PREPU (UNFINISHED) Chapter 18: CNS Stimulants

5 of 10 A mother brings her child to the clinic and informs the health care provider that the child is having a difficult time paying attention in school, seems to be getting in trouble several times a day, and is acting very impulsively. The nurse can expect the provider to order which drugs for this child? • modafinil • methylphenidate • diethylpropion • armodafinil

• methylphenidate Explanation: The health care provider will order methylphenidate, which is used to treat ADHD (attention deficit hyperactivity disorder). Armodafinil and modafinil are both used for narcolepsy. Diethylpropion is a drug used to depress appetite.

4 of 5 A nurse has participated in a family meeting with the parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD) and prescribed dextroamphetamine. The nurse should discuss what black box warning associated with this medication? • risk of hemorrhagic stroke • potential for abuse • anticholinergic effects • hyperglycemic crisis

• potential for abuse Explanation: A black box warning makes users of dextroamphetamine aware of the drug's high abuse potential. Anticholinergic effects, stroke, and hyperglycemia are not addressed in a black box warning for this drug.

Question 4 of 5 The elderly clients taking CNS stimulants are especially sensitive to these drugs. They need to be monitored for which side effects? Select all that apply. • Urinary retention • Excessive anxiety • Nervousness • Insomnia • Mental confusion

Correct response: • Excessive anxiety • Nervousness • Insomnia • Mental confusion Explanation: Older clients are especially sensitive to the effects of CNS stimulants and may exhibit excessive anxiety, nervousness, insomnia, and mental confusion. Urinary retention has not been associated with CNS stimulants in the elderly.

3 of 20 What is the central nervous system stimulant of choice to treat narcolepsy? • guarana • caffeine • atomoxetine • modafinil

• modafinil Explanation: Modafinil is used to treat narcolepsy. Atomoxetine is administered for attention deficit hyperactivity disorder (ADHD). Guarana is the main ingredient in caffeine and is not administered for narcolepsy. Caffeine is not administered for narcolepsy.

13 of 20 The nurse is explaining to a parent of an infant in the NICU why the infant is on caffeine. Which of the following statements would explain the use of caffeine in the NICU? • "I read in the mother's chart that she drank four cups of coffee per day, so we are giving the infant caffeine so that he feels like he is still in utero." • "Caffeine increases the infant's appetite; he will eat better and grow better if he receives caffeine." • "Caffeine is a central nervous system stimulant. It is used to decrease respiratory depression in the infant." • "Caffeine stimulates the infant to learn normal tasks such as sucking and swallowing more quickly."

• "Caffeine is a central nervous system stimulant. It is used to decrease respiratory depression in the infant." Explanation: Caffeine is used in the neonatal intensive care unit as a CNS stimulant, which can decrease respiratory depression in the infant. The amount of coffee the mother drank during pregnancy does not influence an infant's care. Caffeine does not stimulate appetite, growth, or learning in infants.

3 of 5 A client's medication history includes a long-term prescription for modafinil. Which assessment question should the nurse ask to confirm why the medication was prescribed? • "Do you have a problem with sleepwalking?" • "Do you have trouble falling asleep?" • "Have you ever been diagnosed with narcolepsy?" • "Have you ever been diagnosed with attention deficit hyperactivity disorder (ADHD)?"

• "Have you ever been diagnosed with narcolepsy?" Explanation: Modafinil is used to treat narcolepsy and to improve wakefulness in other sleep disorders. It is not used to treat insomnia or somnambulism. It is not commonly used to treat ADHD.

15 of 20 A client is being prescribed dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD). During health education, the nurse should make the client aware of the black box warning relating to what potential risk issue? • unstable blood glucose levels • stroke with excessive doses • potential for abuse • kidney failure

• potential for abuse Explanation: A black box warning makes users of dextroamphetamine aware of the drug's high abuse potential. Black box warnings do not address the potential for renal failure, stroke, or unstable blood sugars.

10 of 20 Doxapram (Dopram) is given to a pediatric client who weighs 4000 g. The maximum dose for this cliient is 250 mcg/kg. How many times can an IV infusion of 0.5 mg be given to this client?

• 2 Explanation: The maximum dose of this medication for this client is 250 mcg/kg. Because the client weighs 4 kg (4000 g = 4 kg), the maximum dosage is 1000 mcg (250 mcg x 4) or 1 mg. This means that the client can receive an infusion of 0.5 mg twice for a total of 1 mg dosage.

8 of 20 A pediatric client has been admitted to the floor and started on ritalin therapy for AHDH. The nurse knows that an important daily intervention for this client would be which? • record a daily summary of client's behavior. • suction the client daily. • perform ROM exercises daily. • weigh the client daily.

