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

Question 1

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?

A)"Many medications given for treatment of ADHD can worsen anxiety,which is a major component of panic attacks."
B)"Medication might help with the ADHD."
C)"Have you tried behavioral therapy for treatment of the ADHD?"
D)"It is better to change the diet first as treatment for the ADHD."

Answer 1

"Many medications given for treatment of ADHD can worsen anxiety,which is a major component of panic attacks."

Question 2

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? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Blood glucose measurements every 2 hours
B)Bilirubin measurement daily
C)Seizure precautions
D)Deep tendon reflex monitoring every 4 hours
E)Skin assessment every 4 hours

Answer 2

Bilirubin measurement daily
Seizure precautions

Question 3

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?

A)Culture the drainage from the rash.
B)Give the a.m.medications and plan to show the rash to the health care provider on morning rounds.
C)Hold the ibuprofen until the nurse can check the client's medical record for drug allergies.
D)Hold the modafinil and talk to the health care provider about the rash.

Answer 3

Hold the modafinil and talk to the health care provider about the rash.

Question 4

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)This medication may be changed.
B)Immediately report signs of a dry mouth.
C)Monitor height and weight very closely.
D)Report any increase in irritability and nervousness.

Question 5

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Measure the client's height and weight.
B)Assess vital signs,especially heart rate and BP.
C)Obtain labs to assess cardiovascular status.
D)Obtain a fasting blood glucose.
E)Instruct the parent and child on how to obtain a 24-hour urine collection for proteinuria.

Question 6

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?

A)A PSA and digital prostate exam
B)A 12-lead EKG and further cardiac workup pending results
C)Urinalysis and lab tests to determine control of gout
D)Labs for cholesterol and triglyceride levels

Question 7

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?

A)"I'll wait until I've taken the medication a few days before driving."
B)"I'll call the doctor immediately if I become jaundiced."
C)"It would be nice if my appetite were decreased with this medication,as I've been wanting to shed a few pounds."
D)"I'll continue to take melatonin at bedtime,as I have difficulty falling asleep at night."

Question 8

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?

A)"Your daughter needs to see her primary care provider to have her asthmatic medication changed to another medication."
B)"Your daughter will need to discontinue her treatment for ADHD,as it is contraindicated with medications use to treat asthma."
C)"The Adderall should be discontinued during times of asthma exacerbation."
D)"Inhalers used for asthma tend to cause central nervous system stimulation,just as medications for ADHD do.Her symptoms are likely due to the additive effect of having both medications."

Question 9

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? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"I'm so glad that the doctor chose a medication that won't make my child sleepy."
B)"I think my dad takes that for his high blood pressure."
C)"I can expect that the doctor will take my child off this medication for a few days every 6 months or so."
D)"I must warn my parents that Dad's clonidine cannot be substituted for the Kapvay."
E)"At least my child will not become addicted to this medication."

Question 10

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)The husband falls asleep as soon as he lies down at night.
B)The husband sometimes nods off and has difficulty staying alert at home Bible study gatherings.
C)The husband has difficulty staying awake about 1-2 hours after having lunch each day.
D)The husband puts his car in park every time he comes to a stoplight,because he often falls asleep for several minutes while waiting for the light to turn green.

Question 11

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?

A)"When I ask him to do his chores,he finishes his game before he starts."
B)"His teacher says that he isn't able to complete assignments that require him to sit and write for 5 to10 minutes at a time.He doodles on his paper or badgers others in the classroom instead of working on his assignment."
C)"In the last month,he has twice forgotten to ask me to give him his lunch money for the day."
D)"When I tell him to clean the house,he doesn't clean under furniture or under the rim of the toilet.He only dusts some of the furniture,but not all of it."

Question 12

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?

A)Sodium oxybate (gammahydroxybutyrate,Xyrem)
B)Modafinil (Provigil,Alertec)
C)Methylphenidate (Ritalin)
D)Selegiline (Eldepryl)

Question 13

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?

