PrepU CH22
The nurse is providing education to an adolescent client who has been prescribed an amphetamine for attention deficit hyperactivity disorder. How does the nurse explain the purpose of a "drug holiday?"
To minimize weight loss 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.
A 9-year-old child receives antipsychotics to manage her disease. The child's mother asks why her daughter receives such a high dose of the medication compared with an adult. How will the nurse explain this to the mother?
"Children usually have a faster metabolic rate than adults and may therefore require relatively high doses for their size and weight." Children usually have a faster metabolic rate than adults and may therefore require relatively high doses of antipsychotics for their size and weight.
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." When a 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).
A client is being prescribed a central nervous system stimulant. Which will have the lowest risk of abuse and dependence?
Atomoxetine Atomoxetine is administered for ADHD and has a lower abuse and dependence capability. Dextroamphetamine, dextroamphetamine and amphetamine, and dexmethylphenidate have strong potential for abuse and dependence.
The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment?
Blood pressure Haloperidol can cause hypotension in clients who are volume depleted or receiving antihypertensive drugs. The client is unlikely to develop hyperthermia, diminished reflexes, or visual dysfunctions.
A client is prescribed risperidone for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of risperidone, what should the nurse suspect is triggering the client's reported polyuria and polydipsia?
Diabetes mellitus The development of polyuria and polydipsia is indicative of diabetes mellitus. Risperidone has been associated with weight gain, diabetes, and dyslipidemia. Adverse effects of risperidone do not include urinary tract infection, renal calculus, or the development of hyperthyroidism.
The instructor is discussing psychosis with the nursing students. The instructor knows that teaching was effective when the students identify what behaviors are exhibited by people with psychosis?
Disorganized and often bizarre thinking Psychosis is characterized by disorganized thought processes, agitation, behavioral disturbances, delusions, hallucinations, insomnia, and paranoia. Psychosis is not characterized by slow reaction time and poor coordination, short manic episodes followed by depression or short/long-term memory deficits.
The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention?
Improving CNS stimulants improve behavior and attention in clients with ADHD.
A diabetic patient being treated for obesity tells the nurse that the patient is having adverse effects from the drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which adverse effects would need the nurse's immediate attention?
Increased blood glucose All of the patient's adverse effects should be addressed by the nurse. However, the most critical effect that needs immediate attention would be the increased blood glucose. Drug therapy for the increased blood glucose may need to be altered. The patient should monitor blood glucose levels carefully and report abnormal findings as soon as possible. Medication can help his dry eyes, and a dose adjustment with the dextroamphetamine may be necessary if the jitteriness is profound and does not subside. Sympathomimetic action of the dextroamphetamine may lead to an inability to ejaculate and either increased or decreased libido. The patient may need to seek counseling for this concern.
The nurse suspects that a client receiving olanzapine is developing type 2 diabetes. Which finding would help support the nurse's suspicion? Select all that apply.
Increased thirst, weight gain, increased urination The nurse would suspect development of type 2 diabetes based on assessment of increased thirst and urination and weight gain. Fever and sore throat would suggest an infection, possibly due to agranulocytosis from clozapine therapy.
A child with attention deficit hyperactivity disorder has been receiving methylphenidate for several years. The prescriber has explained a plan to temporarily discontinue the drug. What rationale for this action should the nurse explain?
It needs to be determined if the child still has symptoms that require treatment. Periodically the drug therapy needs to be interrupted to determine if the child experiences a recurrence of symptoms, which if they do occur, indicates the need for continued treatment. This is not done because the plan is to switch drugs if the current drug is effective or because of an increased risk. The absence of medicine will determine if he no longer needs the medication.
What is the central nervous system stimulant of choice to treat narcolepsy?
Modafinil Modafinil is used to treat narcolepsy. Atomoxetine is administered for attention deficit hyperactivity disorder (ADHD). Guarana is an herbal supplement high in caffeine; it is not administered for narcolepsy. Caffeine is not administered for narcolepsy.
A female client 70 years of age is receiving lithium. Which nursing intervention is appropriate for this client?
Monitor fluid and sodium intake every 12 hours. Older clients, and especially those with renal impairment, should be encouraged to maintain adequate hydration and salt intake. Decreased dosages may also be necessary with the elderly. A client age 70 years would not be concerned about the use of contraceptives. These drugs alone do not affect glucose levels. Weight loss is usually not associated with lithium use.
A client visits the occupational health office of the factory in which he works. He has fallen asleep on the line and has a history of muscle weakness. This instance is not the first time he has fallen asleep on the line. These behaviors support which medical diagnosis?
Narcolepsy Narcolepsy is characterized by daytime sleep attacks in which the person goes to sleep at any place or at any time. Sleep apnea is episodes of apnea, temporary cessation of breathing, during sleep. Insomnia is the inability to sleep. This client is not exhibiting signs and symptoms consistent with substance abuse.
The nurse observes that a client with a long history of chlorpromazine therapy demonstrates lip smacking and appears to be chewing continually. The nurse should recognize that this client is likely experiencing what adverse effect of the medication?
Tardive dyskinesia Tardive dyskinesia occurs as the result of long-term use of chlorpromazine. Clients may experience lip smacking, tongue protrusion, and facial grimaces and may have choreic movements of the trunk and limbs. Akathisia is a form of restlessness, and dystonias are uncoordinated movements. Neuroleptic malignant syndrome is an acute complication.
The nurse on the unit has several clients taking clozapine. For which client is clozapine, an antipsychotic, contraindicated?
The 45-year-old with bone marrow depression Contraindications to antipsychotic drugs include bone marrow depression, liver damage, coronary artery disease, coma, and severe hypotension or hypertension. The use of clozapine is not contraindicated in clients with upper respiratory infection, diabetes insipidus or osteoarthritis.
A female client is diagnosed with renal insufficiency. The nurse develops a teaching plan based on the diagnosis and antipsychotic drug usage. The client asks the nurse why it is so important to have renal function tests routinely. The nurse replies that if renal function test results become abnormal, what may be a consequence?
The drug may need to be lowered in dosage or discontinued. Because most antipsychotic drugs are extensively metabolized in the liver and the metabolites are excreted through the kidneys, the drugs should be used cautiously in clients with impaired renal function. Renal function should be monitored periodically during long-term therapy. If renal function test results (e.g., blood urea nitrogen) become abnormal, the drug may need to be lowered in dosage or discontinued.
Which test should be scheduled every week for a patient taking clozapine?
WBC count Use of the drug clozapine has been associated with severe agranulocytosis, (i.e., decreased white blood cells), so weekly WBC count tests are scheduled. Serum lithium tests are taken for patients who have been administered lithium, not clozapine. There is no need to take blood glucose or pH level tests.
The nurse knows the medication methylphenidate is used to treat attention deficit hyperactivity disorder(ADHD). What type of medication is methylphenidate?
a central CNS stimulant Methylphenidate, a drug used in the treatment of ADHD, is a central CNS stimulant. It is not as SSRI, respiratory stimulant or anorectic agent.
The nurse is planning care for a client who has been prescribed a CNS stimulant. What should the nurse establish as the primary goal of therapy?
relieve the symptoms for which they were prescribed. The main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. A secondary goal is to have clients use the drugs appropriately. Stimulants are often misused and abused by people who want to combat fatigue and delay sleep, such as long-distance drivers, students, and athletes. College students reportedly use stimulants as study aids. Use of stimulants for these purposes is not justified.
While caring for a client who is receiving antipsychotic therapy, the nurse observes lip smacking, a darting tongue, and slow and aimless arm movements. The nurse interprets this as:
tardive dyskinesia. Tardive dyskinesia involves abnormal muscle movements such as lip smacking and tongue darting, slow and aimless arm and leg movements, and chewing movements. Akathisia is manifested by continued restlessness and an inability to sit still. Pseudoparkinsonism is manifested by muscle tremors, cogwheel rigidity, drooling, shuffling gait, and slow movements. Dystonia is manifested by spasms of the tongues, neck, back, and legs.
The nurse expects to monitor a client's white blood count weekly when the client is prescribed:
Clozapine Clozapine is associated with significant leukopenia. Subsequently, is it available only through the Clozaril Client Management System, which involves monitoring white blood cell count and compliance issues with only a 1-week supply being given at a time. Aripiprazole, olanzapine, and quetiapine are not associated with leukopenia.
Serotonin abnormalities are thought to be involved in the following disorders:
Mental depression and sleep disorders. Normal levels of serotonin in the brain produce mood elevation or euphoria, increasing mental alertness and capacity for work, decrease fatigue and drowsiness, and prolong wakefulness. Abnormalities alter these functions.
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?
dopamine 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.
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
electrocardiogram (ECG). In addition to baseline physical data including height, weight, and vital signs, the nurse should prepare the patient for an ECG. This would be important for ruling out any cardiovascular abnormalities that CNS stimulants might exacerbate, especially in this patient who is 7 years old. An EMG measures the electrical activity of muscle and is used to differentiate between neuropathy and myopathy. This test is not indicated in this patient. An EEG is a recording of the electrical activity of the brain and is used to help identify a focus of disturbance in the brain. An EEG may be performed to evaluate narcolepsy, sleeping patterns, and sleep apnea. However, it would not be indicated in this patient with ADHD. EPS is similar to a cardiac catheterization and can monitor the entire conduction system with mapping of normal and abnormal pathways of the heart. This test would not be needed unless the patient had a serious cardiac condition.
The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus?
the importance of adherence to prescribed treatment The success or failure of treatment is largely dependent on the client's adherence to treatment. For most clients, this supersedes the immediate significance of nutrition or teaching about therapeutic effects. There is no need for weekly coagulation tests.
For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months?
White blood cells Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. However, despite these advantages, it is a second-line drug, recommended only for clients who have not responded to treatment with at least two other antipsychotic drugs or who exhibit recurrent suicidal behavior. The reason for the second-line status of clozapine is its association with agranulocytosis, a life-threatening decrease in white blood cells (WBCs), which usually occurs during the first 3 months of therapy. A BLACK BOX WARNING alerts health practitioners to this dangerous side effect. Weekly WBC counts are required during the first 6 months of therapy; if acceptable WBC counts are maintained, then WBC counts can be monitored every 2 weeks.
A 14 year-client with symptoms of psychosis has been prescribed pimozide 0.05 mg/kg PO at bedtime. The client weighs 154 lbs. How many mg of pimozide should the client be administered?
3.5 The client's weight in kg is 70 kg (154 ÷ 2.2). The prescription is for 0.05 mg/kg, and 0.05 X 70 = 3.5 mg. Reference:
