Ch 57 prepu

The peditric client has been prescribed mehtylphenidate. Which statement should be included in the teaching plan for a client receiving methylphenidate?

"Adverse effects include hypertension and nervousness."

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

The parents of a child diagnosed with attention-deficit syndrome receives a prescription for a central nervous system (CNS) stimulant to treat their child. One of the parents asks the nurse, "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."

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."

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

Improving

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 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?

Cardiac dysrhythmias 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, dysrhythmias, hypertension) that may be aggravated by the cardiac-stimulating effects of the drugs, including dietary caffeine

A major criterion for diagnosing later ADHD is:

a previous diagnosis of ADHD by 7 years of age. In adolescents and adults, hyperactivity is not prominent, but impulsiveness, inattention, and difficulties in structured settings such as school or work may continue. In addition, some studies indicate that children with ADHD are more likely to have learning disabilities, mood disorders, and substance-abuse disorders as adolescents and adults.

A nurse is assessing a client who is suspected of having attention deficit hyperactivity disorder (ADHD). Which is a characteristic of ADHD?

impulsiveness. ADHD is characterized by persistent hyperactivity, inattention, and impulsiveness.

A client's medication history includes a long-term prescription for modafinil. Which assessment question should the nurse ask to confirm why the medication was prescribed?

"Have you ever been diagnosed with narcolepsy?"

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

Evaluation of treatment regimen A drug holiday (i.e., stopping drug therapy) is recommended at least annually to evaluate the child's 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.

The nurse should take care not to administer CNS stimulants to clients with which medical conditions? (Select all that apply.)

Hyperthyroidism Cardiac disease

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.

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

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

A client has recently been placed on modafinil 200 mg PO qd daily. Modafinil (Provigil) is first-line pharmacologic therapy for:

narcolepsy.

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

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.

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?

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."

The client taking a CNS stimulant reports insomnia. The best option for the nurse in this case is to do which?

Administer the drug earlier in the day. The client should be provided with distracting activities and encouraged not to nap during the day.

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:

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

What recommendation should the nurse provide to a client diagnosed with narcolepsy who is reluctant to rely on medication therapy?

maintaining regular sleeping and waking times to avoid periods of sleep deprivation 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 client is admitted to the medical floor with a diagnosis of narcolepsy. The nurse can anticipate the health care provider to order which medication to treat this disorder?

modafinil Modafinil is used to treat narcolepsy by binding to dopamine, thereby reducing the number of episodes.

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 An increased risk of suicidal ideation in children and adolescents has been found when using the drug atomoxetine (strattera).

What should the nurse's pre-administration assessment of a client receiving a CNS stimulant for attention deficit hyperactivity disorder include? (Select all that apply.)

Blood pressure Pulse Respiratory rate Behavior pattern

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

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

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

Modafinil

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?

Myocardial infarction 2 months previously 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.

A 7-year-old child who has been taking ritalin for the last 18 months has begun to lose weight and the mother is concerned. The cause of weight loss for this child can be attributed to which?

Side effect of the CNS stimulant

A client taking modafinil (Provigil), for narcolepsy has recently needed an increased dosage. At a follow-up visit, the client is combative, confused, and has a low-grade fever. The nurse knows that this clinical presentation is most likely which?

Signs of toxicity from the medication Signs of toxicity from a CNS stimulant include nervousness, combativeness, confusion, delirium, hallucinations, a high body temperature, insomnia, irritability, panic, restlessness, coma, and death.

A child with attention-deficit hyperactivity disorder is prescribed atomoxetine. The nurse would assess the child closely for which adverse reactions?

Suicidal ideation

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 Because methylphenidate is a central nervous system (CNS) stimulant, it carries the potential to disturb sleep patterns

A child was diagnosed with attention-deficit hyperactivity disorder and methylphenidate was prescribed for treatment to be taken once a day in a sustained release form. On future visits, what is a priority nursing assessment for this child?

weight and height The nurse needs to carefully track this child's weight and height because the drug can cause weight loss, anorexia, and nausea that could result in slowed or absent growth.