A nurse is reinforcing teaching about methylphenidate (Ritalin) with the parents of a school-age child who has ADHD. Which of the following instructions should the nurse include?
"You should give your child's last daily dose of the medication before 6 o'clock in the evening."
"You will need to give your child the medication after meals."
"You will need to have your child's blood glucose level checked monthly."
"You should not give your child the medication on weekends."
The Correct Answer is A
A. "You should give your child's last daily dose of the medication before 6 o'clock in the evening." Methylphenidate is a stimulant, and giving it too late in the day can cause insomnia. Administering the last dose before 6 PM helps minimize sleep disturbances.
B. "You will need to give your child the medication after meals." Methylphenidate is typically given before meals to enhance its absorption and effectiveness. Taking it after meals is not recommended as it can delay absorption.
C. "You will need to have your child's blood glucose level checked monthly." There is no need for regular blood glucose monitoring unless the child has other conditions like diabetes. Methylphenidate does not typically affect blood glucose levels.
D. "You should not give your child the medication on weekends." Continuous use of methylphenidate is generally recommended to provide consistent symptom control, including on weekends. “Drug holidays” may be considered in specific cases but should be discussed with a healthcare provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
Explanation
Increased seizure activity
- Finding: Phenytoin level
The child's phenytoin level is 6 mcg/mL, which is below the therapeutic range of 10-20 mcg/mL. Subtherapeutic levels of phenytoin mean the medication is not providing adequate seizure control, increasing the risk of more seizures. The recent seizure history and the low drug level indicate a direct correlation between insufficient phenytoin levels and increased seizure activity.
Pneumonia
- Finding: Cough
A harsh, non-productive cough that worsens with activity and at night can be indicative of respiratory conditions, including asthma exacerbations. However, in the context of this child's history and symptoms, there is no evidence of a productive cough, fever, or other signs of infection that would typically suggest pneumonia. Hence, pneumonia is not the primary concern.
Liver failure
- Finding: Skin rash
Liver failure is usually associated with jaundice, elevated liver enzymes, and systemic symptoms like fatigue or confusion. The child’s liver function tests are within normal ranges, and there are no signs of jaundice or systemic illness. The skin rash is more likely related to eczema or a possible drug reaction rather than indicating liver failure.
Steven-Johnson syndrome
- Finding: Liver enzymes
Steven-Johnson syndrome (SJS) is a severe skin reaction typically triggered by medications, including anticonvulsants. Elevated liver enzymes can be seen in SJS, but the child’s liver enzymes are within normal ranges. The rash described does not match the characteristics of SJS, which typically presents with widespread, painful, blistering rashes, not localized eczema patches. Therefore, SJS is unlikely in this scenario.
Pneumothorax
- Finding: Lung sounds
A pneumothorax would usually present with decreased breath sounds, possibly on one side, along with signs of respiratory distress such as tachypnea and cyanosis. The child has slight end expiratory wheezes but normal respiratory rates and oxygen saturation, which suggests asthma rather than pneumothorax. Therefore, pneumothorax is not a primary concern here.
Correct Answer is A
Explanation
A. Determine if the toddler is voiding: Assessing urine output is crucial for determining the child’s hydration status. Voiding is an important indicator of kidney function and fluid balance. Ensuring the child is voiding can help determine the severity of dehydration and guide further interventions.
B. Request evaluation of the toddler's serum electrolytes. Evaluating serum electrolytes is important for understanding the extent of dehydration and electrolyte imbalances. However, it is not the immediate first action and should follow the initial assessment of the child's hydration status.
C. Initiate isotonic fluids with 20 mEq/L potassium chloride. Initiating fluid therapy is crucial but should only be done after assessing kidney function through urine output and evaluating the need for potassium supplementation to avoid complications like hyperkalaemia if the kidneys are not functioning properly.
D. Collect a stool sample from the toddler. Collecting a stool sample is useful for diagnosing the cause of gastroenteritis, but it is not the immediate priority. The focus should first be on assessing hydration status and initiating appropriate fluid therapy.
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