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

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

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. 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?

ANS:  C

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.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 401

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

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:

ANS:  B

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.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 396

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

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

ANS:  C

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.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 396

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

4. 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?

ANS:  A

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.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 397-398 | p. 401

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies