Question 1

A university student who is agitated and restless and has tremors is brought to the emergency department. The patient's 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 reports using concentrated energy drinks to stay awake during finals week. What complication will the nurse monitor for in this patient?

Accepted Answer

In large doses,caffeine produces nervousness and tremors; in very large doses,it can cause seizures. This patient has been drinking concentrated energy drinks which are high in caffeine. Caffeine is a stimulant and produces CNS excitation,not depression. Although cardiac side effects are common with caffeine,cardiac arrest is not. Respiratory failure is not an effect of caffeine toxicity.

Question 2

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:

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 effect at therapeutic doses. Loquaciousness is an expected effect at therapeutic doses.

Question 3

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?

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 4

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?

Accepted Answer

Stimulants do not suppress negative behaviors directly and do not directly cause a decrease in hyperactivity. They act by improving attention and focus so that positive behaviors can be learned to replace negative behaviors. Insomnia and poor appetite are common side effects and should be reported to the provider,because alternate dosing regimens often counteract these effects. Taking the medication either during or after breakfast prevents morning appetite suppression at breakfast time. Stimulants improve focus and allow new,more positive behaviors to be learned.

Question 5

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.)

Accepted Answer

ADHD is characterized by inattention,hyperactivity,and impulsivity. Anxiety and compulsivity are not characteristic of ADHD.

Question 6

A child will begin taking methylphenidate [Ritalin] for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include:

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 7

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.)

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 8

A nurse working the night shift begins taking modafinil [Alertec]. The nurse is telling a coworker about the medication. Which statement is correct?

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 9

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?

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 10

An adult patient will begin taking atomoxetine [Strattera] for attention-deficit/hyperactivity disorder. What will the nurse teach this patient?

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 3 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 11

A young adult begins taking clonidine [Kapvay] to treat ADHD symptoms after suffering anorexia with methylphenidate [Ritalin]. What will the nurse include when teaching this patient about taking clonidine?

Accepted Answer

Clonidine causes somnolence,which is made worse by alcohol or other CNS depressants,so clients should avoid alcohol while taking clonidine. Insomnia and anorexia are not side effects of clonidine. Clonidine is not a controlled substance,so prescriptions may be refilled over the phone and may be written for more than one month at a time. The tablets must be swallowed whole and should not be crushed or chewed.

Quiz 36: Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder