CH 57 Drugs for Attention Deficit Hyperactivity and Narcolepsy

A 13-year-old child is started on atomoxetine (Strattera) for ADHD. The patient and his family should be taught about the peak plasma levels of the medication. He takes his medication at 07:00 AM. When will this medication reach its peak plasma level? A) 08:00 to 09:00 AM B) 09:45 to 10:30 AM C) 10:30 to 11:45 AM D) 13:00 to 14:00 PM

A) 08:00 to 09:00 AM

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? antidepressant anorexiant amphetamine 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.

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? increase the ability to study for long periods of time. use the drugs as they are ordered. relieve the symptoms for which they were prescribed. increase productivity and work longer hours.

relieve the symptoms for which they were prescribed. Explanation: 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.

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 30 to 45 minutes before breakfast and lunch. Always take the drug in the morning before breakfast and before going to bed at night. 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.

A female patient asks the nurse how much caffeine is safe to consume per day. What is the recommended amount of caffeine for a nonpregnant woman? A) 125 mg of caffeine B) 250 mg of caffeine C) 500 mg of caffeine D) 1 g of caffeine

B) 250 mg of caffeine

Methylphenidate will be used to treat a 9- year-old boy's ADHD. In light of this drug's most common adverse effects, the nurse who is working with the family should implement what strategy? A) A strategy to ensure that the boy maintains normal bladder function B) A plan to address the boy's loss of appetite C) A plan to enhance the boy's self-esteem D) A strategy to regularly monitor the boy's blood glucose levels

B) A plan to address the boy's loss of appetite

A patient suffers from narcolepsy. Which of the following aspects of patient teaching should be provided? A) Take 250 mg of caffeine daily. B) Avoid working shifts. C) Take a lengthy nap every afternoon. D) Increase the Ritalin dose as needed.

B) Avoid working shifts.

Which of the following groups are most commonly used for drug management of the patient with narcolepsy? A) central nervous system (CNS) depressants B) CNS stimulants C) anticonvulsants D) major tranquilizers

B) CNS stimulants

A client, prescribed dextroamphetamine (Adderall) for attention deficit hyperactivity disorder (ADHD), has developed a common adverse effect of the medication since beginning therapy. Which initial intervention should the client be encouraged to implement? A) Taking an over-the-counter (OTC) laxative daily. B) Increase fiber intake. C) Take diphenoxylate hydrochloride. D) Take metronidazole.

B) Increase fiber intake.

The nurse working with the family of a child prescribed methylphenidate (Ritalin) should implement what strategy to address possible adverse effects? A) a strategy to ensure that the child maintains normal bladder function B) a plan to address the child's loss of appetite C) a plan to enhance the child's self-esteem D) a strategy to regularly monitor the child's blood glucose levels

B) a plan to address the child's loss of appetite

Which behavior would a nurse expect in the child who takes methylphenidate (Ritalin) every morning? A) sitting and playing with toys for 90 minutes B) getting along well with peers C) expressing anger in an appropriate manner D) not throwing toys across the room

B) getting along well with peers

A client is being prescribed dextroamphetamine (Adderall) 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? A) kidney failure B) potential for abuse C) stroke with excessive doses D) unstable blood glucose levels

B) potential for abuse

A patient is being prescribed dextroamphetamine for the treatment of ADHD. During health education, the nurse should make the patient aware of the black box warning relating to A) the risks of kidney failure. B) the potential for abuse. C) the risk of stroke with excessive doses. D) the potential for unstable blood glucose levels

B) the potential for abuse.

When the nurse is caring for a child receiving a central nervous system stimulant for attention deficit hyperactivity disorder, which assessment is most important to monitor? A) liver function B) weight loss C) fever D) seizure activity

B) weight loss

Which of the following statements indicate the patient is in need of further patient teaching regarding medication for attention deficit hyperactivity disorder? A. I should not crush my tablets. B. I can skip doses when I am feeling good. C. I should not change my dosage without consulting my health care provider. D. I should consult with my health care provider before taking any new medications.

B. I can skip doses when I am feeling good.

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

A) improved grades

A mother who calls the clinic to report that her son has recently started medication to treat attention deficit hyperactivity disorder (ADHD) fears her son is experiencing side effects of the medication. Which of the following side effects are typically related to medications used for ADHD? A) poor appetite B) frequency of urination C) weight gain D) sedation

A) poor appetite

A nurse is caring for a school-age child who has a new prescription for atomoxetine (Strattera). The nurse should monitor the client for which of the following manifestations as an adverse effect of this medication? A) Kidney toxicity B) Liver damage C) Seizure activity D) Adrenal insufficiency

B) Liver damage

A clinician prescribes dextroamphetamine for a patient. Which of the following is an adverse effect of this medication? A. increased appetite B. respiratory depression C. sedation D. cardiac dysrhythmias

D. cardiac dysrhythmias

A physician has prescribed a CNS stimulant for a 7 year old child, who is already of short stature. Which of the following interventions will promote growth? A. administer growth hormone B. encourage daily exercise C. maintain a 2200 calorie diet D. drug holidays when on school breaks

D. drug holidays when on school breaks

A nurse is teaching the caregiver of a school-age child about transdermal methylphenidate (Ritalin). Which of the following instructions should the nurse include? A) Apply one patch twice per day. B) Leave the patch on for 9 hr. C) Apply the patch to the child's waist. D) Use opened tray within 6 months.

B) Leave the patch on for 9 hr.

A 13-year-old boy has been taking dextroamphetamine for the treatment of ADHD since he was 10, achieving significant improvements in behavior and mood. When assessing the boy during a scheduled follow- up appointment, the nurse should prioritize what physical assessment? A) Abdominal girth and assessment for peripheral edema B) Measurement of height and body weight C) Visual acuity and hearing ability D) Assessment of deep tendon reflexes and peripheral pulses

B) Measurement of height and body weight

Which of the following groups are most commonly used for drug management of hyperactive child? A. CNS depressants B. CNS stimulants C. anticonvulsants D. major tranquilizers

B. CNS stimulants

Which of the following statements indicate the patient is in need of further patient teaching regarding medication for attention deficit hyperactivity disorder? A) I should not crush my tablets. B) I can skip doses when I am feeling good. C) I should not change my dosage without consulting my health care provider. D) I should consult with my health care provider before taking any new medications.

B) I can skip doses when I am feeling good.

A nurse is teaching the guardians of a child who has a new prescription for desipramine (Norpramin). The nurse should include that which of the following adverse effects is the priority to report to the provider? A) Constipation B) Suicidal thoughts C) Photophobia D) Dry mouth

B) Suicidal thoughts

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" "45 to 60 minutes" "10 to 15 minutes" "15 to 20 minutes"

"30 to 45 minutes" Explanation: Caffeine is well absorbed from the GI tract and reaches a peak blood level within 30 to 45 minutes after oral ingestion. It easily crosses the blood-brain barrier and has a half-life of 3.5 to 5 hours. It is extensively metabolized, mainly in the liver, and excreted mainly in urine.

The nurse is meeting with the family of a 10-year-old child whose medication regimen consists of methylphenidate 25 mg PO BID and over-the-counter pediatric multivitamins. What is the nurse's most appropriate assessment question? "How would you describe your child's behavior lately?" "Do you think your child is generally able to get enough sleep?" "Do you feel like your family is receiving enough support at this time?" "Has your child had any nausea, vomiting, or diarrhea recently?"

"How would you describe your child's behavior lately?" Explanation: ADHD is the most likely indication for the use of methylphenidate in children, and the nurse should prioritize assessment for therapeutic effect (improved behavior and concentration). Nausea, vomiting, diarrhea, and insomnia are possible adverse effects, but the nurse should initially focus on the child's health problem and the management of it. Similarly, the nurse should address psychosocial support but first focus on the underlying health problem.

A nursing student has explained CNS stimulants and their uses in a class presentation. After completing the presentation, the student determines that additional explanation is necessary when the class chooses which category as a CNS stimulant? Anorexiant Amphetamine Antipsychotic Analeptic

Antipsychotic Explanation: Antipsychotics are not CNS stimulants. CNS stimulants include anorexiants, amphetamines, and analeptics.

The nurse is performing a follow-up assessment of a child and family following the child's diagnosis of ADHD. The child has been prescribed methylphenidate PO administered twice daily. The child's parent states, "We give one dose before breakfast, around 7:00 a.m. and one dose before supper at around 5:30 p.m." Which action should the nurse take? Encourage the family to consider administering the second dose earlier in the day. Validate the family's schedule for medication administration. Remind the family to give the medication at least 90 minutes before a meal. Encourage the family to adhere to q12h administration as closely as possible.

Encourage the family to consider administering the second dose earlier in the day. Explanation: A child with ADHD should take the first dose of methylphenidate on awakening or early in the day, and should take the last dose at least 6 hours before bedtime; administration at suppertime would probably fall within this six-hour window for most children, so earlier administration should be discussed with the health care provider. This recommended schedule does not align with q12h administration, which does not align with the need for symptom control during the daytime and especially at school. Children with ADHD should take the drug 30 to 45 minutes before meals to minimize the appetite-suppressive effects, but 90 minutes prior is unnecessary.

After conducting an in-service presentation about CNS stimulants, the presenter determines that the teaching was successful when the group correctly chooses which disorders as a contraindication to their use? Select all that apply. Epilepsy COPD Glaucoma Diabetes GERD

Epilepsy COPD Glaucoma The use of CNS stimulants is contraindicated in clients with known hypersensitivity, glaucoma, convulsive disorders, ventilation disorders, cardiac problems, severe hypertension, hyperthyroidism, or pregnant. CNS stimulants are a pregnancy category X medication. Diabetes and GERD are not contraindications for CNS stimulants.

After teaching a group of nursing students about central nervous stimulants, the instructor determines that the teaching was successful when the students correctly choose which as an effect of caffeine on the body? Select all that apply. Skeletal muscle relaxation Respiratory stimulation Central nervous system (CNS) stimulation Cardiac relaxation Diuresis

Respiratory stimulation Central nervous system (CNS) stimulation Diuresis Caffeine exerts the following effects on the body: stimulates the CNS, cardiac system, and respiratory system and results in mild diuresis.

The nurse is monitoring a client who is receiving caffeine. The nurse determines the client is experiencing a therapeutic response with which assessment finding? Decease in heart rate Decrease in urinary output Feeling of euphoria and well-being Skeletal muscle stimulation

Skeletal muscle stimulation Explanation: Caffeine leads to skeletal muscle stimulation. Caffeine results in an increase, not decrease, in heart rate. Caffeine is a diuretic and it increases, not decreases, urinary output. Caffeine does not lead to a feeling of euphoria or well-being.

A school-aged child with ADHD is prescribed methylphenidate and is able to make progress in school with the medication. The child's parents have approached the care team to explore planning a drug holiday during the summer break. What aspect of the child's status may rule out a safe drug holiday? The child's behavior is extremely disruptive without the medication. The child is experiencing growth retardation. The child's loss of appetite requires focused interventions. The child's methylphenidate is administered by extended release.

The child's behavior is extremely disruptive without the medication. Explanation: A drug holiday may be untenable if the child's behavior cannot be adequately managed without the medication. Growth retardation and loss of appetite are indications for considering a drug holiday, not reasons to rule it out. The route of delivery would not likely be considered in the decision, since it is unlikely to affect how the child responds to the absence of the medication.

The nurse understands that methylphenidate is commonly prescribed and usually given daily for the first 3 to 4 weeks for what purpose? To determine parent and child compliance with the medication regimen To determine medication blood levels in order to modify the dose To assess the education plan and modify the plan to meet the client's needs To assess beneficial and adverse effects

To assess beneficial and adverse effects Explanation: Methylphenidate is commonly prescribed and is usually given daily for the first 3 to 4 weeks of treatment to allow caregivers to assess beneficial and adverse effects.