A)"I will keep this medication in a secure place,because it is popular as a recreationally abused drug."
B)"I will monitor my child's appetite and watch for excessive weight loss."
C)"I will monitor my child for a persistent cough that does not go away."
D)"I must look for signs of suicidal ideation."

Question 14

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? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Assess for caffeine intake,especially late in the afternoon or evening hours.
B)Assess for time of day that Ritalin is taken.
C)Assess for nonpharmacologic measures taken to induce sleep.
D)Inform the health care provider that the client is unable to fall asleep while taking Ritalin.
E)Suggest taking melatonin to assist in nighttime drowsiness.

Question 15

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? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"There is really little you can do to prevent your baby from developing ADHD,but you can watch for symptoms and get help early."
B)"Do not smoke while you are pregnant and avoid secondhand smoke."
C)"You should breast-feed your baby."
D)"Avoid situations that would expose your baby to lead or lead paint."
E)"Keep your baby's intake of sugar very low for the first 3 years of life."

Question 16

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

A)"I get lightheaded when I get out of bed in the mornings."
B)"Sometimes I have difficulty going to sleep."
C)"I always feel like I have such a dry mouth."
D)"Sometimes I feel like I'd be better off if I were dead."

Question 17

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?

A)"Stimulants can cause the side effect of excessive excitation."
B)"Have you made an appointment for your son to see the health care provider?"
C)"Stimulants can be helpful in hyperactivity disorders."
D)"What actions lead you to think your son is hyperactive?"

Question 18

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? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Chlorpromazine IV
B)Sodium bicarbonate
C)Flumazenil (Romazicon)IV
D)Gastric lavage
E)Phentolamine IV

Question 19

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? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"I will talk with the school nurse about administering a dose at about noon each day."
B)"We should fold the patch with the medication side facing in before it is thrown in the garbage."
C)"We should not expect physical dependence at the low dose given for ADHD."
D)"We can expect that the health care provider will occasionally tell us to stop giving the medication for a few days."
E)"If our child experiences loss of appetite,we should immediately contact the health care provider."

Question 20

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?

A)"Make an appointment each week for us to monitor against too much weight loss."
B)"It is normal for clients to lose weight when taking Adderall."
C)"Over time,the diminished appetite might be reduced.Begin by offering small,frequent meals,and monitor for excessive weight loss."
D)"The Adderall will help the client to return to normal weight for his height."

Question 21

A mother tells the nurse,"My son has ADHD and so does my sister's daughter.They are the same age,but they are on two different drugs.Why is that?" Which information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"All the drugs used to treat ADHD are basically the same."
B)"Children often have severe reactions to ADHD drugs and have their therapy changed."
C)"The choice of drug can be guided by different dosing schedules."
D)"Some children just do better on one drug or the other."
E)"Girls don't respond to medications as well as boys."

Question 22

A nurse is developing the initial care plan for a client who is prescribed a central nervous system stimulant for the treatment of ADHD.Which nursing diagnoses will most likely be a part of this care plan? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Family Processes,Interrupted
B)Development: Delayed,Risk for
C)Sleep Pattern,Disturbed
D)Gas Exchange,Impaired
E)Nutrition,Imbalanced: Less than Body Requirements

Question 23

What should the nurse teach a client about obtaining prescribed central nervous system stimulant medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Have the health care provider call the prescription in to a pharmacy that knows your health history.
B)The prescription can be filled only at a pharmacy especially licensed to dispense these drugs.
C)There must be a new prescription written each time additional medication is needed.
D)Ask the pharmacy to pre-certify the number of refills indicated on the prescription form.
E)Extra rules apply to these drugs because of their abuse potential.

Question 24

A pediatric client diagnosed with ADHD is being treated with dexmethylphenidate (Focalin XR).The client's mother reports that the child has started saying "huh" very loudly several times each day.What should the nurse tell the mother about this finding? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)This sound may represent a vocal tic.
B)Children with ADHD often make such sounds to call attention to themselves.
C)The Focalin XR may need to be discontinued.
D)Focalin XR causes an inhibition of growth in many children.
E)Many illicit drugs cause this type of behavior.