Question 1

An adult client who is seen by the primary care provider for complaints of inability to focus and concentrate on college studies is prescribed atomozetine (Strattera).Which client comment indicates that the nurse should provide additional information about the drug?

Accepted Answer

Atomoxetin (Strattera) may cause insomnia, so continuing to take melatonin, which is also used to promote sleep, could exacerbate this side effect. The nurse should advise the client to discuss sleep management strategies with the provider instead of taking additional medications. Option A indicates the client is aware of potential driving impairment and will wait before driving, option B indicates understanding of the potential for liver damage and need to report jaundice, and option C indicates a desire for weight loss which may or may not occur as a side effect of this medication.

Question 2

Which client comment would alert the nurse that atomoxetine (Strattera)should be held and the health care provider notified?

Accepted Answer

The comment "Sometimes I feel like I'd be better off if I were dead" suggests the client may be experiencing suicidal ideation, which is a serious adverse effect of atomoxetine. The medication should be held and the health care provider should be notified immediately to assess the client's safety and make any necessary adjustments to their treatment plan. Options A, B, and C are common and expected side effects of atomoxetine and may not require immediate intervention.

Question 3

A school-age client who is taking amphetamine sulfate (Adderall)for treatment of ADHD is seen in the clinic for routine follow-up.The nurse will automatically perform which functions?
Select all that apply.

Accepted Answer

A school-age client on amphetamine sulfate (Adderall) for treatment of ADHD requires routine monitoring of height and weight to ensure they are growing and gaining weight appropriately. Vital signs, especially heart rate and BP, should also be assessed regularly as these medications can cause increased cardiovascular effects. Obtaining labs to assess cardiovascular status such as ECGs, troponin levels, and lipid panels are not routinely necessary. Fasting blood glucose monitoring is also not routinely necessary unless the child has pre-existing diabetes or is at high risk of developing it. A 24-hour urine collection for proteinuria is not indicated unless there are specific concerns related to kidney function.

Question 4

A friend of the nurse expresses concern that her husband might have narcolepsy.Which behavior would indicate to the nurse that he needs further workup by his health care provider?

Accepted Answer

Falling asleep at stoplights while driving can be dangerous and could indicate narcolepsy, which requires further medical evaluation. Falling asleep quickly at night, having difficulty staying alert at social gatherings, and feeling sleepiness after lunch are all common occurrences for many people, and may not necessarily indicate a condition requiring medical attention.

Question 5

A client recently prescribed methylphenidate (Ritalin)for treatment of ADHD complains of an inability to go to sleep at night.Which nursing actions are indicated?Select all that apply.

Accepted Answer

These actions are indicated because caffeine can interfere with sleep, the time of day that Ritalin is taken can affect its impact on sleep, and nonpharmacologic measures such as relaxation techniques or a regular sleep schedule can help to promote sleep.

Question 6

The mother of a pediatric client prescribed clonidine (Kapvay)for treatment of ADHD makes these remarks.Which statements indicate that the nurse should provide additional information about the drug?Select all that apply.

Accepted Answer

- Clonidine (Kapvay) is known to cause sedation or sleepiness as a common side effect, so the statement about the medication not making the child sleepy indicates a misunderstanding.- Clonidine is not typically prescribed with planned drug holidays (periods of time off the medication) for ADHD treatment, which is more common with stimulant medications. This suggests a need for clarification.

Question 7

A mother tells the school nurse that she is concerned over her daughter's use of an inhaler for asthmatic episodes.The daughter is taking amphetamine and dextroamphetamine (Adderall XR)for ADHD.The mother states that since beginning the Adderall,every time the daughter uses her inhaler,she gets very agitated,jittery,and anxious.Which response by the nurse is the most appropriate?

Accepted Answer

The nurse should explain to the mother that both inhalers for asthma and medications for ADHD can cause central nervous system stimulation, leading to agitated, jittery, and anxious behavior when used in combination. Therefore, discontinuing either medication is not necessary. Instead, the mother should discuss adjusting the daughter's dosage or timing of the medications with the primary care provider.

Question 8

A pregnant client says,There is a strong history of ADHD in my husband's family.What can I do to help my baby avoid developing it?" How should the nurse respond?Select all that apply.

Accepted Answer

Smoking during pregnancy and exposure to lead are risk factors for ADHD.

Question 9

An older adult client with Parkinson disease is seen because the daughter states the client cannot stay awake in the daytime.The client is sleeping most of the day,and is having trouble sleeping at night.The client has no history of cardiac events or psychiatric disorders.Vital signs,electrolytes,liver and renal test results are within normal limits.The client is slightly underweight for height.The nurse would anticipate a prescription for which medication?

Accepted Answer

Modafinil (Provigil,Alertec) is a medication commonly used to treat excessive sleepiness caused by Parkinson disease. It works by stimulating the brain and promoting wakefulness without causing agitation or nervousness. Sodium oxybate (Gammahydroxybutyrate, Xyrem) is used to treat narcolepsy, and methylphenidate (Ritalin) is used to treat attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. Selegiline (Eldepryl) is used to treat Parkinson disease but is not indicated for excessive sleepiness.

Question 10

During a routine dressing change,the nurse notes a vesicular rash across the abdomen of a client who is 2 days postop after hysterectomy.The client's a.m.meds,including modafinil (Provigil),ibuprofen,and a multivitamin with iron,are due in 30 minutes.What nursing action is essential?

Accepted Answer

Holding the modafinil is the essential nursing action because modafinil is a medication which can cause a severe and potentially fatal skin reaction called Stevens-Johnson syndrome. The presence of a vesicular rash indicates the possibility of a severe skin reaction, thus it is essential to hold the modafinil and consult with the healthcare provider about the rash. Furthermore, it would also be appropriate to assess the client for other signs and symptoms of Stevens-Johnson syndrome such as fever, malaise, and mucosal involvement, and to document the findings in detail. It is not necessary to culture the drainage from the rash since the primary concern is preventing a life-threatening reaction. Administering the medications and showing the rash to the healthcare provider on rounds later in the day are not appropriate actions since modafinil needs to be held due to the possibility of Stevens-Johnson syndrome. Holding ibuprofen to check the client's medical record for drug allergies is not relevant since the main concern is identifying the cause of the rash and ruling out Stevens-Johnson syndrome.

Question 11

A client is brought to the emergency department with severe hypertension,nervousness,tremors,tachycardia,and post-seizure.According to the paramedics,the client was found lying next to an open bottle of amphetamine and dextroamphetamine (Adderall).The client is not coherent,but admits to taking the Adderall.The nurse should prepare to administer which treatments?Select all that apply.

Accepted Answer

The answer of A client is brought to the emergency...

Question 12

An adolescent female is brought to the emergency department after experiencing a panic attack while at school.She had forgotten to study for a test in Biology.The mother indicates that her daughter is easily distracted,often forgets schoolwork,and has difficulty completing assignments and following instructions.She asks if her daughter should be on medication for ADHD.What is the nurse's best response?

Accepted Answer

Many medications for ADHD, such as stimulants, can potentially worsen anxiety, which is a concern given the daughter's panic attack.

Question 13

The nurse provides information regarding methylphenidate (Concerta)to the parents of a school-age client.Which statements indicate that the parents have good understanding of the information?Select all that apply.

Accepted Answer

Methylphenidate is not typically associated with physical dependence at therapeutic doses for ADHD. It is common for healthcare providers to recommend periodic breaks from the medication to assess its effectiveness and the child's behavior without it.

Question 14

Atomoxetine (Strattera)has been prescribed for a school-age client newly diagnosed with ADHD.Which comment by the mother would indicate that the nurse should provide more teaching about this medication?

Accepted Answer

Atomoxetine (Strattera) is not a stimulant medication and is less likely to be abused recreationally compared to stimulant medications used for ADHD. Therefore, the mother's concern about it being popular as a recreationally abused drug indicates a misunderstanding about the nature of Atomoxetine, suggesting the need for more education on this aspect.

Question 15

The mother of a school-age client tells the school nurse,My son is so hyperactive.I can't see any harm in putting him on medication,especially since the stimulants have so few side effects." Which response by the nurse is the most appropriate?

Accepted Answer

Stimulants can indeed cause side effects such as excessive excitation, and it is important for the nurse to inform the mother about potential side effects of medication.

Question 16

A school-age client comes to the clinic for routine follow-up after being placed on amphetamine sulfate (Adderall)2 weeks ago for a diagnosis of ADHD.The client weighed 15 pounds over normal for height prior to the start of the Adderall.The mother states concern that the client is no longer snacking,barely finishes meals,and will lose too much weight." What is the nurse's best response to this concern?

Accepted Answer

The best response is to acknowledge the mother's concern and offer practical solutions to minimize any excessive weight loss that might arise. Encouraging the mother to offer small, frequent meals, and monitoring for excessive weight loss will reassure the mother and help ensure that the client maintains a healthy weight. Option A might be too frequent of an appointment, and option B and D are incorrect since weight loss should only be as much as necessary to achieve healthy weight goals.

Question 17

An adolescent client who has been taking amphetamine sulfate (Adderall)since age 7 now presents with new-onset type 1 diabetes mellitus.What should be of highest priority in the nurse's education regarding the diabetes for this client?