The nurse is 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 functions? Select all that apply. stamina behavior endurance motor task performance cognitive task performance

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

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 client should be questioned about her intake of: alcohol. trans fat. caffeine. grapefruit juice.

caffeine. Explanation: Caffeine-containing drinks such as tea, coffee, and cola may increase the adverse effects associated with dextroamphetamine. Intake of trans fat and grapefruit does not impact the use of dextroamphetamine. A history of drug and alcohol abuse may contribute a risk of dextroamphetamine abuse, but the concurrent use of dextroamphetamine and alcohol is not necessarily contraindicated.

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? armodafinil methylphenidate modafinil diethylpropion

methylphenidate 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.

A 6-year-old child has been diagnosed with ADHD and has been prescribed methylphenidate 5 mg PO daily. When providing anticipatory guidance to the child's family, what should the nurse include? strategies for promoting food intake and adequate nutrition warning signs of drug diversion or abuse strategies for combating daytime drowsiness techniques for monitoring the child's respiratory status

strategies for promoting food intake and adequate nutrition Explanation: Loss of appetite and subsequent weight loss is a significant adverse effect of methylphenidate. It would be beneficial to explore strategies for monitoring and addressing this with the family at the beginning of treatment. Methylphenidate carries a high risk of diversion and abuse, but the risks of this would be exceedingly low with a client of this age. Overstimulation is a greater risk than drowsiness, and methylphenidate does not significantly affect respiratory status.

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

Which aspect of client teaching should be provided to a client diagnosed with narcolepsy? A) Take 250 mg of caffeine daily. B) Avoid working shifts. C) Take a lengthy nap every afternoon. D) Increase the methylphenidate dose as needed.

B) Avoid working shifts.

Which of the following groups are most commonly used for drug management of the hyperactive child? A) central nervous system (CNS) depressants B) CNS stimulants C) anticonvulsants D) major tranquilizers

B) CNS stimulants

A boy come to the school nurse's office and states "I did not take my Ritalin today." Which of the following is the most appropriate nursing intervention? A. Call the child's parent or guardian to try to find out if the boy has taken his medication. B. Give the child his morning dose since it is in the office. C. Send him back to class and tell him it is not necessary to take his medication. D. Call the physician to obtain a one-time dose of methylphenidate.

A. Call the child's parent or guardian to try to find out if the boy has taken his medication.

What would indicate to the nurse that the child taking methylphenidate (a stimulant) requires more teaching? A. The child is seen drinking a cola product. B. The child checks his weight twice a week. C. The child takes the drug 45 minutes before a meal. D. The child takes the drug before breakfast and lunch.

A. The child is seen drinking a cola product. (The nurse should teach the child to avoid caffeine because of its potentiation of methylphenidate. The child should be checked twice a week for weight loss. The drug should be taken 30 to 45 minutes before a meal to promote absorption. The drug should be taken before breakfast and lunch and not within 6 hours of sleeping.)

A mother calls the clinic to report that her son has recently started medication to treat ADHD. The mother fears her son is experiencing side effects of the medication. Which of the following side effects are typically related to medications used for ADHD? A. poor appetite B. frequency of urination C. weight gain D. sedation

A. poor appetite

A 10 year old child diagnosed with ADHD has been taking amphetamine sulfate for the past 2 years. Which of the following are normal adverse effects of the drug? (Select all that apply) A. weight loss B. anorexia C. dry mouth D. bradycardia

A. weight loss B. anorexia C. dry mouth

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 Decrease K+ Alter the interpretation of information in the brain Lower glucose levels

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

A patient with narcolepsy is placed on a central nervous system stimulant. What is the central nervous system stimulant of choice to treat narcolepsy? A) Atomoxetine (Strattera) B) Guarana C) Caffeine D) Modafinil (Provigil)

D) Modafinil (Provigil)

A client admitted for elective surgery reports regularly abusing illicit amphetamines. The nurse understands that the client must be assessed regularly for what clinical symptoms associated with this behavior? Decreased CNS stimulation, slowed thought process, and increased pulse. Excessive CNS stimulation and sympathetic nervous system stimulation. Agitation, hallucinations, and decreased urinary output. Parasympathetic stimulation and dampened CNS stimulation.

Excessive CNS stimulation and sympathetic nervous system stimulation. Explanation: Amphetamines increase the amounts of norepinephrine, dopamine, and possibly serotonin in the brain, thereby producing mood elevation or euphoria, increasing mental alertness and capacity for work, decreasing fatigue and drowsiness, and prolonging wakefulness. However, large doses produce signs of excessive CNS stimulation (e.g., agitation, confusion, hyperactivity, difficulty concentrating on tasks, hyperactivity, nervousness, restlessness) and sympathetic nervous system stimulation (e.g., increased heart rate and blood pressure, pupil dilation, slowed gastrointestinal motility, and other symptoms). Overdoses can result in psychosis, convulsions, stroke, cardiac arrest, and death.

A middle-school student has been prescribed methylphenidate for the treatment of ADHD. The child's current prescription is 30 mg PO BID. The child weighs 88 lb and the maximum suggested daily dose for methylphenidate is 2 mg/kg/day. What is the nurse's best action? Monitor the client closely for therapeutic effects. Teach the family that the risk for adverse effects is exceptionally high. Contact the prescriber promptly to have the dose reconsidered. Advocate for an extended-release form of the medication.

Monitor the client closely for therapeutic effects. Explanation: First, convert the child's weight to kg by dividing by 2.2, yielding a weight of 40 kg. With a maximum daily dose of 2 mg/kg/day, this yields of a maximum of 2 mg X 40 kg/day = 80 mg/day. The child's daily dose is 30 mg x 2 doses = 60 mg, which is below the maximum. Thus, a safety risk is not indicated and there is no obvious reason to contact the prescriber or consider an alternative delivery mode. There is no reason to suggest the risk of adverse effects is higher than usual. The nurse should continue providing care, including assessment for the desired changes in behavior.

