The 10-year-old patient is receiving methylphenidate (Ritalin). The patient's mother tells the nurse he just won't sleep while on his medication. What is the best response by the nurse?
1. "You can give him a 25 mg diphenhydramine (Benadryl) tablet at bedtime."
2. "Do not give the medication after 4:00 p.m."
3. "Do not give the medication after 6:00 p.m."
4. "This is serious; you should ask the doctor about atomoxetine (Strattera)."
Correct Answer: 2
Rationale: Stimulant medications like methylphenidate (Ritalin) will interfere with sleep. To avoid insomnia, it is best to give the last dose prior to 4:00 p.m. Diphenhydramine (Benadryl) is not necessary. The effects of methylphenidate (Ritalin) will wear off by bedtime if it is given prior to 4:00 p.m. 6:00 p.m. is too late for the last dose of methylphenidate (Ritalin). A medication change is premature without first trying to give the medication earlier in the day.
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