Question 1

An adult patient reports feeling unfocused all the time,loses things,and has difficulty completing tasks and says that this is interfering with family relations and work.The symptoms have been present as long as the patient can remember,although there is no previous documentation of attention-deficit/hyperactivity disorder (AD/HD)in this patient's medical history.The primary care nurse practitioner (NP)should:

A) tell the patient that a diagnosis of AD/HD as a child is a prerequisite for diagnosing this in adults.
B) conduct a thorough evaluation to document behaviors associated with AD/HD and begin treatment if indicated.
C) suggest that the patient may have a major depressive disorder and refer the patient for psychiatric evaluation and treatment.
D) prescribe a methylphenidate trial, ask the patient to keep a diary of behaviors and feelings, and reevaluate in 1 to 2 months.

Accepted Answer

Although childhood AD/HD is a prerequisite for diagnosis in an adult,it is increasingly recognized that many adults have the disorder without having been diagnosed as children.The NP should evaluate the patient's symptoms and treat if indicated.The patient does not have symptoms of depression.Methylphenidate should not be given unless the patient meets the diagnostic criteria.

Question 2

The parent of an 8-year-old child recently diagnosed with AD/HD verbalizes concerns about giving the child stimulants.The primary care NP should recommend:&#10;A) modafinil (Provigil).&#10;B) guanfacine (Intuniv).&#10;C) bupropion (Wellbutrin).&#10;D) atomoxetine (Strattera).

Accepted Answer

Atomoxetine is not a stimulant medication but is thought to be as effective as stimulant medications.It is the only nonstimulant treatment approved by the U.S.Food and Drug Administration for AD/HD that has been shown to be safe,well tolerated,and efficacious in the treatment of children.

Question 3

The parent of a 4-year-old child is concerned that the child may have AD/HD and wants to know if medications can be given.The primary care NP should tell the parent that:&#10;A) children cannot be diagnosed with AD/HD at this age.&#10;B) alternative therapies to treat AD/HD are used at this age.&#10;C) symptoms at this age are more likely due to environmental factors.&#10;D) most drugs for AD/HD are not approved for children younger than 6 years.

Accepted Answer

Most AD/HD medications are not approved for use in children younger than 6 years.Children can be diagnosed with AD/HD at age 4.Alternative therapies are not necessarily used.

Question 4

A patient who has recently begun working at night reports having difficulty staying awake at work.The primary care NP should consider prescribing:&#10;A) caffeine.&#10;B) modafinil (Provigil).&#10;C) methylphenidate (Ritalin).&#10;D) dextroamphetamine (Dexedrine).

Accepted Answer

Modafinil is approved for day/night shift changes in adults as well as narcolepsy,excessive daytime sleepiness,and sleep apnea.

Question 5

A child has been taking methylphenidate 5 mg at 8 AM,12 PM,and 4 PM for 30 days after a new diagnosis of AD/HD and comes to the clinic for evaluation.The child's mother reports that the child exhibits some nervousness and insomnia but is doing much better in school.The primary care NP should suggest:

A) discontinuing the 4 PM dose.
B) increasing the dose to 10 mg each time.
C) giving 10 mg at 8 AM and 5 mg at noon.
D) changing the dosing to 15 mg twice daily.

Accepted Answer

Nervousness and insomnia are the most common adverse effects and are usually controlled by reducing the dose or omitting the afternoon or evening dose.

Question 6

A primary care NP sees a child for an annual well-child check-up.The child has been taking methylphenidate for AD/HD for 3 months.The NP should discontinue the medication if which symptom is present?&#10;A) Motor tics&#10;B) Decreased appetite&#10;C) Occasional headaches&#10;D) Decreased blood pressure

Accepted Answer

Methylphenidate is contraindicated in patients who have motor tics or a diagnosis of Tourette's syndrome.Decreased appetite,occasional headaches,and changes in blood pressure are not concerning.

Question 7

A child is diagnosed with AD/HD after being expelled from school for disruptive behaviors.The child's parents are reluctant to start medication because of the stigma attached.The primary care NP should suggest:

A) Ritalin.
B) Concerta.
C) Adderall.
D) Dexedrine.

Accepted Answer

Concerta is a long-acting stimulant,and children taking it can avoid having to take a dose of medication at school.The other choices are shorter acting and may require dosing during school.

Question 8

A child is taking methylphenidate (Ritalin)for AD/HD.The child's parent calls the primary care NP to report increased behavior problems and delusional thinking.The NP should:&#10;A) increase the drug dose.&#10;B) discontinue the medication.&#10;C) change to dextroamphetamine.&#10;D) order methylphenidate SR.

Accepted Answer

Exacerbation of behavioral and processing symptoms can occur in patients with preexisting psychosis,and manic and behavioral symptoms may occur in patients who do not have an underlying psychiatric disorder.This is true with all stimulant medications,so increasing the dose,switching to another stimulant,or switching to a long-acting form are not indicated.

Deck 41: Medications for Attention Deficit/Hyperactivity Disorder