• record a daily summary of client's behavior. Explanation: When a client is started on an amphetamine for any reason the nurse weighs the client and should take the blood pressure, pulse, and respiratory rate before starting therapy. The nurse records a daily summary of the client's behavior on the chart if the client is hospitalized.

5 of 5 A nurse is providing care for a client diagnosed with attention deficit hyperactivity disorder (ADHD) who has been taking methylphenidate for several months. When monitoring for potential adverse effects, the nurse should include what assessments? • sleep patterns • sexual function • pupillary response • orientation to person, place, and time

• sleep patterns Explanation: Because methylphenidate is a central nervous system (CNS) stimulant, it carries the potential to disturb sleep patterns. The client's pupillary response, orientation, and sexual function are less likely to be affected.

6 of 20 The nurse has learned that there is a high incidence of suicidal ideation in children and adolescents when using which of the following drugs? • dopram • provigil • strattera • nuvigil

• strattera Explanation: An increased risk of suicidal ideation in children and adolescents has been found when using the drug atomoxetine (strattera). The other drugs listed are analeptics and are not associated with the risk factor of suicide.

14 of 20 What is the purpose of a "drug holiday" for a teenager prescribed an amphetamine for attention deficit hyperactivity disorder (ADHD)? • to prevent hyperthyroidism • to minimize weight loss • to allow electrolyte imbalances to resolve • to slow bone resorption

• to minimize weight loss Explanation: Dextroamphetamine often causes loss of appetite, and the health care provider may stop the medication during the months when the child is not in school. A drug holiday, as this is called, helps decrease weight loss and growth suppression. It does not address potential electrolyte imbalances, thyroid imbalances, or the process of bone remodeling.

12 of 20 The nurse is educating the parent of a child diagnosed with ADHD. Which statement from the parent indicates she understands when to give the medication? • "I'll give my child his medication only on the weekends when I can watch him." • "I'll give my child his medication approximately 45 minutes before breakfast and lunch." • "I'll give my child his medication when he seems hyperactive." • "I'll mix my child's medication with milk so that it doesn't upset his stomach."

• "I'll give my child his medication approximately 45 minutes before breakfast and lunch." Explanation: Medications for ADHD should be given approximately 45 minutes prior to breakfast and lunch. The medication is to be given on a routine basis, not just when the child is hyperactive. The medication should not be mixed in anything. ADHD medications are sometimes prescribed exclusively for school days because that is when the child most needs to pay attention. Giving the medication only on the weekends will not help the child concentrate at school.

18 of 20 The nurse is teaching the parents of a child diagnosed with attention-deficit hyperactivity disorder how to administer extended release methylphenidate (Ritalin). What should the nurse teach the parents? • "Contact the school nurse to work out a convenient schedule." • "It's best to give it at breakfast every day." • "It can be given at any time, as long as it's on an empty stomach." • "Giving it at bedtime will minimize the adverse effects."

• "It's best to give it at breakfast every day." Explanation: Several long-acting formulations of methylphenidate have become available that allow the drug to be given only once a day. It should always be given in the morning because administration at dinnertime or bedtime could result in insomnia. The nurse should not defer to the school nurse.

1 of 20 A nursing instructor is conducting a class about drugs that affect the central nervous system (CNS). The instructor determines that the teaching was successful when the students identify which as a component of the CNS? Select all that apply. • Efferent nerves • Autonomic nerves • Spinal cord • Afferent nerves • Brain

• Brain • Spinal cord Explanation: The CNS is composed of the brain and spinal cord. Afferent neurons are sensory neurons that carry nerve impulses from the stimuli toward the CNS and brain, while efferent neurons are motor neurons that carry neural impulses away from the CNS and toward muscles to move away from the stimuli. The autonomic nervous system is part of the nervous system responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes.

19 of 20 A client asks to have a year's worth of prescription refills for methylphenidate, explaining that it is very hard to get off work and come in for refill appointments. How should the nurse respond to that request to best assure client safety? • "I understand the inconvenience, but you have to come in at least every month to have blood work done." • "The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse." • "It would be very costly to purchase a years' worth of medication at one time." • "I will speak with your health care prescriber about getting you a new prescription that allows for greater amounts of pills per refill."

• "The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse." Explanation: When a central nervous system (CNS) stimulant is prescribed, it is started with a low dose that is then increased as necessary, usually at weekly intervals, until an effective dose (i.e., decreased symptoms) or the maximum daily dose is reached. In addition, the number of doses that can be obtained with one prescription should be limited. This action reduces the likelihood of drug dependence or diversion (use by people for whom the drug is not prescribed). None of the other options effectively address this risk for injury.

3 of 5 An adult client, diagnosed with narcolepsy, admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology? • "This is the result of neurological factors over which you have no direct control." • "In a lot of cases, making improvements to your sleep habits can resolve narcolepsy." • "This usually stems from suppressed emotions, so counseling usually helps greatly." • "This is something that runs in certain families, and it's not your fault that this has happened."

• "This is the result of neurological factors over which you have no direct control." Explanation: Narcolepsy is a neurological sleep disorder, not the result of mental illness or psychological problems. It is most likely due to several genetic abnormalities, but family history is not noted to be highly significant. While learning that improvement of symptoms is important, it will not address embarrassment.

7 of 10 The nurse is teaching parents of a pediatric client diagnosed with ADHD. Teaching has been about the disorder and its treatment. The nurse determines that teaching has been effective when the parents state which? • "We need to be careful so he doesn't develop a substance abuse problem as he grows older." • "We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention." • "We should stop the medication after 2 months to see how effective it is in really controlling his symptoms." • "We should set up regular routines for him but not worry if he violates the limits once in a while."

• "We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention." Explanation: Teaching patients and families about the biological basis of ADHD helps parents understand that these children are not "bad" kids but that they have problems with impulse control and attention. It may be helpful to review the purposes of the medications and assure the parents that there is evidence that medications help most children. Studies show that treatment of ADHD is not associated with a risk of substance disorders. The physician, not the parents, would determine when it would be appropriate to take a drug holiday to evaluate the need for continued medication therapy. Regular routines are important but so are clear limits with clear consequences when these limits are violated.

4 of 10 The nursing student is reviewing information learned in anatomy and physiology class about the nervous system. The student recalls that the nervous system has how many divisions? • 3 • 1 • 4 • 2

• 2 Explanation: The nervous system has two main divisions: the central nervous system and the peripheral nervous system.

20 of 20 A nurse is caring for an obese client with no identified comorbidities. Which body mass index (BMI) would be required for the use of a prescribed anorexiant? • 31 • 25 • 27 • 23

• 31 Explanation: Anorexiants should only be used for obesity (BMI of 30 or greater) or overweight (BMI of 27) when comorbid conditions exist, such as hypertension, type 2 diabetes, or dyslipidemia. The other two values of 23 and 25 do not indicate the need for an anorexiant.

10 of 20 A pediatric client has been prescribed dextroamphetamine (Adderall) 2.5 mg PO BID. How many mg would this client take each day?

• 5 Explanation: BID signifies that this medication should be taken twice a day; 2.5 mg x 2 times a day = a total of 5 mg per day.

14 of 20 The client has been prescribed caffeine therapeutically. While educating the client the nurse should make a point to tell the client which? • The use of caffeine is still experimental, but not harmful. • Caffeine is a central nervous system depressant. • Sleepiness, anxiety, and increased sex drive may occur when you take caffeine. • Nervousness, restlessness, and palpitations may occur when you take caffeine.

• Nervousness, restlessness, and palpitations may occur when you take caffeine. Explanation: Caffeine is a CNS stimulant and can cause nervousness, restlessness, and palpitations. Caffeine is not a CNS depressant, it is not experimental, and it does not cause sleepiness or increased sex drive.

5 of 20 A nurse works at a weight management clinic. To which overweight client could the nurse safely administer dextroamphetamine? • A 48-year-old Caucasian man who has adult-onset diabetes • A 38-year-old Caucasian woman with glaucoma • A 28-year-old African-American woman with hyperthyroidism • A 60-year-old African-American man who experiences angina

• A 48-year-old Caucasian man who has adult-onset diabetes Explanation: Dextroamphetamine is contraindicated in clients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and glaucoma. Use of this drug could place the clients at risk for hypertension and increased intraocular pressure. The only client that the nurse could administer this drug to would be the 48-year-old Caucasian man who has adult-onset diabetes.

7 of 20 The client taking a CNS stimulant reports insomnia. The best option for the nurse in this case is to do which? • Administer the drug right before bedtime. • Administer the drug earlier in the day. • Administer the drug 2 hours before bedtime. • Hold the drug.

• Administer the drug earlier in the day. Explanation: When CNS stimulants cause insomnia, the nurse should administer the drug early in the day to diminish sleep disturbances. The client should be provided with distracting activities and encouraged not to nap during the day.

6 of 20 The nursing student learned in pharmacology class that drugs that affect the CNS do which of the following? (Check all that apply.) • Decrease K+ • Alter sensation • Lower glucose levels • Alter the interpretation of information in the brain • Alter mood

• Alter mood • Alter sensation • Alter the interpretation of information in the brain Explanation: Drugs that affect the CNS alter mood, sensation, and the interpretation of the information in the brain. They do not have any effect on blood glucose or blood K+.

8 of 20 A nurse is instructing a mother about a new drug her son was prescribed for ADHD. The nurse should include which instructions? • Always take the drug after breakfast and after lunch. • Always take the drug in the morning before breakfast and before going to bed at night. • Always take the drug in the morning 30 to 45 minutes before breakfast and lunch. • Always take the drug 30 minutes before lunch and dinner.

• Always take the drug in the morning 30 to 45 minutes before breakfast and lunch. Explanation: Medications for ADHD should be given in the morning 30 to 45 minutes before breakfast and lunch. They should not be given in the late afternoon.

7 of 20 The nurse practitioner is prescribing CNS medications. The nurse practitioner knows that central nervous system stimulants can be used successfully to treat which disorders? Select all that apply. • Narcolepsy • Sleep apnea • Attention deficit/hyperactivity disorder • Fatigue • Appetite stimulant • Drug-induced respiratory depression

• Attention deficit/hyperactivity disorder • Drug-induced respiratory depression • Narcolepsy • Sleep apnea • Fatigue Explanation: The central nervous stimulants are used to treat the following: ADHD, drug-induced respiratory depression, postanesthesia repsiratory depression, narcolepsy, sleep apnea, exogenous obesity, and fatigue. They are not used to stimulate appetite.

9 of 20 An infant born at 31 weeks' gestation is admitted to the neonatal intensive care unit (NICU). The infant's heart rate is 70 bpm; oxygen saturation is between 80% to 85%. The infant is also having periodic apnea lasting longer than 20 seconds. Of the following, which would be part of the treatment plan for this infant? • Dextroamphetamine (Dexedrine) • Caffeine • Atomoxetine (Strattera) • Anorectics

• Caffeine Explanation: Caffeine is the prototype of the drug class respiratory stimulant and is used to treat apnea of prematurity. Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor. Dextroamphetamine (Dexedrine) is a central nervous system stimulant that is not appropriate for children younger than 3 yeras and is used primarily to treat ADHD. Anorectics are used to suppress appetite.

1 of 10 A nurse is reviewing information about anorexiants. The nurse would expect to find that most of these drugs are classified as which pregnancy category? • Category B • Category C • Category A • Category X

• Category X Explanation: Most anorexiants are pregnancy category X and should not be used during pregnancy. Category A drugs are the safest to take during pregnancy and have no adverse effects. Category B drugs have no risks found in humans. Category C drugs---not enough research has been done on these drugs to determine if they are safe.

2 of 20 A client has been treated with amphetamines for ADHD. At the age of 16 years, the client is diagnosed with hyperthyroidism. What intervention should be implemented with this client? • Discontinue the amphetamines • Administer a proton pump inhibitor • Assess the client for pulmonary edema • Discontinue the high-calorie diet

• Discontinue the amphetamines Explanation: Amphetamines are contraindicated upon the development of hyperthyroidism. The client will require a higher calorie count, not a discontinuation of a high-calorie count. The client will not require an assessment for pulmonary edema. The client will only require a proton pump inhibitor if gastric hyperacidity occurs.

2 of 5 A teenage client, treated with dextroamphetamine for attention deficit hyperactivity disorder (ADHD) for the last 10 years, is now diagnosed with hyperthyroidism. What intervention should be implemented with this client to provide safe management of all conditions? • Assess the client for pulmonary edema. • Discontinue the dextroamphetamine. • Administer a proton pump inhibitor. • Discontinue the high-calorie diet.

• Discontinue the dextroamphetamine. Explanation: Dextroamphetamine, an amphetamine, is contraindicated upon the development of hyperthyroidism. The client will require a higher-calorie count, not a discontinuation of a high-calorie count. The client will not require an assessment for pulmonary edema. The client will only require a proton pump inhibitor if gastric hyperacidity occurs.

4 of 20 Prior to administering a CNS stimulant to reverse respiratory depression, which would the nurse need to ensure about the client? • Respiration greater than 24 breaths per minute • Pulse less than 100 beats per minute • Patent airway • Normal blood pressure

• Patent airway Explanation: Prior to administering a CNS stimulant to reverse respiratory depression the nurse must ensure that the client has a patent airway. Since the client may have respiratory depression, a normal blood pressure can be seen, normal heart rate of less than 100 beats per minute and because they have respiratory depression, the respiratory rate is slower.