A nurse is preparing a teaching session for a client with narcolepsy. Which instruction should the nurse prioritize if teaching about modafinil? Record any changes in weight. Avoid coffee or tea. Record number of episodes of sleepiness. Take over-the-counter antidepressants for depression.

Record number of episodes of sleepiness. Explanation: The nurse should instruct the client to keep a record of the number of times per day that periods of sleepiness occur and to bring this record to each visit to the primary health care provider or clinic. There is no need to avoid tea or coffee or to record weight. The client should be instructed not to take antidepressants for the duration of the dosage regimen.

The parents of a male child with attention deficit-hyperactivity disorder (ADHD) bring the child to the health care provider's office for a follow-up visit. During the visit, the parents tell the nurse that the child receives his first dose of Ritalin at 7:30 every morning. The child's teacher and school nurse have reported that his ADHD symptoms return just before his second daily dose, which coincides with the lunch period at noon. Which might the nurse suggest to help better control the child's symptoms during school hours? Delaying the first dose until the child arrives at school Talking to the health care provider about switching to a longer acting preparation Splitting the first dose so that half is taken before leaving for school and half is taken upon arriving at school Asking the teacher to allow the child to attend a different lunch period so that he can take his second dose earlier in the day

Talking to the health care provider about switching to a longer acting preparation Explanation: Immediate release preparations of methylphenidate, such as Ritalin, are typically taken twice daily, before breakfast and lunch. Delaying the child's first dose until after his arrival at school might result in ADHD symptoms being poorly controlled at the start of the school day. Extended release preparations, such as Ritalin SR, are taken less frequently but are intended to control symptoms for longer periods. The provider can substitute extended release methylphenidate once the daily dose is titrated with an immediate release version.

An adult client is diagnosed with narcolepsy following a workplace accident and has been prescribed dextroamphetamine. Which assessment finding by the nurse would best suggest that the medication is achieving a therapeutic effect? ​​​​ The client reports getting through the day without being excessively drowsy. The client reports approximately six hours of restful sleep per night. The client is able to focus on work tasks for more than 30 minutes at a time. The client describes less volatility in relationships at home and at work.

The client reports getting through the day without being excessively drowsy. Explanation: The hallmark of narcolepsy is daytime drowsiness that interferes with safety and quality of life. Resolution of this problem suggests the medication is having its desired effect. Insomnia, focus, and interpersonal coping are not directly affected by narcolepsy and would not be the immediate focus of treatment.

The nurse is providing ongoing care for an adolescent client whose ADHD is being treated with dextroamphetamine and amphetamine. What assessment finding should prompt the nurse to investigate the possibility of drug diversion? The client's medication supply often runs out ahead of schedule. The client denies the medication is working, but others notice improved behavior. The client requests extended-release rather than immediate-release medication. The client's parents state that he constantly needs to be reminded to take the medication.

The client's medication supply often runs out ahead of schedule. Explanation: Unexplained supply shortages should cue the nurse to the possibility that a drug is being diverted to unprescribed users for recreational purposes. Desired changes in the release time (extended vs immediate) are not normally associated with drug diversion, nor is the need for reminders to take the medication. A lack of insight is common among medications intended to change behavior, but this is not suggestive of drug diversion.

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 prevent adverse reactions To serve as a study aid To have clients use the drugs appropriately To prevent side effects

To have clients use the drugs appropriately Explanation: 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.

The nurse is providing education on the safe use of caffeine. The nurse would strongly discourage use in clients with a history of what disorders? Select all that apply. cardiac dysrhythmias bipolar disorder history of stroke hypothyroidism cataracts

cardiac dysrhythmias bipolar disorder history of stroke 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.

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.

A teenage client was diagnosed with ADHD several years ago and has not achieved adequate symptom control. The care team has proposed changing the client's medication to dextroamphetamine. What education should the nurse prioritize with the client and family? the high abuse potential of the medication the need to avoid driving while taking the medication the necessity of a drug holiday at least once per year the need to monitor for self-harm or suicidal ideation

the high abuse potential of the medication Explanation: Dextroamphetamine carries a high risk for abuse, a fact that is communicated in the drug's black box warning. This medication is not linked to an increased risk for self-harm. Driving is not necessarily contraindicated, since the medication stimulates (not depresses) the CNS. Drug holidays are considered on a case-by-case basis, and they are not absolutely indicated for all clients taking CNS stimulants for ADHD.

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 resolves by adolescence." "ADHD usually starts in childhood and resolves by adulthood." "ADHD usually starts in childhood and resolves before adolescence." "ADHD usually starts in childhood and may persist through adulthood."

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

The pediatric client has been prescribed methylphenidate. Which statement should be included in the teaching plan for a client receiving methylphenidate? "Adverse effects include hypertension and nervousness." "The medication is usually taken just before bedtime." "The drug may cause weight gain." "There is no risk of dependence."

"Adverse effects include hypertension and nervousness." Explanation: Adverse effects of methylphenidate include hypertension, tachycardia, nervousness, and appetite suppression with resulting weight loss. The drug has a high potential for abuse and dependence. The last dose of any CNS stimulant is usually taken at least 6 hours before bedtime to prevent interference with sleep.

A 12-year-old girl has undergone an extensive diagnostic workup that has resulted in a diagnosis of ADHD. The prescriber has reviewed the benefits and risks of dextroamphetamine therapy, and the nurse is now reviewing the correct schedule for taking the drug. The child should most likely take her dextroamphetamine at what times? A) 07:00 and 11:30 B) 07:30, 11:30, 16:30, and 20:00 C) 08:00 and 20:00 D) 09:00, 14:00, and 19:00

A) 07:00 and 11:30

The parents of a child diagnosed with attention-deficit syndrome receive a prescription for a central nervous system (CNS) stimulant to treat their child. One of the parents states, "I don't understand why we're giving a stimulant to calm our child down." What is the nurse's best response? "It helps the reticular activating system, a part of the brain, to be more selective in response to incoming stimuli." "It helps energize the child so they use up all of their available energy and then focus on quieter stimuli." "No one truly understands why it works, but it has been demonstrated to be very effective in treating attention-deficit." "The drug works really well, and you will see a tremendous change in your child within a few weeks without any other treatment."

