Chest pain, palpitations, syncope, or marked hypertension - report immediately.
Before you read
Test yourself first: 1 question
Question 1 of 1
A client on methylphenidate for attention-deficit hyperactivity disorder (ADHD) is being monitored. Which adverse effect should the nurse assess for?
Answer: B. Methylphenidate is a CNS stimulant. Common adverse effects include decreased appetite, weight loss, insomnia, and increased heart rate and blood pressure. In children, growth should be monitored. It is given in the morning to limit insomnia.
Keep the streak going with more questions like these, each with a full rationale.
What is methylphenidate?
It increases dopamine and norepinephrine, improving attention and impulse control, but it is a Schedule II controlled substance with abuse potential. Key nursing concerns are appetite suppression, growth delay in children, insomnia, and cardiovascular stimulation.
Key points to remember
- Schedule II controlled substance with high abuse/diversion potential; requires careful prescribing and storage.
- Suppresses appetite and can slow growth in children; monitor height and weight.
- Causes insomnia, so the last dose should be given several hours before bedtime (or early in the day).
- Increases heart rate and blood pressure; carries cardiovascular warnings.
- May worsen tics, anxiety, and is contraindicated with MAOIs (hypertensive crisis).
- Can cause weight loss, headache, irritability, and abdominal pain.
Nursing priorities
- Monitor growth (height/weight) in children and overall nutritional intake.
- Assess baseline and ongoing heart rate, blood pressure, and cardiac history.
- Give after breakfast and avoid late-day dosing to reduce insomnia.
- Teach 'drug holidays' if ordered and safe storage to prevent misuse/diversion.
- Monitor for therapeutic effect on attention and for adverse CNS/cardiac effects.
Patient teaching
- Give doses in the morning/early day and not close to bedtime to avoid sleep problems.
- Offer high-calorie, nutritious meals; monitor your child's weight and growth.
- Store securely and do not share - this is a controlled medication.
- Report chest pain, racing heart, fainting, or significant mood/behavior changes.
Red flags: report now
- Chest pain, palpitations, syncope, or marked hypertension - report immediately.
- Signs of misuse, dependence, or diversion.
- Never give with or within 14 days of an MAOI (hypertensive crisis).
- New or worsening psychosis, mania, or aggression.
References
Clinical references for this topic
