12. A patient reports difficulty staying awake during thedaytime despite getting adequate sleep every night and is diagnosed with narcolepsy. Which medication will thenurse expect theprovider to order for this patient? a. Caffeine b. Albuterol c. Modafinil d. Theophylline

ANS: C Modafinil is given to treat narcolepsy

1. The nurse is performing a medication history on a patient who plans to begin using phentermine HCl. thenurse knows which of thefollowing to be true about use of phentermine? a. It is used short-term for thetreatment of obesity. b. Use of phentermine can result in tachycardia. c. Phentermine is a controlled substance. d. All of theabove.

ANS: D Phentermine is indicated for short-term use to treat obesity. Phentermine is a controlled substance (schedule IV), and patients can experience tachycardia with use.

The nurse is caring for a patient who describes symptoms indicative of narcolepsy. The nurse recognizes that the physician is most likely to order which medication for the patient? A. Phentermine-topiramate B. Modafinil C. Diethylpropion HCl D. Benzphetamine HCl

B. Modafinil Modafinil (Provigil) is indicated for treatment of narcolepsy.

A patient taking methylphenidate is nauseous and vomiting. What is the nurse's best action? A. Administer an antiemetic medication. B. Assess the patient's temperature. C. Ask the patient if he or she has been taking the medication regularly. D. Monitor the patient's vital signs.

C. Ask the patient if he or she has been taking the medication regularly. Nausea, vomiting, and headache are symptoms of withdrawal. The nurse should find out if the patient has been taking the medication regularly.

Which suggestion should the nurse provide to the parents of a child taking methylphenidate for attention-deficit/hyperactivity disorder to offset anticipated side effects? A. Take the medication with grapefruit juice. B. Increase vitamin C in the diet. C. Chew sugarless gum. D. Decrease fluid intake prior to bedtime.

C. Chew sugarless gum. Side effects of amphetamines include dry mouth. Chewing on sugarless gum can help eliminate this effect. Vitamin loss does not accompany the use of amphetamines. Dehydration is not a common side effect, and grapefruit juice could alter the metabolism of the drug.

The patient asks the nurse if there is anything that the physician could order that would function as an appetite suppressant. The nurse anticipates that the physician may order which medications? (Select all that apply.) A. Armodafinil B. Diethylpropion HCl C. Phentermine-topiramate D. Benzphetamine HCl E. Caffeine citrate

CORRECT B. Diethylpropion C. Phentermine-topiramate D. Benzphetamine HCl HClPhentermine-topiramate, diethylpropion HCl, and benzphetamine HCl are all appetite suppressants.

What is a priority nursing action when taking care of a patient who is prescribed a central nervous system (CNS) stimulant? A. Keep the patient on bed rest. B. Continuously monitor the patient's pulse rate. C. Obtain a bedside commode for the patient. D. Monitor the patient for seizure activity.

D. Monitor the patient for seizure activity. Central nervous system (CNS) stimulation occurs when the amount and duration of action of excitatory neurotransmitters are increased. This can lead to the development of seizure activity in the patient who has received a central nervous system stimulant.

4. The nurse is teaching a patient to self-administer medications. The nurse knows that which drug is used to treat narcolepsy? a. Modafinil b. Atomoxetine c. Lisdexamfetamine d. Phendimetrazine

a. Modafinil

3. The nurse monitoring a patient for methylphenidate withdrawal should observe the patient for which condition? a. Tremors b. Insomnia c. Weakness d. Tachycardia

c. Weakness

2. Several children are admitted for diagnosis with possible attention-deficit/hyperactivity disorder. Which is most important for the nurse to observe? a. A girl who is lethargic b. A girl who lacks impulsivity c. A boy with smooth coordination d. A boy with an inability to complete tasks

d. A boy with an inability to complete tasks

1. When a 12-year-old child is prescribed methylphenidate, which is most important for the nurse to monitor? a. Temperature b. Respirations c. Intake and output d. Height and weight

d. Height and weight