"It helps the reticular activating system, a part of the brain, to be more selective in response to incoming stimuli." Explanation: The paradoxical effect of calming hyperexcitability through CNS stimulation seen in attention-deficit syndrome is believed to be related to increased stimulation of an immature RAS, which leads to the ability to be more selective in response to incoming stimuli. CNS stimulants do not cause children to use all their energy, and the effect is thought to be understood. Telling the parents the drug just works without any explanation is not appropriate and may result in noncompliance with therapy if the parents do not understand why the drug is given.

The parents of a school-aged child have sought care for the first time because of their son's increasingly hyperactive and disruptive behaviors. The child's mother states, "We're having a hard time choosing between asking for medications and starting family therapy." What is the nurse's best response? "Many children benefit from simultaneous medication and psychotherapy." "Your care provider is likely to trial one-on-one psychotherapy before resorting to medications." "For many children, taking the appropriate medication eliminates the need for psychotherapy." "There is an increasing trend away from pharmacologic treatment and toward psychological treatment."

"Many children benefit from simultaneous medication and psychotherapy." Explanation: For many children with ADHD, concurrent pharmacologic treatment and psychotherapy bring the best results. The two approaches are not mutually exclusive, and medications remain a mainstay of treatment for ADHD.

A 12-year-old has been prescribed dextroamphetamine (Adderall) therapy, and the nurse is now reviewing the correct schedule for taking the drug. The child should most likely take the initial daily dose of dextroamphetamine at what times? A) 07:00 and 11:30 B) 07:30, 11:30, 16:30, and 20:00 C) 08:00 and 20:00 D) 09:00, 14:00, and 19:00

A) 07:00 and 11:30

A client asks to have a year's worth of prescription refills for methylphenidate, explaining that it is very hard to leave work for clinic appointments. How should the nurse respond to that request to best assure client safety? "It would be very costly to purchase a years' worth of medication at one time." "The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse." "I understand the inconvenience, but you have to come in at least every month to have blood work done." "I will speak with your health care provider about increasing the size of each 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 stimulant is prescribed, it is started with a low dose that is then increased as necessary, usually at weekly intervals, until an effective dose or the maximum daily dose is reached. The number of doses that can be obtained with one prescription should be limited; this 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.

After experiencing two workplace accidents in which he fell asleep, a 30-year-old construction worker has been diagnosed with narcolepsy. The patient admits that he is embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the patient by explaining what aspect of the etiology? A) "This is the result of neurological factors over which you have no direct control." B) "In a lot of cases, making improvements to your sleep habits can resolve narcolepsy." C) "This is something that runs in certain families, and it's not your fault that this has happened." D) "This usually stems from suppressed emotions, so counseling usually helps greatly."

A) "This is the result of neurological factors over which you have no direct control."

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

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.

A 13-year-old child is prescribed atomoxetine (Strattera) to be at 07:00. When will this medication reach its peak plasma level? A) 08:00 to 09:00 B) 09:45 to 10:30 C) 10:30 to 11:45 D) 13:00 to 14:00

A) 08:00 to 09:00

A nurse is teaching the guardians and their school-age child about a new prescription for lisdexamfetamine (Vyvanse). Which of the following information should the nurse include in the teaching? SELECT ALL THAT APPLY. A) An adverse effect of this medication is CNS stimulation. B) Administer the medication before bedtime. C) Monitor blood pressure while taking this medication. D) Therapeutic effects of this medication will take 1 to 3 weeks to fully develop. E) This medication raises the levels of dopamine in the brain.

A) An adverse effect of this medication is CNS stimulation. C) Monitor blood pressure while taking this medication. E) This medication raises the levels of dopamine in the brain.

A boy comes to the school nurse's office and states, "I did not take my Ritalin today." Which of the following is the most appropriate nursing intervention? A) Call the child's parent or guardian to try to find out if the boy has taken his medicine. B) Give the child his morning dose because it is in the office. C) Send him back to class and tell him it is not necessary to take the medication. D) Call the child's physician to obtain a one-time dose of methylphenidate.

A) Call the child's parent or guardian to try to find out if the boy has taken his medicine.

A patient is seen in the ambulatory care clinic with a complaint of insomnia. What should the nurse assess in regard to the complaint of insomnia? A) Daily intake of caffeine-containing products B)The amount of exercise in which the patient engages C) The family history of insomnia and sleep D) Possible use of amphetamines

A) Daily intake of caffeine-containing products

A child, diagnosed with attention deficit hyperactivity disorder (ADHD), has been prescribed methylphenidate (Ritalin). 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? A) Methylphenidate helps with the symptoms of ADHD, but the reasons for this are not well understood. B) Methylphenidate stimulates the parasympathetic nervous system, resulting in increased control of behavior. C) Methylphenidate stimulates the limbic system, which regulates control over behavior and affect. D) Methylphenidate enhances the function of dopamine, which regulates cognition.

A) Methylphenidate helps with the symptoms of ADHD, but the reasons for this are not well understood.

A boy has been diagnosed with ADHD and has been prescribed Ritalin. The boy's mother tells the nurse that she does not understand why a stimulant would help him, stating, "If anything, he's completely overstimulated, not understimulated!" What should the nurse explain to the mother about the therapeutic use of Ritalin? A) Ritalin helps with the symptoms of ADHD, but the reasons for this are not well understood. B) Ritalin stimulates the parasympathetic nervous system, resulting in increased control of behavior. C) Ritalin stimulates the limbic system, which regulates control over behavior and affect. D) Ritalin enhances the function of dopamine, which regulates cognition.

A) Ritalin helps with the symptoms of ADHD, but the reasons for this are not well understood.

A teenage boy is on amphetamine therapy for attention deficit hyperactivity disorder. The care provider has suggested a "drug holiday" for July and August. What is the purpose of this drug holiday? A) To minimize weight loss B) To prevent hyperthyroidism C) To allow electrolyte imbalances to resolve D) To slow bone resorption

A) To minimize weight loss

A nurse is teaching an adolescent client who has a new prescription for clomipramine (Anafranil) for OCD. Which of the following instructions should the nurse include to minimize an adverse effect of this medication? A) Wear sunglasses when outdoors. B) Check your temperature daily. C) Take this medication in the morning. D) Add extra calories to your diet.

A) Wear sunglasses when outdoors.

Which characteristics would the nurse recognize as primary symptoms of narcolepsy? SELECT ALL THAT APPLY. A) excessive daytime drowsiness B) fatigue C) cataplexy D) hypnagogic hallucinations E) sleep paralysis

A) excessive daytime drowsiness B) fatigue C) cataplexy - sudden loss of muscle tone while a person is awake D) hypnagogic hallucinations - hallucinations that happen as you're falling asleep E) sleep paralysis

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? A) height and weight. B) Vision. C) body temperature. D) blood pressure.

A) height and weight. (these drugs have been associated with growth suppression.)

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

A) to minimize weight loss

Which of the following are expected adverse effects of amphetamine sulfate? SELECT ALL THAT APPLY. A) weight loss B) anorexia C) dry mouth D) bradycardia E) constipation

A) weight loss B) anorexia C) dry mouth

A nurse is assessing an older client for a response to a CNS stimulant. The nurse will prioritize which responses? Select all that apply. Anxiety Insomnia Bradycardia Confusion Hypotension

Anxiety Insomnia Confusion A nurse caring for an older adult client receiving CNS stimulants should monitor the client closely for anxiety, nervousness, insomnia, and mental confusion because older clients are more sensitive to the adverse reactions of this group of drugs.

A prescriber has ordered a central nervous system stimulant for a child. What is the expected outcome of this medication? A. increased behavioral problems B. improved performance in schoolwork C. decreased ability to complete a task D. increased hyperactivity

B. improved performance in schoolwork

A 7-year-old boy takes methylphenidate every morning. Which of the following behaviors would a nurse expect the child to engage in? A. to sit and play with his toys for 90 minutes B. to get along better with his peers C. to express his anger in an appropriate manner D. not to throw his toys across the room

B. to get along better with his peers

The nurse is caring for a child who is receiving a central nervous system stimulant for attention deficit hyperactivity disorder. It is most important to monitor for which of the following? A. liver function B. weight loss C. fever D. seizure activity

B. weight loss

A neonate is suffering from apnea. Which of the following medications may be administered as a respiratory stimulant? A) Caffeine and methylphenidate B) Caffeine and Mefoxitin C) Caffeine and sodium benzoate D) Caffeine and sodium bicarbonate

C) Caffeine and sodium benzoate

A 4-year-old child is brought to the pediatric clinic by his mother. She states, "I don't know what to do with him. He is in constant motion. He won't sit for more than a few seconds and he is doing something else. He often throws his toys and yells loudly, even compared with other kids his age." The child is diagnosed with attention deficit hyperactivity disorder. Which of the following medications will most likely be administered in conjunction with treatment? A) ACE inhibitors B) SSRIs C) Central nervous system stimulants D) MAO inhibitors

C) Central nervous system stimulants

A patient has been treated with dextroamphetamine for ADHD. At the age of 16 years, she is diagnosed with hyperthyroidism. What intervention should be implemented with this patient? A) Discontinue the high-calorie diet. B) Assess the patient for pulmonary edema. C) Discontinue the amphetamines. D) Administer a proton pump inhibitor.

C) Discontinue the amphetamines.

A patient 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. From what disease process does the occupational health nurse suspect the patient is suffering? A) Sleep apnea B) Insomnia C) Narcolepsy D) Substance abuse

C) Narcolepsy

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

C) central nervous system (CNS) stimulants

An 8-year-old boy has been taking dexmethylphenidate (Adderall) 5 mg daily for 3 months. His mother is concerned that this dosage is not adequately treating his symptoms of attention deficit hyperactivity disorder. Which of the following behaviors would support the mother's concerns? A) increased concentration during school B) weight gain of 8 lbs over the past 3 months C) increased activity D) bradycardia

C) increased activity

An 8 year old boy has been taking dexmethylphenidate 5 mg daily for 3 months. His mother is concerned that this dosage is not adequately treating his symptoms of ADHD. Which of the following behaviors would support the mother's concerns? A. increased concentration during school B. weight gain of 8 lbs over the past 3 months C. increased activity D. bradycardia

C. increased activity

A 75-year-old male client is given an order for a CNS stimulant secondary to a new diagnosis of narcolepsy. He begins to experience signs and symptoms of excessive CNS stimulation. The nurse knows that the client is likely to also experience an exacerbation of which preexisting condition? Diabetes Cardiac arrhythmias Gout Hyperparathyroidism

Cardiac arrhythmias Explanation: Older adults are likely to experience anxiety, confusion, insomnia, and nervousness from excessive CNS stimulation. In addition, older adults often have cardiovascular disorders (e.g., angina, arrhythmias, hypertension) that may be aggravated by the cardiac-stimulating effects of the drugs, including dietary caffeine. In general, reduced doses are safer in older adults.

A client has been prescribed benzphetamine. The nurse would question administering this drug if which is noted in the client medical record? Drinks coffee at each meal Ordered to take at 6 p.m. Currently takes an antidepressant Drinks several carbonated caffeine beverages each day

Currently takes an antidepressant Explanation: The nurse should ensure that benzphetamine, or any other anorexiant, is not taken concurrently with antidepressant medications. The nurse should avoid or decrease the use of coffee, tea, and carbonated beverages containing caffeine. The drug should be taken early in the day, not around dinner time, to avoid insomnia.

A high school boy has been brought to the emergency department (ED) by his friends who state that he has taken a "whole handful of Dex" and is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose? A) Blood glucose monitoring B) Cognitive assessment C) Lung function testing D) Cardiac monitoring

D) Cardiac monitoring

Patient teaching for children taking methylphenidate (Ritalin) for attention deficit hyperactivity disorder should include which of the following? A) Give the child the drug at bedtime. B) Drowsiness may be a side effect. C) If necessary, the child may take over-the-counter cold products without problems. D) Provide for periodic drug-free holidays.

D) Provide for periodic drug-free holidays.

A client should be educated concerning the effect of combining theophylline with what chemical substance? A) methylphenidate B) atomoxetine C) modafinil D) caffeine

D) caffeine

A patient who suffers from asthma is given theophylline. Theophylline will have an increased effect if taken with A) Ritalin. B) atomoxetine (Strattera). C) modafinil (Provigil). D) caffeine.

D) caffeine.

Which finding is indicative of an adverse effect of dextroamphetamine (Adderall)? A) increased appetite B) respiratory depression C) sedation D) cardiac dysrhythmias

D) cardiac dysrhythmias

When a 7-year-old child, already of short stature, is prescribed amphetamine sulfate, which intervention will promote growth? A) administering growth hormone B) encouraging daily exercise C) maintaining a 2200-calorie diet D) drug holidays when on school breaks

D) drug holidays when on school breaks

What is the central nervous system stimulant of choice to treat narcolepsy? A) atomoxetine (Strattera) B) guarana C) caffeine D) modafinil (Provigil)

D) modafinil (Provigil)

When providing teaching to a group of parents regarding attention-deficit/hyperactivity disorder (ADHD), which information will the nurse include? A. Children with ADHD have low intelligence. B. Children with ADHD have an infection in their spinal fluid. C. EEG results are typically normal in children with ADHD. D. Learning disabilities are often present in the child who has ADHD.

D. Learning disabilities are often present in the child who has ADHD. (Intelligence is usually not affected by ADHD. The CSF of children with ADHD is not affected. Children with ADHD often have learning disabilities. Children with ADHD often have abnormal EEG studies.)

Patient teaching for children taking methylphenidate for ADHD should include which of the following? A. Give the child the drug at bedtime. B. Drowsiness may be a side effect. C. If necessary, the child may take OTC cold products without problems. D. Provide for periodic drug-free holidays.

D. Provide for periodic drug-free holidays.

A child with attention deficit hyperactivity disorder would most likely exhibit which of the following symptoms? A. anxiety B. positive peer relationships C. hostility D. restlessness

D. restlessness

Which of the following effects can be noticed in a patient who has been administered amphetamines? Decreased appetite Low blood pressure Drowsiness Depression

Decreased appetite Explanation: Amphetamines have the ability to suppress appetites so the patient will show a decrease in appetite. Their drug action results in high blood pressure, not low blood pressure. The patient also experiences wakefulness, not drowsiness. Amphetamines produce a euphoric state, not depression.

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 increase Scott's ability to understand information better. Dexmethylphenidate will stabilize Scott's mood so that he can concentrate. Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task. Dexmethylphenidate will improve Scott's memory.

Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task. Explanation: Dexmethylphenidate is thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. This activity results in improved attention spans, decreased distractibility, and increased ability to follow directions or complete tasks, and decreased impulsivity and aggression in patients with ADHD. Although dexmethylphenidate does not produce a physical dependence, it may induce tolerance or psychic dependence.

When providing education to a patient who is taking dextroamphetamine, what would be a priority teaching point? Dextroamphetamine should not be taken with other over-the-counter medications. There is no need to limit the amount of other caffeine while taking this medication. Dextroamphetamine should be taken before dinner to be most effective because of the short duration of action of the medication. Dextroamphetamine should be taken on an empty stomach to promote absorption of the drug.

Dextroamphetamine should not be taken with other over-the-counter medications. Explanation: It is important to administer dextroamphetamine with food in the morning and no fewer than 6 hours before bedtime, preferably earlier, for the sustained-release formulations. Ask the patient about his or her regular consumption of caffeine-containing drinks such as tea, coffee, and cola because they may increase the adverse effects associated with dextroamphetamine. Question the patient regarding the use of nonprescription drugs, particularly those with sympathomimetic effects, because patients often do not report the occasional use of over-the-counter (OTC) drugs unless asked. Following oral ingestion, dextroamphetamine has an onset of 20 to 60 minutes and a duration of 5 hours. The sustained-release form of the drug has an onset of 60 to 90 minutes and lasts 6 to 10 hours. The half-life ranges between 10 and 30 hours.

An adolescent client's ADHD has not responded to first-line therapies and the care team has agreed on a trial of dextroamphetamine. How should the nurse best address the safety risks associated with this medication? Monitor closely for suicidal ideation or self-harm. Create a meal plan with the family prior to starting the medication. Educate about the risk for abuse and monitor the client accordingly. Provide anticipatory guidance about sleep disturbances.

Educate about the risk for abuse and monitor the client accordingly. Explanation: Dextroamphetamine is associated with a high abuse potential, a fact reflected in the medication's black box warning. Abuse is a major risk to safety, exceeding the likelihood of sleep disturbances or nutritional deficits. Dextroamphetamine is not linked to an increased risk for suicidal ideation.

The nurse is aware that medication dosage for a child with ADHD is stopped occasionally for what reason? Onset of puberty Evaluation of treatment regimen Brain growth Musculoskeletal growth

Evaluation of treatment regimen Explanation: A drug holiday (i.e., stopping drug therapy) is recommended at least annually to evaluate the child's treatment regimen. Dosage adjustments are usually needed as the child grows and hepatic metabolism slows. Also, drug holidays decrease weight loss and growth suppression.

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? The cost is prohibitive when prescribed in a large number. It reduces the likelihood of drug dependence or diversion. Changes in dosages are common. HMOs will not reimburse the cost for larger numbers.

