Prep-U: Amphetamines

A female client asks why it is not legal to have a year's worth of prescription refills for Ritalin, since she has been on it for more than a year. She would also like to have the largest dose possible, so she can use the prescription for 2 months, instead of one. She explains that it is very hard to get off work and come in for appointments. The nurse's best response would be:

"The prescription dose is always started as low as possible and the refills are monitored to prevent abuse."

A nurse works at a weight management clinic. To which overweight patients could the nurse safely administer dextroamphetamine?

A 48-year-old Caucasian man who has adult-onset diabetes

To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan?

A preterm neonate who has apnea Explanation: The nurse would most likely administer the caffeine to the preterm neonate with apnea. Caffeine stimulates gastric secretions and would aggravate gastric ulcerations. Caffeine is not used to treat ADHD or narcolepsy. Dextroamphetamine is the drug of choice for these conditions.

The patient taking a CNS stimulant reports insomnia. The best option for the nurse in this case is which of the following?

Administer the drug earlier in the day.

The nursing student learned in pharmacology class that drugs that affect the CNS do which of the following? (Check all that apply.)

Alter mood Alter sensation Alter the interpretation of information in the brain

A nurse is instructing a mother about a new drug her son was prescribed for ADHD. The nurse should include which of the following instructions?

Always take the drug in the morning 30 to 45 minutes before breakfast and lunch.

A patient who has already started behavioral therapy for attention deficit hyperactivity disorder (ADHD) will also need pharmacologic therapy. The nurse anticipates that this patient will be placed on which type of medication?

Analeptic

A client taking a CNS stimulant may experience altered sleep patterns. What can the nurse instruct the client to do to help with altered sleep patterns? Select all that apply:

Avoid other caffeine. Be active during the day. Administer the drug early in the day.

Which of the following are true in regards to the effect of caffeine on the body? Select all that apply:

Central nervous system (CNS) stimulation Respiratory stimulation Diuresis

Rodney, 7 years old, was started on atomoxetine (Strattera) for the treatment of ADHD. What features should be assessed due to the side effects of the medication? (Select all that apply.)

Weight Height Blood pressure

A 10-year-old child is being administered CNS stimulants for ADHD. What should the nurse instruct the parents to record periodically?

Weight and growth

When would treatment with medication be considered for a child with attention deficit hyperactivity disorder (ADHD)? Select all that apply.

When symptoms interfere with social and academic functioning When symptoms interfere with behavioral functioning When symptoms are moderate to severe

A client comes into the emergency department. He is highly active, cannot sleep, and says his heart is pounding. On further questioning, he says he took several pills at a party and has felt this way ever since. What type of medication does the nurse suspect he could have taken?

amphetamine

A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse's priority assessment would be

height and weight

A client asks the nurse how quickly a cup of coffee will cause the greatest stimulation to the central nervous system. What is the nurse's best response?

"30 to 45 minutes"

The community health nurse is conducting a class for parents of preschoolers. One of the parents asks if a child with ADHD will always have problems with hyperactivity. What is the nurse's best response?

"ADHD usually starts in childhood and may persist through adulthood."

Which statement should be included in the teaching plan for a patient receiving methylphenidate (Ritalin)?

"Adverse effects include hypertension and nervousness."

The nurse is describing to a child diagnosed with ADHD the different parts of her assessment. What are the common parts of an assessment for a child with ADHD prior to being prescribed medications? Select all that apply.

BP Respiratory rate Weight Pulse rate

When should the nurse instruct a client's parents to administer dexmethylphenidate (Focalin) to the client? Select all that apply:

Before breakfast Before lunch

A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of

Caffeine

Which of the following effects can be noticed in a patient who has been administered amphetamines?

Decreased appetite

A patient with postpartum thyroiditis could potentially experience all the following adverse cardiovascular effects from caffeine, EXCEPT:

Decreased cardiac output

Dexmethylphenidate has been prescribed to Scott, a 7-year-old boy who was diagnosed with ADHD. The mother asks how this medication will help her son. Which would be the most accurate description of the purpose of this medication?

Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task.

A 49-year-old woman experienced postsurgical respiratory depression and was given caffeine to stimulate the respiratory system. The patient is now irritable, excited, and unable to sleep. She is also complaining of a headache and muscle twitching. Appropriate nursing diagnoses for the patient would include which of the following? (Select all that apply.)

Disturbed Sleep Pattern Anxiety

The nurse is aware that medication dosage for a child with ADHD is stopped occasionally for what reason?

Evaluation of treatment regimen

You are assuming care for a client admitted for elective surgery. During the admission process, his family tells you that the client regularly takes illicit amphetamines. They are concerned that the client may not have shared this information with his surgeon. You understand that clinical symptoms associated with using large amounts of amphetamines include:

Excessive CNS stimulation and sympathetic nervous system stimulation.

A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather's antidepressant to improve his mood. After immediately phoning the boy's stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?

Hypertensive crisis

The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention?

Improving

A nurse is assessing a child who is suspected of having attention deficit hyperactivity disorder (ADHD). ADHD is characterized by persistent hyperactivity, inattention, and

Impulsiveness

The nurse is aware that caffeine may be contraindicated because of what effect?

Increases analgesia

A client calls the clinic reporting only being able to get a 1-month supply of pills for the client's son, who takes a CNS stimulant for ADHD. The nurse understands that these medications are given in limited numbers for what reason?

It reduces the likelihood of drug dependence or diversion.

The nurse is aware that drinking caffeinated coffee is contraindicated for which individuals? (Select all that apply.)

Long-haul truckers Clients diagnosed with cardiac dysrhythmias Clients with peptic ulcer disease

A mother brings her child to the clinic and informs the physician that he is having a difficult time paying attention in school, seems to be getting in trouble several times a day, and is acting very impulsive. The nurse can expect the physician to order which of the following drugs for this patient?

Methylphenidate

John is a 45-year-old man who is obese. He is coming to see the physician today about diet and medications to help him lose weight. He wants to be prescribed dextroamphetamine. Based on John's history, what would contraindicate the use of this medication?

Myocardial infarction 2 months previously

When using caffeine therapeutically, which education point is important for the nurse to tell the client?

Nervousness, restlessness, and palpitations may occur when you take caffeine.

The nurse is discussing with a client adverse reactions to caffeine. Which of the following adverse reactions should the nurse cover? Select all that apply.

Palpitations Nausea Insomnia

The nurse instructs a patient with a history of heart palpatations not to take oral caffeine. He asks the nurse why, and she then explains to the patient that nonprescription caffeine should be avoided in the following patients. (Check all that apply.)

Patient with history of stomach ulcers Patient with history of heart disease Patient with history of high blood pressure

For which patient are CNS stimulants contraindicated?

Patients with severe hypertension

A nurse should instruct clients with which of the following conditions to avoid over-the-counter caffeine preparation? Select all that apply:

Peptic ulcer disease Hypertension Heart disease

A patient with attention deficit hyperactivity disorder (ADHD) has not had an adequate response to behavioral therapy. All the following medications would be acceptable for this patient, EXCEPT:

Phentermine (Ionamin)

The main goal of therapy when using CNS stimulants is to:

Relieve the symptoms for which they were prescribed.

Use of dextroamphetamine (Adderall) is contraindicated in patients with which of the following condition(s)? Select all that apply.

Severe hypertension History of drug abuse Hyperthyroidism Known structural cardiac abnormalities Advanced arteriosclerosis

The school nurse is conducting a screening of kindergarten students. The nurse will assess the children for what characteristics of ADHD? Select all that apply.

Short attention span Hyperactivity Impulsivity

Pediatric patients given atomoxetine (Strattera) should be monitored closely for which of the following?

Suicidal ideation

When counseling a patient who is about to begin taking dextroamphetamine, which of the following should the nurse include in the teaching?

Take this medication with food in the morning.

A nurse is explaining to a friend why CNS medications are addictive. What is one reason CNS medications are addictive?

The medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine.

A xanthine used in the treatment of respiratory disorders, such as asthma and bronchitis is:

Theophylline.

The nurse understands that methylphenidate is commonly prescribed and usually given daily for the first 3 to 4 weeks for what purpose?

To assess beneficial and adverse effects

The nurse understands that the main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. What is a secondary goal for their use?

To have clients use the drugs appropriately

The nurse has learned that there is a high incidence of suicidal ideation in children and adolescents when using which of the following drugs?

strattera