Question 1

A child has been taking SD methylphenidate (Ritalin), 10 mg at 0800 and 1200 and 5 mg at 1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school. The child's appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do?

A) Ask the prescriber whether this child could be given methylphenidate (Concerta).
B) Contact the prescriber to suggest using a nonstimulant medication.
C) Reinforce the need to take all doses as prescribed.
D) Suggest drug holidays for the child on weekends.

Accepted Answer

This child is showing slight improvement with the medication but has trouble taking the noon dose; therefore, a once daily formulation would increase compliance and improve effects. There is no indication to use a nonstimulant medication, because the child's appetite is normal. If 3 times/day dosing were the only option available, reinforcing the need to take all doses would be necessary; however, some children avoid taking medication at school because of the stigma attached to being different from their peers. The use of drug holidays is controversial; this approach is used when growth suppression is a problem.

Question 2

A nurse is teaching the parents of a child who has attention-deficit/hyperactivity disorder about methylphenidate (Concerta). Which statement by the child's parents indicates understanding of the teaching?

A) "The effects of this drug will wear off in 4 to 6 hours."
B) "The tablet needs to be swallowed whole, not crushed or chewed."
C) "This medication has fewer side effects than amphetamines."
D) "We should call the provider if we see parts of the medicine in our child's stools."

"The tablet needs to be swallowed whole, not crushed or chewed."

Accepted Answer

Concerta tablets must be swallowed whole and should not be crushed, chewed, or dissolved in liquids. This is a long-duration preparation with effects that last 10 to 12 hours. Methylphenidate has the same actions and adverse effects as amphetamines. The tablet shell may not fully dissolve in the gastrointestinal (GI) tract; therefore, tablet "ghosts" in the stool are normal.

Question 3

A nurse working the night shift begins taking modafinil (Alertec). The nurse is telling a coworker about the medication. Which statement is correct?&#10;A) &#34;I can take it during pregnancy.&#34;&#10;B) &#34;It doesn't have cardiovascular side effects.&#34;&#10;C) &#34;It is safe and has no serious adverse effects.&#34;&#10;D) &#34;It will not interfere with my normal sleep.&#34;

Accepted Answer

Modafinil is used to increase wakefulness in patients with excessive sleepiness, including those with shift-work sleep disorder (SWSD). It acts without disrupting nighttime sleep. It is embryotoxic in laboratory animals and therefore is contraindicated during pregnancy. It can increase the heart rate and blood pressure. In rare cases it has been linked to serious skin reactions, including Stevens-Johnson syndrome, erythema multiforme, and toxic epidermal necrolysis.

Question 4

A university student is brought to the emergency department after having a seizure at a party. The heart rate is 110 beats per minute, the respiratory rate is 18 breaths per minute, and the blood pressure is 160/95 mm Hg. The patient is agitated and restless and has tremors. The patient takes clonidine for ADHD. The nurse smells alcohol on the patient's breath. Toxicology results are pending. The nurse suspects what about this patient?

A) The patient has severe alcohol poisoning.
B) An adverse drug interaction between the clonidine and the alcohol has occurred.
C) The patient may have consumed a large amount of caffeine.
D) The patient may have ingested strychnine.

Accepted Answer

In large doses, caffeine produces nervousness and tremors; in very large doses, it can cause convulsions. People often consume caffeine when drinking alcohol to offset the sedative effects of the alcohol, and many college students consume highly caffeinated energy drinks with alcohol. Severe alcohol poisoning may produce seizures, but the patient would not be agitated and restless. Clonidine would cause somnolence, which would increase with alcohol. Strychnine causes severe muscle stiffness.

Question 5

A toddler arrives in the emergency department by ambulance. The nurse observes that the child's facial and neck muscles are stiff and that the child is hyperreflexive. The parents tell the nurse that the child ingested something at a neighbor's house. The nurse will correctly suspect which agent?

A) Amphetamines
B) Chocolate
C) Caffeine
D) Strychnine

Accepted Answer

Strychnine, which may be used in rat poisons, causes stiffness of the muscles of the face and neck, along with reflex excitability. Amphetamines produce dizziness, confusion, and convulsions. Theobromine, which is found in chocolate, is a methylxanthine and causes hyperactivity, vomiting, diarrhea, and cardiovascular effects. Caffeine causes excitement, restlessness, and cardiovascular effects.