1 of 5 A 49-year-old woman experienced postsurgical respiratory depression and was given caffeine to stimulate the respiratory system. The client is now irritable, excited, unable to sleep, has headache, and muscle twitching. The appropriate nursing diagnoses for the client would include which? Select all that apply. • Disturbed Sleep Pattern • Anxiety • Deficient Fluid Volume • Imbalanced Nutrition • Nonadherence to Therapeutic Regimen

• Disturbed Sleep Pattern • Anxiety Explanation: All of the nursing diagnoses could be applicable to this client. However, the client's behavior indicates that Disturbed Sleep Pattern related to Insomnia and Anxiety related to stimulatory effects of caffeine would be appropriate. Deficient Fluid Volume could be related to the diuretic effects of caffeine and possible diarrhea, but no information was presented to indicate that was an issue. Imbalanced Nutrition related to possible diarrhea and anorexia could also be an issue, but no information was presented to indicate that it was. Nonadherence to Therapeutic Regimen could be related to lack of motivation, poor self-image, or negative effects of caffeine; but again, no information was presented to indicate that it was an issue.

16 of 20 The nurse is working in post-op and the client has just come out of surgery. The nurse notes that the clients respiratory rate is 4 breaths per minute. The nurse has a standing order to give doxapram 0.5 mg/kg IV for respiratory depression. What should the nurse do next? • Draw up the medication and give it to the client without getting it double checked (since it is an emergency). • Continually shake the client and talk loudly to him to wake him up. • Give Narcan instead of doxapram because the client received a large dose of fentanyl while in surgery, causing his respiratory depression. • Draw up the medication, have it checked by a second provider, have suction close by, and give the medication.

• Draw up the medication, have it checked by a second provider, have suction close by, and give the medication. Explanation: Doxapram is given for postanesthesia respiratory depression. All medications should be double-checked by a second provider prior to administration. Clients often vomit after being given doxapram so suction should be close by. Narcan is not recommended because the client would be in severe pain if the narcotic was counteracted by the Narcan. Continually shaking and talking loudly to the client may stimulate the client for that moment, but will not help continual respiratory depression.

4 of 10 The nursing student, in pharmacology class, is learning about amphetamines. The student identifies this class of drugs to have what actions? Select all that apply. • Elevate blood pressure • Cause wakefulness • Increase pulse rate • Decrease respiratory rate • Decrease pulse rate

• Elevate blood pressure • Cause wakefulness • Decrease pulse rate • Increase pulse rate Explanation: Amphetamines are sympathomimetic and their drug actions result in an elevation of blood pressure, wakefulness, and increased or decreased pulse rate. Amphetamines also produce a euphoric state that increases their potential for dependency.

4 of 5 A female client comes to the clinic for an examination after being on benzphetamine for 6 weeks with a weigt loss of 30 pounds. The priority nursing diagnosis for this client would be which? • Disturbed sleep pattern • Risk for ineffective coping • Imbalanced nutrition • Ineffective breathing pattern

• Imbalanced nutrition Explanation: Imbalanced nutrition, less than body requirements is the best nursing diagnosis based on the data given. There is no mention that this client is having problems with sleep or breathing. There also are no data stating that this client is having difficulty coping.

2 of 5 A client is prescribed doxapram as part of the treatment plan. Which would be most important for the nurse to do when caring for this client? Select all that apply. • Keep a suction machine nearby • Administer drug on an empty stomach • Measure urinary intake and output • Palpate the bladder for distention • Avoid giving the client coffee, tea, and carbonated beverages

• Keep a suction machine nearby • Avoid giving the client coffee, tea, and carbonated beverages • Measure urinary intake and output • Palpate the bladder for distention Explanation: Clients receiving modafinil may develop nausea, so the nurse should keep a suction machine nearby in case the client vomits. Coffee, tea, and carbonated beverages should be avoided when the client is taking a CNS stimulant. Urinary retention may occur, so it is important to monitor the client's intake and output and palpate the bladder for distention. Doxapram is given intravenously.The drug should be administered with food or immediately afterward but not on an empty stomach.

19 of 20 A child, diagnosed with attention deficit hyperactivity disorder (ADHD), has been prescribed methylphenidate. The child's mother tells the nurse that she does not understand why a stimulant would help since, "my child is completely overstimulated, not under-stimulated!" What should the nurse explain to the mother about the therapeutic use of methylphenidate? • Methylphenidate enhances the function of dopamine, which regulates cognition. • Methylphenidate helps with the symptoms of ADHD, but the reasons for this are not well understood. • Methylphenidate stimulates the parasympathetic nervous system, resulting in increased control of behavior. • Methylphenidate stimulates the limbic system, which regulates control over behavior and affect.

• Methylphenidate helps with the symptoms of ADHD, but the reasons for this are not well understood. Explanation: The efficacy of methylphenidate in the management of ADHD is paradoxical and not well understood. It does not significantly affect dopamine levels or the function of the limbic system and parasympathetic nervous system.

2 of 20 A nurse is administering a CNS stimulant to a client with narcolepsy. The nurse understands that this drug does not cause cardiac and other systemic stimulatory effects like other CNS stimulants. Which drug is the nurse most likely administering? • Dopram • Dexmethylphenidate • Modafinil • Caffeine

• Modafinil Explanation: Modafinil is used to treat narcolepsy and does not cause cardiac and other systemic stimulatory effects like other CNS stimulants. Caffeine is a CNS stimulant and can cause increased heart rate. Doxapram is a respiratory stimulant that increases respiratory rate and tidal volume. Dexmethylphenidate is a CNS stimulant used to treat ADHD and narcolepsy; it is highly addictive and can be psychologically dependent.

1 of 20 A child is prescribed an amphetamine for attention deficit hyperactivity disorder (ADHD). Which effect provides evidence that the medications are working? • lethargy • polyphagia • increased sleep quality • improved grades

• improved grades Explanation: Amphetamines used with ADHD improve academic performance. Amphetamines often decrease sleep. Amphetamines will not result in lethargy. Amphetamines decrease appetite and do not cause polyphagia, the demonstration of excessive hunger and abnormally large intake of solids by mouth

1 of 5 Due to excessive stimulation, caffeine is not recommended for: • People who have a history of depression. • People with myofascial pain syndrome. • People who have a history of dependency. • People with cardiac dysrhythmias, a history of stroke, peptic ulcer disease, bipolar mood disorder, and schizophrenia.

• People with cardiac dysrhythmias, a history of stroke, peptic ulcer disease, bipolar mood disorder, and schizophrenia. Explanation: CNS stimulants also stimulate the cardiovascular system and thus are contraindicated in clients with cardiovascular disorders (eg, angina, dysrhythmias, and hypertension) that are likely to be aggravated by the drugs. They also are contraindicated in clients with anxiety or agitation, glaucoma, or hyperthyroidism. They are usually contraindicated in clients with a history of drug abuse. Caffeine is not recommended for people with cardiac dysrhythmias, a history of stroke, peptic ulcer disease, bipolar mood disorder, and schizophrenia.

3 of 5 A group of nursing students are reviewing information about CNS stimulants. The students demonstrate understanding of the information when they identify which drug as being used to treat obesity? • Phentermine • Dexmethylphenidate • Methylphenidate • Modafinil

• Phentermine Explanation: This drug is a CNS stimulant used to treat obesity. This CNS stimulant is used to treat attention-deficit hyperactivity disorder. Modafinil is a CNS stimulant used to treat narcolepsy. Methylphenidate is a CNS stimulant used to treat attention-deficit hyperactivity disorder.

12 of 20 A client with attention deficit hyperactivity disorder (ADHD) has not had an adequate response to behavioral therapy. All these medications would be acceptable except: • Amphetamine (Adderall). • Atomoxetine (Strattera). • Phentermine (Ionamin). • Methylphenidate (Ritalin).

• Phentermine (Ionamin). Explanation: Atomoxetine (Strattera) is the nonstimulant treatment for ADHD. Phentermine (Ionamin) is a central nervous system stimulant and anorexiant used to treat obesity. Methylphenidate (Ritalin) and amphetamine (Adderall) are CNS stimulants used to treat ADHD.

2 of 5 A child with attention-deficit hyperactivity disorder is prescribed atomoxetine. The nurse would assess the child closely for which adverse reactions? • Hyperglycemia • Dyspnea • Suicidal ideation • Hypertension

• Suicidal ideation Explanation: Children and adolescents given atomoxetine (Strattera) should be monitored closely for suicidal ideations. Atomoxetine has not shown adverse effects of hypertension, dyspnea, or hyperglycemia.

1 of 5 A nurse is administering an anorexiant. The nurse understands that this drug is used primarily for which purpose? • Stimulate the respiratory system • Suppress the cardiovascular system • Treat attention deficit hyperactivity disorder • Suppress the appetite

• Suppress the appetite Explanation: Anorexiants are drugs used to suppress the appetite. Amphetamines are used to treat attention-deficit hyperactivity disorder. No CNS stimulants suppress the cardiovascular system. Analeptics stimulate the respiratory center of the brain.

5 of 10 The client is prescribed dextroamphetamine. The nurse is counseling the client prior to beginning this medication. Which information should the nurse include in the teaching? Select all that apply. • Take this medication first thing in the morning on an empty stomach. • You may see an improvement within 24 to 48 hours. • Take this medication with food at night. • Take this medication in the morning before breakfast. • You may see an improvement in symptoms within 5 to 7 days.

• Take this medication in the morning before breakfast. Explanation: Improvement in symptoms may not be seen for several weeks. Because this medication can cause insomnia, it should be taken in the morning. It is best when taken with food to minimize GI disturbances.

3 of 5 The nursing student has learned that caffeine is a drug with many different effects on the body. The student realizes that caffeine can be found in many different foods including which? Select all that apply. • Pasta • Coffee • Red meats • Chocolate • Tea

• Tea • Coffee • Chocolate Explanation: Caffeine is a CNS stimulant. It has a big effect on the body. People take caffeine on their own in the form of coffee, tea, and chocolate. The nurse needs to assess how much caffeine the client is consuming independently when doing an assessment.

13 of 20 A nurse is teaching the client about CNS medications and how they are addictive. What is primary reason CNS medications are addictive? • The medication decreases the amount of dopamine released into the body, causing feelings of euphoria. • The medication stimulates the brain's sleep centers, so the client can sleep more soundly. • The medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine. • The medication stimulates the brain's visual centers, so the client sees everything more clearly.

• The medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine. Explanation: CNS medications have a high degree of addiction potential because they stimulate the brain's pleasure centers with enhanced neurotransmission of dopamine. CNS stimulants do not promote sleep. CNS stimulants do not change visual acuity. Decreased dopamine does not produce feelings of euphoria.

15 of 20 The home health nurse is gathering a client's medication prior to going to see the physician. The nurse cannot find the bottle for the methylphenidate, Daytrana. What would be the reason for this? • This is an IV medication. • This is an IM medication. • Nurses often misplace medication bottles. • This is a transdermal patch medication.

• This is a transdermal patch medication. Explanation: Daytrana is a transdermal patch, which delivers the medication slowly through the skin. Nurses do not normally misplace medications. Medications are kept in specific places with many safeguards in place for proper administration. Daytrana is not given IM or IV.

9 of 10 A child was diagnosed with attention-deficit hyperactivity disorder and methylphenidate was prescribed for treatment to be taken once a day in a sustained release form. On future visits what is a priority nursing assessment for this child? • Electrocardiogram (ECG) and echocardiogram • Urine output and kidney function • Weight and height • Breath sounds and respiratory rate

• Weight and height Explanation: The nurse needs to carefully track this child's weight and height because the drug can cause weight loss, anorexia, and nausea that could result in slowed or absent growth. There would be no need to monitor breath sounds, respiratory rate, urine output, and kidney function. Although arrhythmias may occur as an adverse effect necessitating an ECG, there is no need to perform echocardiograms.

11 of 20 When a nurse is educating a client taking anorexiants for weight management, which teaching should be included? Select all that apply. • Once you begin this medication, you will have to remain on it for several years. • You may experience some side effects of this medication, including agitation, dizziness, and restlessness. • You should take your medication before you eat dinner. • You may take this medication in lieu of diet and exercise modifications to manage your weight. • You should not deviate from the prescribed dosage unless your provider instructs you to do so.

• You should not deviate from the prescribed dosage unless your provider instructs you to do so. • You may experience some side effects of this medication, including agitation, dizziness, and restlessness. Explanation: Anorexiants are short-term therapy for weight management and an adjunct to diet and exercise modifications. Clients should be educated not to adjust their medications unless their provider instructs them to do so. Anorexiants should be taken early in the day to minimize the side effect of insomnia.

9 of 20 The students are learning about medications to treat ADHD. The pharmacology instructor discusses the medication methylphenidate, used to treat attention deficit hyperactivity disorder. According to the instructor, methylphenidate is which? • an anoretic agent. • a respiratory stimulant. • a selective serotonin reuptake inhibitor (SSRI). • a central CNS stimulant.

• a central CNS stimulant. Explanation: Methylphenidate, a drug used in the treatment of ADHD, is a central CNS stimulant. It is not as SSRI, respiratory stimulant or anoretic agent.

17 of 20 A 22-year-old client comes into the emergency department. He is highly active, and says his heart is pounding. On further questioning, he says he took several pills at a party. What type of medication does the nurse suspect he took at the party? • anorexiant • amphetamine • antidepressant • analeptic

• amphetamine Explanation: Amphetamines are sympathomimetic drugs that stimulate the central nervous system to speed up. This results in increased blood pressure, wakefulness, and increased pulse rate. Antidepressants are given for clients with depression or mood disorders. Anorexiants suppress the appetite. Analeptic drugs stimulate the respiratory center of the brain and CV system.

18 of 20 When assessing an adolescent client diagnosed with attention deficit hyperactivity disorder (ADHD) for therapeutic effects of methylphenidate, the nurse should focus on improvement associated with what client function? Select all that apply. • behavior • endurance • cognitive task performance • stamina • motor task performance

• behavior • motor task performance • cognitive task performance Explanation: For clients with ADHD, the nurse assesses for improved behavior and performance of cognitive and psychomotor tasks. Endurance and stamina are not considered.

10 of 10 Due to the actions of caffeine, the nurse is concerned when it is consumed by clients with what medical diagnosis? Select all that apply. • hypothyroidism • bipolar disorder • cataracts • cardiac dysrhythmias • history of stroke

• cardiac dysrhythmias • bipolar disorder • history of stroke Explanation: CNS stimulants stimulate the cardiovascular system and thus are contraindicated in clients with cardiovascular disorders (e.g., angina, dysrhythmias, and hypertension) that are likely to be aggravated by the drugs. They also are contraindicated in clients with anxiety or agitation, glaucoma, or hyperthyroidism. They are usually contraindicated in clients with a history of drug abuse. Caffeine is not recommended for people with a history of stroke, peptic ulcer disease, bipolar mood disorder, and schizophrenia. Reasonable consumption of caffeine is not contraindicated for clients diagnosed with hypothyroidism or cataracts.

4 of 5 A high school age client, brought to the emergency department (ED) by friends after taking a "whole handful of dextroamphetamine," is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose? • blood glucose monitoring • cardiac monitoring • lung function testing • cognitive assessment

• cardiac monitoring Explanation: Dextroamphetamine misuse may cause sudden death or serious cardiovascular events. It is essential to obtain a baseline electrocardiogram (ECG) and blood pressure reading. These assessments are priorities over blood glucose monitoring, respiratory assessment, and cognitive assessment.

4 of 5 The child is diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will most likely be administered in conjunction with treatment? • selective serotonin reuptake inhibitors (SSRIs) • central nervous system (CNS) stimulants • monoamine oxidase inhibitors (MAOIs) • ACE inhibitors

• central nervous system (CNS) stimulants Explanation: Attention deficit hyperactivity disorder (ADHD) is characterized by persistent hyperactivity, short attention span, and difficulty completing tasks, restlessness, and impulsivity. The diagnosis has increased in recent years, with a concomitant increase in the use of prescribed CNS stimulants for its treatment. SSRIs, ACE inhibitors, and MAOIs are not typically used; they do not affect CNS stimulation.

5 of 5 A nursing instructor is describing the effects of CNS stimulants and their potential for addiction due to their euphoric sensations. The instructor determines that the discussion was successful when the students identify which substance as being involved with this pleasurable feeling? • serotonin • norepinephrine • epinephrine • dopamine

• dopamine Explanation: Stimulants enhance dopamine transmission to areas of the brain that interpret well-being. To maintain pleasurable feelings, people continue the use of stimulants, which leads to their abuse and the potential for addiction. Low serotonin levels are believed to cause depression and anxiety. Epinephrine is a hormone that increases cardiac output. Low levels of norepinephrine are believed to lead to ADHD and depression.

4 of 20 A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse must assess the child. The priority assessment since he is on this medication would be which? • blood pressure. • height and weight. • body temperature. • Vision.

• height and weight. Explanation: The nurse should assess blood pressure, body temperature, and vision at each clinic visit as routine nursing measures in caring for a pediatric client. However, the priority assessment would be of height and weight. Monitoring the growth and development of children taking amphetamines is extremely important because these drugs have been associated with growth suppression.

5 of 5 A nurse is assessing a client who is suspected of having attention deficit hyperactivity disorder (ADHD). Which is a characteristic of ADHD? • hallucinations. • impulsiveness. • spasticity. • drowsiness.

• impulsiveness. Explanation: ADHD is characterized by persistent hyperactivity, inattention, and impulsiveness.

20 of 20 A 13-year-old has been prescribed dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) since age 10, achieving significant improvements in behavior and mood. When assessing the child during a scheduled follow-up appointment, the nurse should prioritize what physical assessment to monitor for a potential adverse reaction to the therapy? • abdominal girth and assessment for peripheral edema • assessment of deep tendon reflexes and peripheral pulses • measurement of height and body weight • visual acuity and hearing ability

• measurement of height and body weight Explanation: Suppression of weight and height may occur in children taking amphetamines, and the nurse ensures that growth is monitored during drug therapy. Assessments for edema, diminished reflexes, and sensory deficits are not normally warranted.

11 of 20 A client has recently been placed on modafinil 200 mg PO qd daily. Modafinil (Provigil) is first-line pharmacologic therapy for: • attention deficit hyperactivity disorder (ADHD). • narcolepsy. • schizophrenia. • anxiety.

• narcolepsy. Explanation: Modafinil is first-line pharmacologic therapy for narcolepsy, because it has high effectiveness and is easily tolerated. It also has fewer side effects than an amphetamine or amphetamine-like medications.

5 of 20 The client is admitted to the medical floor with a diagnosis of narcolepsy. The nurse can anticipate the health care provider to order which medication to treat this disorder? • dospan • dopram • didrex • provigil

• provigil Explanation: Provigil (modafinil) is used to treat narcolepsy by binding to dopamine, thereby reducing the number of episodes. Didrex and dospan are anorexiants used to depress appetite. Dopram is used to treat respiratory depression.