A client recently prescribed methylphenidate (Ritalin) for ...

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A client recently prescribed methylphenidate (Ritalin) for treatment of ADHD complains of an inability to go to sleep at night. Which nursing actions are indicated?
 
  Standard Text: Select all that apply.
  1. Assess for caffeine intake, especially late in the afternoon or evening hours.
  2. Assess for time of day that Ritalin is taken.
  3. Assess for nonpharmacologic measures taken to induce sleep.
  4. Inform the health care provider that the client is unable to fall asleep while taking Ritalin.
  5. Suggest taking melatonin to assist in nighttime drowsiness.

Question 2

An adolescent client who has been taking amphetamine sulfate (Adderall) since age 7 now presents with new-onset type 1 diabetes mellitus. What should be of highest priority in the nurse's education regarding the diabetes for this client?
 
  1. This medication may be changed.
  2. Immediately report signs of a dry mouth.
  3. Monitor height and weight very closely.
  4. Report any increase in irritability and nervousness.

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Answer to Question 1

Correct Answer: 1,2,3
Rationale 1: Caffeine intake will cause additive CNS stimulant effects when taken concurrently with Ritalin.
Rationale 2: Ritalin should be taken no later than 6 p.m., and should be taken earlier if interference with sleep occurs.
Rationale 3: An assessment should be made of what measures the client has tried to help with sleep before contacting the health care provider (for example, meditation, quiet activities at bedtime, reduced lighting, etc.).
Rationale 4: Before informing the health care provider that the client is having difficulty falling asleep while taking Ritalin, find out what other measures could be causative factors.
Rationale 5: Melatonin should not be taken with amphetamines, as CNS stimulation can be enhanced.
Global Rationale: Caffeine intake will cause additive CNS stimulant effects when taken concurrently with Ritalin. Ritalin should be taken no later than 6 p.m., and should be taken earlier if interference with sleep occurs. An assessment should be made of what measures the client has tried to help with sleep before contacting the health care provider (for example, meditation, quiet activities at bedtime, reduced lighting, etc.). Before informing the health care provider that the client is having difficulty falling asleep while taking Ritalin, find out what other measures could be causative factors. Melatonin should not be taken with amphetamines, as CNS stimulation can be enhanced.

Answer to Question 2

Correct Answer: 1
Rationale 1: The health care provider might change treatment to a nonamphetamine as Adderall is contraindicated in clients with diabetes.
Rationale 2: Adderall can have the side effect of dry mouth, which this client would have dealt with since age 7.
Rationale 3: Height and weight should have been monitored since beginning Adderall. Diabetes will not change this.
Rationale 4: An increase in irritability and nervousness should be reported, but it is not the most important issue in a client recently diagnosed with diabetes.
Global Rationale: The health care provider might change treatment to a nonamphetamine as Adderall is contraindicated in clients with diabetes. Adderall can have the side effect of dry mouth, which this client would have dealt with since age 7. Height and weight should have been monitored since beginning Adderall. Diabetes will not change this. An increase in irritability and nervousness should be reported, but it is not the most important issue in a client recently diagnosed with diabetes.

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