It reduces the likelihood of drug dependence or diversion. Explanation: 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 child diagnosed with ADHD returns for a follow-up visit since starting lisdexamfetamine. The caregiver reports behavior has improved, the child is sleeping okay at night, and eats all the time. Assessment reveals the child has lost a few pounds since last visit and is in the lower percentile for age appropriateness. Which nursing diagnosis will be most appropriate for this client? Disrupted Sleep Patterns Ineffective Coping Malnutrition Nutrition: Less Than Body Requirements Altered Breathing Pattern

Malnutrition Nutrition: Less Than Body Requirements Explanation: Based on the assessment findings, the child is clearly having difficulty with nutritional intake. Therefore, Malnutrition: Less Than Body Requirements would be the priority. The mother reports that the child's sleeping is "okay," so Disrupted Sleep Patterns would not be an issue. There is no evidence to suggest Ineffective Coping or Altered Breathing Pattern.

The client is a 45-year-old man who is obese. He is seeking help losing weight. He wants to be prescribed dextroamphetamine. Based on the client's history, what would contraindicate the use of this medication? Blood pressure of 118/72 Use of CPAP at night for sleep apnea Myocardial infarction 2 months previously Shortness of breath with moderate activity

Myocardial infarction 2 months previously Explanation: Dextroamphetamine is contraindicated in clients with advanced arteriosclerosis, symptomatic cardiovascular disease, and moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncratic reactions to other sympathomimetic drugs, glaucoma, or a history of drug abuse.

For which patient are CNS stimulants contraindicated? Patients with Parkinson's disease Patients with severe hypertension Patients younger than 20 Patients with renal dysfunction

Patients with severe hypertension Explanation: CNS stimulants are contraindicated for patients with severe hypertension. CNS stimulants are not contraindicated in patients younger than 20 or patients with Parkinson's disease. Even though CNS stimulants are not contraindicated in patients with renal dysfunction, they need to be administered with extreme caution.

The nurse is meeting a school-aged client and the client's parents following the child's diagnosis of ADHD and prescription of methylphenidate. In what sequence should the nurse perform the following actions? (just flip)

Perform baseline assessment of the client's behavior health status. Provide education about therapeutic and adverse effects, as well as safe administration of the medication. Administer the medication. Monitor the client's initial response to the medication. Monitor the client's ongoing response to the medication, assessing for therapeutic and adverse effects.

Central nervous system stimulants may used to treat which conditions? (Select all that apply.) Sleep apnea Hypertension Attention deficit hyperactivity disorder (ADHD) Drug-induced respiratory depression Hyperglycemia

Sleep apnea Attention deficit hyperactivity disorder (ADHD) Drug-induced respiratory depression The CNS stimulants are used in the treatment of ADHD, drug-induced respiratory depression, narcolepsy, sleep apnea, exogenous obesity, and fatigue.

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 Strattera Nuvigil Provigil

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.

A client has been prescribed dextroamphetamine-amphetamine for the treatment of ADHD. What assessment finding would most clearly suggest that the client's dose is excessive? The client reports feeling agitated and restless during the day. The client reports a large increase in appetite and food intake. The client reports waking up between 4 a.m. and 5 a.m. each day. The client reports a marked decrease in mood.

The client reports feeling agitated and restless during the day. Explanation: Excessive central nervous system stimulants such as dextroamphetamine-amphetamine can cause hyperactivity, agitation, and restlessness, suggesting a change in drug or dose is necessary. This is usually accompanied by a decrease, not an increase, in appetite. Sleep disturbances would be more likely during the first half of the night, due to CNS stimulation from daytime doses. Stimulants do not normally cause mood depression.

When would treatment with medication be considered for a child with attention deficit hyperactivity disorder (ADHD)? Select all that apply. Within 2 to 4 weeks of the onset of symptoms When symptoms are moderate to severe When symptoms interfere with social and academic functioning When symptoms interfere with behavioral functioning Before beginning psychotherapy

When symptoms are moderate to severe When symptoms interfere with social and academic functioning When symptoms interfere with behavioral functioning Pharmacological treatment may be necessary when symptoms are moderate to severe, persist beyond 4 weeks, and the child has difficulty with social, academic, or behavioral functioning. Psychotherapy is generally recommended before pharmacological therapy.

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? Nurses often misplace medication bottles. This is an IV medication. This is an IM medication. 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.

A school nurse provides care in a large elementary school. Many of the students have diagnoses of ADHD. For which child with ADHD would the use of methylphenidate most likely be safe and effective? a student who admits to recent substance abuse a child who lives with a cardiomyopathy a child who has generalized anxiety disorder in addition to ADHD a child who had Hodgkin lymphoma four years ago

a child who had Hodgkin lymphoma four years ago Explanation: Contraindications to the use of methylphenidate include cardiac disorders, anxiety disorders, and substance abuse. However, the drug is not contraindicated in clients with a history of lymphoma or other cancers.

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). electromyelogram (EMG). electroencephalogram (EEG). electrophysiologic study (EPS).

electrocardiogram (ECG). Explanation: 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.

A client diagnosed with narcolepsy expresses reluctance to rely on medication therapy. What recommendation should the nurse provide? maintaining regular sleeping and waking times to avoid periods of sleep deprivation taking an herbal supplement to assist in staying awake during times when alertness is imperative discussing the concern with the health care provider, as only medication can assist clients with this diagnosis increasing consumption of beverages containing caffeine to help promote wakefulness

maintaining regular sleeping and waking times to avoid periods of sleep deprivation Explanation: In addition to drug therapy, prevention of sleep deprivation, regular sleeping and waking times, avoiding shift work, and short naps may be helpful in reducing daytime sleepiness associated with narcolepsy. However, even adequate amounts of nighttime sleep do not produce full alertness. The nurse should discuss the client's concerns before suggesting a conversation with the prescriber. Neither caffeinated teas nor coffee will significantly increase alertness in this situation.