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The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching?
- A. I will take this medication regularly to prevent a migraine headache from occurring.'
- B. I will take this medication when I feel a migraine headache starting.'
- C. This medication will not reduce the number of migraines I will have.'
- D. I will keep a journal to record the headaches I have and how the injections are working.'
Correct Answer: A
Rationale: Triptans are used to treat acute migraine attacks, not to prevent them. The patient's statement about taking the medication regularly for prevention indicates a misunderstanding, requiring further teaching. The other statements align with proper triptan use.
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A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present?
- A. A history of peptic ulcers
- B. Migraine headaches
- C. Asthma
- D. A history of kidney stones
Correct Answer: A
Rationale: Caffeine can exacerbate peptic ulcers by increasing gastric acid secretion, which may worsen the condition. It is not contraindicated in migraine headaches, asthma, or kidney stones, though it may have varying effects on these conditions.
The order reads: 'Give atomoxetine 0.5 mg/kg/day once daily in the morning before school.' The child weighs 88 pounds. Identify how many milligrams will be administered per dose.
Correct Answer: 20 mg
Rationale: Convert 88 pounds to kilograms: 88 ?· 2.2 = 40 kg. Calculate dose: 0.5 mg/kg/day ?? 40 kg = 20 mg/day.
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.
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 who started taking orlistat 1 month ago calls the clinic to report some 'embarrassing' adverse effects. She tells the nurse that she has had episodes of 'not being able to control my bowel movements.' Which statement is true about this situation?
- A. These are expected adverse effects that will eventually diminish.
- B. The patient will need to stop this drug immediately if these adverse effects are occurring.
- C. The patient will need to increase her fat intake to prevent these adverse effects.
- D. The patient will need to restrict fat intake to less than 30% of total calories to help reduce these adverse effects.
Correct Answer: D
Rationale: Orlistat's gastrointestinal side effects, such as fecal incontinence, are related to its mechanism of inhibiting fat absorption. Restricting dietary fat to less than 30% of total calories can reduce these effects. They are not expected to diminish entirely without dietary changes, stopping the drug is not necessary, and increasing fat intake would worsen the effects.