Chapter 13: Central Nervous System Stimulants and Related Drugs

Test Bank

MULTIPLE CHOICE

1. 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
ANS: A
Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac
dysrhythmias or who have recently had myocardial infarctions. The other conditions are not
contraindications to the use of caffeine.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 212

TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient who started taking orlistat (Xenical) 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% to help reduce these
adverse effects.
ANS: D
Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the
GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other
options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 209

TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. A 6-year-old boy has been started on an extended-release form of methylphenidate

hydrochloride (Ritalin) 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.
 ANS: D
Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease
insomnia. Generally speaking, once-a-day dosing is used with extended-release or long-acting
preparations. These formulations eliminate the need to take this medication at school.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 215

TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks
to “make it through” the end of the semester and exam week. She is in the university clinic
today because she is “exhausted.” What nursing diagnosis may be appropriate for her?
a. Noncompliance
b. Impaired physical mobility
c. Sleep deprivation
d. Imbalanced nutrition: less than body requirements
ANS: C
The main ingredient in NoDoz, caffeine, is a central nervous system stimulant that can be
used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse
effects. Thus, sleep deprivation is the most appropriate nursing diagnosis of those listed.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 214

TOP: NURSING PROCESS: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. An ergot alkaloid is prescribed for a patient who is having frequent migraine headaches. The
nurse provides information to the patient about the medication and tells the patient to contact
the prescriber if which problem occurs?
a. Nervousness
b. Dizziness
c. Chest pain
d. Nausea and vomiting
ANS: C
Nervousness, dizziness, and nausea and vomiting are expected adverse effects of ergot
alkaloids. However, if chest pain occurs, the prescriber should be contacted immediately, or
the patient should seek emergency care.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 215

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The

nurse will perform which essential baseline assessment before this drug is started?
a. Eye examination
b. Height and weight
c. Liver studies
d. Hearing test
ANS: B
 Assessment of baseline height and weight is important before beginning Ritalin therapy
because it may cause a temporary slowing of growth in prepubertal children. The other studies
are not as essential at this time.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 213

TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. Before a patient receives triptans for the treatment of migraines, the nurse will assess for the
presence of which condition, which is a contraindication if present?
a. Hypotension
b. Renal disease
c. Liver damage
d. Cardiovascular disease
ANS: D
Triptans are contraindicated in patients with serious cardiovascular disease because of the
vasoconstrictive potential of these medications. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 210

TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

8. When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic
effect?
a. Increased wakefulness
b. Increased appetite
c. Decreased weight
d. Decreased hyperactivity
ANS: C
Orlistat (Xenical) is a nonstimulant drug that is used as part of a weight loss program. The
other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 208

TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. 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 does 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.”
ANS: A
 Although they may be taken during aura symptoms by patients who have auras with their
headaches, these drugs are not indicated for preventive migraine therapy. The medication is
intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The
triptans do not reduce the number of migraines a person will have. Journal recordings of
headaches and the patient’s responses to the medication are helpful.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 209

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. 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
ANS: A, D, E, F
Central nervous system stimulants can be used for narcolepsy, neonatal apnea, ADHD, and
appetite suppression in the treatment of obesity. They are not used for depression and panic
attacks.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: pp. 204-205

TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient has a new prescription for phentermine (Ionamin) 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.
ANS: B, C, D, E
This drug should be taken in the morning to avoid interference with sleep, and the patient
should also be on a supervised exercise and dietary regime. Caffeine-containing products
should be avoided because of possible additional stimulation. Dry mouth can be minimized by
the use of mouth rinses, sugarless gum, or hard candy. The other option is incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 215

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

OTHER
1. The order reads, “Give atomoxetine (Strattera) 0.5 mg/kg/day once daily in the morning
before school.” The child weighs 88 pounds. How many milligrams will be administered per
dose?

ANS:
20 mg
88 pounds ÷ 2.2 = 40 kg
0.5 mg/kg/day ´ 40 kg = 20 mg/day

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. N/A

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies