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.
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.
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