Question 6

An adult patient will begin taking atomoxetine (Strattera) for attention-deficit/hyperactivity disorder. What will the nurse teach this patient?&#10;A) Appetite suppression does not occur, because this drug is not a stimulant.&#10;B) Stopping the drug abruptly will cause an abstinence syndrome.&#10;C) Suicidal thoughts may occur and should be reported to the provider.&#10;D) Therapeutic effects may not be felt for 1 or 2 weeks after beginning therapy.

Accepted Answer

Atomoxetine is a selective inhibitor of norepinephrine (NE) reuptake, and its effects probably are the result of adaptive changes that occur after uptake blockade, which can take 1 to 2 weeks. Appetite suppression is an adverse effect of this drug. Atomoxetine does not have abuse potential, and abstinence syndrome does not occur when it is withdrawn. Suicidal thoughts may occur in children and adolescents but not in adults.

Question 7

A parent thinks a school-aged child has ADHD. The nurse asks the parent to describe the child's behaviors. Which behaviors are characteristic of ADHD? (Select all that apply.)&#10;A) Accident-prone&#10;B) Compulsive&#10;C) Forgets to turn in homework&#10;D) Interrupts others&#10;E) Plays video games &#34;all the time&#34;

Accepted Answer

Children with ADHD often act without thinking and thus are more likely to have accidents and injuries. They have difficulty following through with tasks, and forgetting to turn in homework is a manifestation of this. They interrupt others frequently. They are impulsive, not compulsive (a behavior associated with obsessive-compulsive disorder [OCD]). Playing video games requires sustained attention and mental effort and is not characteristic of ADHD.

Question 8

A child will begin taking methylphenidate (Ritalin) for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include:&#10;A) results of an electrocardiogram (ECG).&#10;B) family history of psychosis.&#10;C) height and weight.&#10;D) renal function.

Accepted Answer

Side effects of methylphenidate include a reduced appetite, and children taking these drugs should be monitored for growth suppression. Baseline height and weight measurements help with this ongoing assessment. The value of an ECG for children has not been proven, except when known heart disease is a factor. Excessive use of stimulants can produce a state of psychosis but is not related to the family history. Renal function tests are not indicated.

Question 9

A nurse is providing education to a group of patients regarding amphetamines. To evaluate the group's understanding, the nurse asks a participant what effects amphetamines would have on her. The participant shows that she understands the effects of these drugs if she gives which answers? (Select all that apply.)

A) "Amphetamines increase fatigue."
B) "Amphetamines suppress the perception of pain."
C) "Amphetamines increase appetite."
D) "Amphetamines increase the heart rate."
E) "Amphetamines elevate mood."

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Accepted Answer

At customary doses, amphetamines increase wakefulness and alertness, reduce fatigue, elevate mood, and augment self-confidence and initiative. Amphetamines also suppress appetite and the perception of pain and increase the heart rate. Amphetamines do not increase fatigue or appetite.

Question 10

A patient who is morbidly obese is admitted for treatment. The prescriber orders lisdexamfetamine (Vyvanse). The nurse will be concerned if this patient shows signs of:&#10;A) anorexia.&#10;B) dyspnea.&#10;C) insomnia.&#10;D) loquaciousness.

Accepted Answer

Stimulants can produce cardiovascular effects. Any patient reporting shortness of breath needs to be evaluated for cardiovascular problems. Anorexia, or poor appetite, is an expected effect of stimulants and is the desired effect when these drugs are used for obesity. Stimulants increase alertness and can cause insomnia, which is an expected affect at therapeutic doses. Loquaciousness is an expected effect at therapeutic doses.

Question 11

A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child's parent indicates a need for further teaching?

A) "I should report insomnia and poor appetite to his provider."
B) "I will make sure he takes his medication after breakfast every day."
C) "This drug will make him less impulsive while he's at school."
D) "This medication will help my child focus so he can learn new behaviors."

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Accepted Answer

The answer of A child is diagnosed with attention-deficit/hyperactivity disorder...

Deck 36: Central Nervous System Stimulants and Attention-Deficithyperactivity Disorder