Accepted Answer

Amphetamine sulfate (Adderall) can increase blood sugar levels and potentially exacerbate diabetes, therefore changing the medication may be necessary. It is important for the nurse to communicate with the healthcare provider to determine the best course of action for the client's individual situation. While monitoring symptoms such as a dry mouth, changes in weight, and irritability is important, these do not address the potential impact of the medication on the client's diabetes.

Question 18

A mother expresses concern that her school-age child may need to be started on medication for ADHD.When asked to describe the child's behaviors that lead to this concern,the mother makes these statements.Which would the nurse interpret as a potential indicator of ADHD?

Accepted Answer

The behavior described in statement B, not being able to complete assignments and instead doodling or becoming distracted, is a potential indicator of ADHD. The other statements describe behaviors that may be related to a lack of motivation, forgetfulness, or incomplete understanding of expectations, but are not necessarily indicative of ADHD.

Question 19

An infant in the neonatal intensive care unit is prescribed caffeine (Cafcit)IV as treatment for apnea.Which medical orders should the nurse plan for,based on the addition of this medication?Select all that apply.

Accepted Answer

The answer of An infant in the neonatal intensive care...

Question 20

A client with a history of benign prostatic hyperplasia (BPH),gout,hyperlipidemia,and palpitations is being seen for symptoms of narcolepsy.Before starting on methylphenidate (Concerta)for treatment of narcolepsy,which testing would the nurse anticipate?

Accepted Answer

The client's history of palpitations warrants further cardiac workup before starting a stimulant medication like methylphenidate. A 12-lead EKG should be performed, and additional cardiac testing may be necessary depending on the results. Testing for BPH, gout, and hyperlipidemia are not directly related to the use of methylphenidate for narcolepsy.

Quiz 24: Central Nervous System Stimulants and Drugs for Attention Deficit

An adult client who is seen by the primary care provider for complaints of inability to focus and concentrate on college studies is prescribed atomozetine (Strattera) .Which client comment indicates that the nurse should provide additional information about the drug?

Which client comment would alert the nurse that atomoxetine (Strattera) should be held and the health care provider notified?

A school-age client who is taking amphetamine sulfate (Adderall) for treatment of ADHD is seen in the clinic for routine follow-up.The nurse will automatically perform which functions? Select all that apply.

A friend of the nurse expresses concern that her husband might have narcolepsy.Which behavior would indicate to the nurse that he needs further workup by his health care provider?

A client recently prescribed methylphenidate (Ritalin) for treatment of ADHD complains of an inability to go to sleep at night.Which nursing actions are indicated?Select all that apply.

The mother of a pediatric client prescribed clonidine (Kapvay) for treatment of ADHD makes these remarks.Which statements indicate that the nurse should provide additional information about the drug?Select all that apply.

A pregnant client says,There is a strong history of ADHD in my husband's family.What can I do to help my baby avoid developing it?" How should the nurse respond?Select all that apply.

During a routine dressing change,the nurse notes a vesicular rash across the abdomen of a client who is 2 days postop after hysterectomy.The client's a.m.meds,including modafinil (Provigil) ,ibuprofen,and a multivitamin with iron,are due in 30 minutes.What nursing action is essential?

The nurse provides information regarding methylphenidate (Concerta) to the parents of a school-age client.Which statements indicate that the parents have good understanding of the information?Select all that apply.

Atomoxetine (Strattera) has been prescribed for a school-age client newly diagnosed with ADHD.Which comment by the mother would indicate that the nurse should provide more teaching about this medication?

The mother of a school-age client tells the school nurse,My son is so hyperactive.I can't see any harm in putting him on medication,especially since the stimulants have so few side effects." Which response by the nurse is the most appropriate?

An adolescent client who has been taking amphetamine sulfate (Adderall) since age 7 now presents with new-onset type 1 diabetes mellitus.What should be of highest priority in the nurse's education regarding the diabetes for this client?

A mother expresses concern that her school-age child may need to be started on medication for ADHD.When asked to describe the child's behaviors that lead to this concern,the mother makes these statements.Which would the nurse interpret as a potential indicator of ADHD?

An infant in the neonatal intensive care unit is prescribed caffeine (Cafcit) IV as treatment for apnea.Which medical orders should the nurse plan for,based on the addition of this medication?Select all that apply.

A client with a history of benign prostatic hyperplasia (BPH) ,gout,hyperlipidemia,and palpitations is being seen for symptoms of narcolepsy.Before starting on methylphenidate (Concerta) for treatment of narcolepsy,which testing would the nurse anticipate?