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A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be 'in his system' when he goes to school the next morning. What is the nurse's appropriate evaluation of the mother's actions?
- A. She is giving him the medication dosage appropriately.
- B. The medication should not be taken until he is at school.
- C. The medication should be taken with meals for optimal absorption.
- D. The medication should be given 4 to 6 hours before bedtime to diminish insomnia.
Correct Answer: D
Rationale: Methylphenidate, a CNS stimulant, can cause insomnia if taken close to bedtime. Administering it 4 to 6 hours before bedtime helps minimize sleep disturbances while maintaining therapeutic levels during the day. Bedtime dosing, school-time dosing, or meal-dependent administration are not appropriate for extended-release formulations.
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The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.)
- A. Narcolepsy
- B. Depression
- C. Panic attacks
- D. Neonatal apnea
- E. Attention deficit hyperactivity disorder (ADHD)
- F. Appetite suppression
- G. Migraine headaches
Correct Answer: A,D,E,F,G
Rationale: CNS stimulants are indicated for narcolepsy, neonatal apnea, ADHD, appetite suppression in obesity treatment, and migraine headaches (via triptans). They are not used for depression or panic attacks, as they may worsen these conditions.
A patient has a new prescription for phentermine as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply.)
- A. Take this medication after meals.
- B. Take this medication in the morning.
- C. This drug is taken along with supervised exercise and suitable diet.
- D. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth.
- E. Avoid foods that contain caffeine, such as coffee, tea, and colas.
Correct Answer: B,C,D,E
Rationale: Phentermine should be taken in the morning to avoid insomnia, alongside supervised exercise and diet for weight loss, and with measures like mouth rinses to manage dry mouth. Avoiding caffeine prevents additive stimulant effects. Taking it after meals is not necessary, as timing is not meal-dependent.
When evaluating a patient who is taking orlistat, which is an intended therapeutic effect?
- A. Increased wakefulness
- B. Increased appetite
- C. Decreased weight
- D. Decreased hyperactivity
Correct Answer: C
Rationale: Orlistat is a nonstimulant drug used for weight loss by inhibiting fat absorption, making decreased weight the intended therapeutic effect. It does not affect wakefulness, appetite, or hyperactivity.
A 10-year-old patient will be started on methylphenidate hydrochloride therapy. The nurse will perform which essential baseline assessment before this drug is started?
- A. Eye examination
- B. Height and weight
- C. Liver function studies
- D. Hearing test
Correct Answer: B
Rationale: Methylphenidate may cause temporary growth suppression in children, making baseline height and weight assessment essential for monitoring. Eye exams, liver function studies, and hearing tests are not routinely required for this therapy.
A patient has just received an injection of onabotulinumtoxin A. The nurse will monitor for which adverse effects? (Select all that apply.)
- A. Insomnia
- B. Dysphagia
- C. Weight gain
- D. GI upset
- E. Difficulty breathing
Correct Answer: B,E
Rationale: Onabotulinumtoxin A (Botox) carries a Black Box Warning for toxin spread beyond the injection site, which may cause dysphagia and breathing difficulties. Insomnia, weight gain, and GI upset are not commonly associated adverse effects.