Deck 28: Central Nervous System Stimulants and Drugs for Attention-Deficit Hyperactivity Disorder

Question 1

Atomoxetine (Strattera)has been prescribed for an 8-year-old patient newly diagnosed with ADHD.Which of the following comments by the mother would indicate that the nurse needs to perform more teaching?
1)"I will monitor my child's appetite and watch for excessive weight loss."
2)"I will monitor my child for a persistent cough that does not go away."
3)"I will keep this medication in a secure place, because it is popular as a
Recreationally abused drug."
4)"I must look for signs of suicidal ideation."

Answer 1

3

Question 2

A 10-year-old client comes to the clinic for routine follow-up after being placed on amphetamine sulfate (Adderall)two 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 in between meals and barely finishes all the food placed on the client's plate.She fears the client will lose too much weight.What would be the most appropriate response?
1)"It is normal for clients to lose weight when taking Adderall."
2)"We will monitor the client's weight every week to make sure that there is not too much weight loss."
3)"The Adderall will help the client to return to normal weight for his height."
4)"Over time, the diminished appetite might be reduced.Begin by offering small, frequent meals, and monitor for excessive weight loss."

Answer 2

4

Question 3

A mother brings her 10-year-old son to see the health care provider because she feels he might have ADHD, and feels that he might need to be started on medication.Which of the following actions would support a diagnosis of ADHD?
1)When asked to perform a chore, the son completes his game before getting up to perform the chore.
2)When asked to clean the house, the son fails to clean under furniture, fails to clean the rim of the toilet, and dusts some of the furniture, but not all of it.
3)The teacher notes that the son is not able to complete assignments that require
Him to sit and write for 5-10 minutes at a time.He doodles on his paper, or
Uses his pencil as a drumstick, or badgers others in the classroom, instead of
Working on his assignment.
4)On occasion, the son forgets to ask for lunch money for that day.

Answer 3

3

Question 4

A 9-year-old 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 of the following functions? Select all that apply.
1)Assess vital signs, especially heart rate and B/P.
2)Obtain a 24-hour urinalysis for proteinuria.
3)Check the client's height and weight.
4)Obtain labs to assess cardiovascular status.
5)Obtain a fasting blood sugar.

Question 5

A mother expresses concern over her daughter's use of an inhaler for asthmatic episodes.The daughter is taking 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.What would be an appropriate response?
1)"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."
2)"The Adderall should be discontinued during times of asthma exacerbation."
3)"The daughter needs to see her primary care provider to have her asthmatic
Medication changed to another medication."
4)"The daughter will need to discontinue her treatment for ADHD, as it is
Contraindicated with medications use to treat asthma."

Question 6

A client is brought to the ED with severe hypertension, nervousness, tremors, tachycardia, and post-seizure.According to the EMTs, the client was found lying next to an open bottle of methylphenidate (Ritalin).The client is not coherent, but admits to taking the Ritalin.The nurse should prepare to administer: (Select all that apply.)
1)Activated charcoal.
2)Gastric lavage.
3)Phentolamine IV.
4)Chlorpromazine IV.
5)Flumazenil (Romazicon)IV.

Question 7

A 14-year-old who has been taking amphetamine sulfate (Adderall)since age 7 now presents with new-onset juvenile diabetes.Which of the following should be of highest priority in the nurse's education regarding the diabetes for this client?
1)Monitor height and weight very closely.
2)Immediately report signs of a dry mouth.
3)Monitor blood glucose more frequently.
4)Report any increase in irritability and nervousness.

Question 8

An elderly client with Parkinson's disease is being 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, and liver and renal test results are within normal limits.The client has no other psychiatric history.VS and electrolytes are within normal limits.The client is slightly underweight for height.The nurse would anticipate a prescription for which of the following medications?
1)Modafinil (Provigil, Alertec)
2)Sodium oxybate
3)Selegiline (Eldepryl)
4)Methylphenidate (Ritalin)

Question 9

A mother is speaking to a friend, who is a nurse, at a local school event.She wants her 8-year-old son placed on medication because she states he is hyperactive.She states that it would not do any harm to place her son on medication because those stimulants don't have side effects.What would be the best response of this nurse friend?
1)"Have you made an appointment for your son to see the physician?"
2)"What actions lead you to think your son is hyperactive?"
3)"Stimulants can be helpful in hyperactivity disorders."
4)"Stimulants have side effects due to excessive excitation."

Question 10

A friend of the nurse expresses concern that her husband might have narcolepsy.She states that he falls asleep whenever he sits quietly for more than five minutes.He even falls asleep during his favorite team's football games.Which of the following would indicate to the nurse that he needs further workup by his health care provider?
1)The husband falls asleep as soon as he lies down at night.
2)The husband sometimes nods off, and has difficulty staying alert at home Bible study gatherings.
3)The husband has to put the vehicle in park every time he comes to a stoplight,
Because he often falls asleep for several minutes whenever parked and waiting
For the light to turn green.
4)The husband has difficulty staying awake about 1-2 hours after having lunch
Each day.

Question 11

A 12-year-old female is brought to the ED 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.The nurse can best respond by stating:
1)"Many medications given for treatment of ADHD can worsen anxiety, which is a major component of panic attacks."
2)"Medication might help with the ADHD."
3)"It is better to change the diet first, as treatment for the ADHD."
4)"Have you tried behavioral therapy for treatment of the ADHD?"

Question 12

A 35-year-old client is seen by the primary care provider for complaints of inability to focus and concentrate on her studies at college.She is unable to sit down for extended periods of time to write or to read, and finds herself doodling on her notepad while the teacher is lecturing.Which of the following indicates a need for more instruction regarding atomoxetine (Strattera)?
1)"I'll continue to take melatonin at bedtime, as I have difficulty falling asleep at night."
2)"I'll wait until I've taken the medication a few days before driving."
3)"It would be nice if my appetite were decreased with this medication, as I've
Been wanting to shed a few pounds."
4)"I'll call the doctor immediately if I become jaundiced."

Question 13

A client recently started on methylphenidate (Ritalin)for treatment of ADHD complains that he is unable to go to sleep at night.Which of the following is the best response of the nurse? Select all that apply.
1)Inform the health care provider that the client is unable to fall asleep while taking Ritalin.
2)Assess for caffeine intake, especially late in the afternoon or evening hours.
3)Assess for time of day that Ritalin is taken.
4)Assess for non-pharmacological measures taken to induce sleep.
5)Suggest taking melatonin to assist in nighttime drowsiness.

Question 14

A client with a history of BPH, gout, hyperlipidemia, and palpitations is being seen for symptoms of narcolepsy.Before starting on methylphenidate (Concerta)for treatment of narcolepsy, which of the following would the nurse anticipate?
1)A 12-lead EKG and further cardiac workup pending results
2)A PSA and digital prostate exam
3)Urinalysis and lab tests to determine control of gout
4)Labs for cholesterol and triglyceride levels

Question 15

Which of the following comments by a client would alert the nurse that atomoxetine (Strattera)should be held and the health care provider notified?
1)"Sometimes I have difficulty going to sleep."
2)"I always feel like I have such a dry mouth."
3)"Sometimes I feel like I'd be better off if I were dead."
4)"I get lightheaded when I get out of bed in the mornings."

Question 16

A nurse is taking care of a client admitted to the hospital for a hysterectomy.It is the second day postop, and the client has had an uneventful recovery.The nurse came to the client's room for a.m.assessment and to administer medications, which consisted of Modafinil for narcolepsy and Fosamax for osteoporosis.The nurse notes yellowish coloration of the sclera and skin.What would be the next appropriate action of the nurse?
1)Give the a.m.medications and notify the physician of the jaundice sclera and skin.
2)Hold the Fosamax and notify the physician of the jaundice.
3)Hold the Modafinil and notify the physician of the jaundice.
4)Give the medications as ordered and call for the lab to draw liver enzymes.