Review Practice Exercise 4

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) > Mental Health

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Practice Exercise 4

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Total Questions : 5

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Question 1:

A nurse is caring for a 9-year-old client with attention-deficit/hyperactivity disorder. Which medication is most frequently prescribed for ADHD?

A. Lorazepam (Ativan). B. Haloperidol (Haldol). C. Methylphenidate (Ritalin). D. Methocarbamol (Robaxin).

Answer and Explanation

Choice A:

Lorazepam (Ativan) is a benzodiazepine used for anxiety and acute agitation. It enhances GABA activity, causing sedation. It does not improve attention or hyperactivity, making it inappropriate for ADHD management.

Choice B:

Haloperidol (Haldol) is a typical antipsychotic used for schizophrenia and severe agitation. It blocks dopamine receptors, which may worsen attentional deficits. It is not indicated for ADHD and carries risk of extrapyramidal side effects.

Choice C:

Methylphenidate (Ritalin) is the first-line stimulant for ADHD. It increases synaptic dopamine and norepinephrine, improving attention span and reducing impulsivity. It is widely prescribed in pediatric ADHD due to strong evidence of efficacy and safety.

Choice D:

Methocarbamol (Robaxin) is a muscle relaxant used for musculoskeletal pain. It acts centrally to reduce muscle spasms but has no role in ADHD treatment. It does not affect attention or impulsivity.

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Question 2:

A nurse is caring for a client with attention-deficit/hyperactivity disorder (ADHD) who is prescribed methylphenidate (Ritalin). Which symptoms should the nurse monitor as potential side effects? Select all that apply

A. Hypotension. B. Decreased appetite. C. Sedation. D. Insomnia. E. Headache. F. Seizures.

Answer and Explanation

Choice A:

Hypotension is not typical of methylphenidate. Stimulants usually cause hypertension or tachycardia due to sympathetic activation. Monitoring blood pressure is important, but hypotension is not expected.

Choice B:

Decreased appetite is a frequent side effect due to stimulant-induced suppression of dopaminergic pathways regulating hunger. This can lead to weight loss in children, requiring monitoring of growth and nutritional intake.

Choice C:

Sedation is inconsistent with stimulant pharmacology. Methylphenidate increases alertness and activity, not drowsiness. Sedation would suggest another drug effect or comorbidity, not methylphenidate.

Choice D:

Insomnia occurs because stimulants increase CNS activity. Evening dosing exacerbates sleep disturbance. Nurses should advise morning administration and monitor sleep hygiene to reduce impact on rest.

Choice E:

Headache is a common adverse effect linked to stimulant-induced changes in neurotransmitter balance. It is usually mild but can interfere with adherence, requiring symptomatic management.

Choice F:

Seizures are a rare but serious adverse effect. Stimulants lower the seizure threshold, especially in clients with preexisting epilepsy. Monitoring neurological status is essential to detect early warning signs.

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Question 3:

A nurse is caring for a 10-year-old client prescribed dextroamphetamine (Dexedrine) who has a nursing diagnosis of imbalanced nutrition: less than body requirements related to anorexia. Which nursing intervention addresses this problem?

A. Monitor output and sleep patterns daily. B. Administer medication with food to prevent nausea. C. Schedule medication administration after meals. D. Increase fiber and fluid intake to prevent constipation.

Answer and Explanation

Choice A:

Monitoring output and sleep patterns daily is important for stimulant therapy but does not directly address nutrition. It helps detect insomnia or urinary changes, yet it fails to correct anorexia-related weight loss.

Choice B:

Administering medication with food prevents nausea, not anorexia. Stimulants primarily suppress appetite rather than cause gastrointestinal upset. This intervention does not resolve the nutritional deficit associated with dextroamphetamine.

Choice C:

Administering dextroamphetamine after meals minimizes anorexia by ensuring the child eats before appetite suppression occurs. This intervention directly addresses imbalanced nutrition and supports growth and weight maintenance in pediatric ADHD clients.

Choice D:

Increasing fiber and fluid intake prevents constipation, a possible side effect of stimulants. While beneficial, it does not address anorexia or weight loss, which are the primary nutritional concerns in this scenario.

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Question 4:

A nurse educates parents about non-stimulant medications used to treat attention-deficit/hyperactivity disorder (ADHD). Which medication is a non-stimulant option?

A. Atomoxetine (Strattera). B. Methylphenidate (Ritalin). C. Dextroamphetamine (Dexedrine). D. Lisdexamfetamine (Vyvanse).

Answer and Explanation

Choice A:

Atomoxetine (Strattera) is a non-stimulant norepinephrine reuptake inhibitor approved for ADHD. It improves attentional control without the abuse potential of stimulants. It is particularly beneficial in children with comorbid anxiety or those intolerant to stimulant side effects.

Choice B:

Methylphenidate (Ritalin) is a stimulant that blocks dopamine and norepinephrine reuptake. It is first-line therapy for ADHD but not classified as non-stimulant.

Choice C:

Dextroamphetamine (Dexedrine) is a stimulant that increases dopamine and norepinephrine release. It is effective for ADHD but carries abuse potential, making it unsuitable as a non-stimulant option.

Choice D:

Lisdexamfetamine (Vyvanse) is a stimulant prodrug of dextroamphetamine. It is long-acting and effective for ADHD but remains a stimulant, not a non-stimulant medication.

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Question 5:

A nurse monitors a client prescribed atomoxetine for attention-deficit/hyperactivity disorder (ADHD). Which adverse effect should the nurse assess for?

A. Liver dysfunction. B. Severe hypoglycemia. C. Respiratory depression. D. Constipation.

Answer and Explanation

Choice A:

Atomoxetine may cause liver dysfunction, including hepatotoxicity with elevated ALT/AST and jaundice. Monitoring liver enzymes and clinical signs such as dark urine or right upper quadrant pain is essential to detect early hepatic injury.

Choice B:

Severe hypoglycemia is not associated with atomoxetine. Hypoglycemia is linked to insulin or oral hypoglycemics, not norepinephrine reuptake inhibition. Atomoxetine does not alter glucose metabolism significantly.

Choice C:

Respiratory depression is a risk with opioids or sedatives, not atomoxetine. Atomoxetine does not depress respiratory drive, as it lacks GABAergic or opioid receptor activity.

Choice D:

Constipation is not a major adverse effect of atomoxetine. While mild gastrointestinal upset may occur, constipation is not a clinically significant or frequent finding compared to hepatic risk.

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Practice Exercise 4

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