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NSG 533 – Advanced Pharmacology Exam 3 | Wilkes
University | 2025/2026 | Verified Study Guide
Q1. A patient with epilepsy is prescribed phenytoin (Dilantin). Which adverse
effect requires routine monitoring of serum levels?
A) Nystagmus and ataxia
B) Gingival hyperplasia
C) Hirsutism
D) Osteomalacia
✔✔ Answer ✔✔ A) Nystagmus and ataxia
*Rationale: Phenytoin has a narrow therapeutic index (10–20 mcg/mL).
Nystagmus, ataxia, and dysarthria are early signs of toxicity. While gingival
hyperplasia and hirsutism are common, they are not dose-related toxicities
requiring level monitoring. Osteomalacia occurs with long-term use due to
vitamin D metabolism alteration.*
Q2. A patient with Parkinson’s disease is taking carbidopa/levodopa (Sinemet).
After several years, the patient develops “on-off” fluctuations. Which adjunctive
medication can help reduce these fluctuations?
A) Entacapone
B) Benztropine
C) Selegiline
D) Amantadine
✔✔ Answer ✔✔ A) Entacapone
Rationale: Entacapone is a COMT inhibitor that prolongs the half-life of levodopa,
reducing “off” time. Selegiline (MAO-B inhibitor) and amantadine are also used,
but entacapone is specifically indicated for motor fluctuations. Benztropine is an
anticholinergic used for tremor.
,2
Q3. A patient with Alzheimer’s disease is prescribed donepezil (Aricept). The
nurse should monitor for which common adverse effect?
A) Bradycardia
B) Constipation
C) Diarrhea
D) Insomnia
✔✔ Answer ✔✔ C) Diarrhea
Rationale: Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
commonly cause gastrointestinal effects: nausea, diarrhea, vomiting. Bradycardia
can occur but is less common. Constipation and insomnia are not typical.
Q4. A patient with multiple sclerosis is started on interferon beta-1a (Avonex).
Which adverse effect is most important to discuss before initiation?
A) Flu-like symptoms
B) Injection site reaction
C) Depression
D) Hepatotoxicity
✔✔ Answer ✔✔ A) Flu-like symptoms
Rationale: Flu-like symptoms (fever, myalgia, fatigue) are very common with
interferon beta, especially at the start of therapy. Pre-medication with
acetaminophen or NSAIDs can reduce symptoms. While injection site reactions,
depression, and hepatotoxicity can occur, flu-like symptoms are the most frequent
and expected.
Q5. A patient with epilepsy is being switched from phenytoin to levetiracetam
(Keppra). Which advantage does levetiracetam offer?
A) No need for therapeutic drug monitoring
B) Fewer drug interactions
C) Less sedation
D) Both A and B
✔✔ Answer ✔✔ D) Both A and B
, 3
Rationale: Levetiracetam does not require serum level monitoring and has
minimal drug interactions (no hepatic metabolism). Sedation is still a common side
effect.
Q6. A patient with Parkinson’s disease is prescribed pramipexole (Mirapex).
Which adverse effect requires immediate patient education?
A) Impulse control disorders (gambling, hypersexuality)
B) Orthostatic hypotension
C) Hallucinations
D) Nausea
✔✔ Answer ✔✔ A) Impulse control disorders (gambling, hypersexuality)
Rationale: Dopamine agonists (pramipexole, ropinirole) are associated with
impulse control disorders, which can be devastating. Patients and families must be
warned. Orthostatic hypotension, hallucinations, and nausea are also common but
less specific to this class.
Q7. A patient with Alzheimer’s disease is prescribed memantine (Namenda).
Memantine works by:
A) Inhibiting acetylcholinesterase
B) Blocking NMDA receptors
C) Increasing dopamine release
D) Reducing beta-amyloid plaques
✔✔ Answer ✔✔ B) Blocking NMDA receptors
Rationale: Memantine is an NMDA receptor antagonist that modulates glutamate
activity. It is used in moderate-to-severe Alzheimer’s disease. Cholinesterase
inhibitors (donepezil, etc.) work on acetylcholine.
Q8. A patient with epilepsy is prescribed valproate (Depakote). Which
laboratory test should be monitored at baseline and periodically?
A) Complete blood count (CBC)
NSG 533 – Advanced Pharmacology Exam 3 | Wilkes
University | 2025/2026 | Verified Study Guide
Q1. A patient with epilepsy is prescribed phenytoin (Dilantin). Which adverse
effect requires routine monitoring of serum levels?
A) Nystagmus and ataxia
B) Gingival hyperplasia
C) Hirsutism
D) Osteomalacia
✔✔ Answer ✔✔ A) Nystagmus and ataxia
*Rationale: Phenytoin has a narrow therapeutic index (10–20 mcg/mL).
Nystagmus, ataxia, and dysarthria are early signs of toxicity. While gingival
hyperplasia and hirsutism are common, they are not dose-related toxicities
requiring level monitoring. Osteomalacia occurs with long-term use due to
vitamin D metabolism alteration.*
Q2. A patient with Parkinson’s disease is taking carbidopa/levodopa (Sinemet).
After several years, the patient develops “on-off” fluctuations. Which adjunctive
medication can help reduce these fluctuations?
A) Entacapone
B) Benztropine
C) Selegiline
D) Amantadine
✔✔ Answer ✔✔ A) Entacapone
Rationale: Entacapone is a COMT inhibitor that prolongs the half-life of levodopa,
reducing “off” time. Selegiline (MAO-B inhibitor) and amantadine are also used,
but entacapone is specifically indicated for motor fluctuations. Benztropine is an
anticholinergic used for tremor.
,2
Q3. A patient with Alzheimer’s disease is prescribed donepezil (Aricept). The
nurse should monitor for which common adverse effect?
A) Bradycardia
B) Constipation
C) Diarrhea
D) Insomnia
✔✔ Answer ✔✔ C) Diarrhea
Rationale: Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
commonly cause gastrointestinal effects: nausea, diarrhea, vomiting. Bradycardia
can occur but is less common. Constipation and insomnia are not typical.
Q4. A patient with multiple sclerosis is started on interferon beta-1a (Avonex).
Which adverse effect is most important to discuss before initiation?
A) Flu-like symptoms
B) Injection site reaction
C) Depression
D) Hepatotoxicity
✔✔ Answer ✔✔ A) Flu-like symptoms
Rationale: Flu-like symptoms (fever, myalgia, fatigue) are very common with
interferon beta, especially at the start of therapy. Pre-medication with
acetaminophen or NSAIDs can reduce symptoms. While injection site reactions,
depression, and hepatotoxicity can occur, flu-like symptoms are the most frequent
and expected.
Q5. A patient with epilepsy is being switched from phenytoin to levetiracetam
(Keppra). Which advantage does levetiracetam offer?
A) No need for therapeutic drug monitoring
B) Fewer drug interactions
C) Less sedation
D) Both A and B
✔✔ Answer ✔✔ D) Both A and B
, 3
Rationale: Levetiracetam does not require serum level monitoring and has
minimal drug interactions (no hepatic metabolism). Sedation is still a common side
effect.
Q6. A patient with Parkinson’s disease is prescribed pramipexole (Mirapex).
Which adverse effect requires immediate patient education?
A) Impulse control disorders (gambling, hypersexuality)
B) Orthostatic hypotension
C) Hallucinations
D) Nausea
✔✔ Answer ✔✔ A) Impulse control disorders (gambling, hypersexuality)
Rationale: Dopamine agonists (pramipexole, ropinirole) are associated with
impulse control disorders, which can be devastating. Patients and families must be
warned. Orthostatic hypotension, hallucinations, and nausea are also common but
less specific to this class.
Q7. A patient with Alzheimer’s disease is prescribed memantine (Namenda).
Memantine works by:
A) Inhibiting acetylcholinesterase
B) Blocking NMDA receptors
C) Increasing dopamine release
D) Reducing beta-amyloid plaques
✔✔ Answer ✔✔ B) Blocking NMDA receptors
Rationale: Memantine is an NMDA receptor antagonist that modulates glutamate
activity. It is used in moderate-to-severe Alzheimer’s disease. Cholinesterase
inhibitors (donepezil, etc.) work on acetylcholine.
Q8. A patient with epilepsy is prescribed valproate (Depakote). Which
laboratory test should be monitored at baseline and periodically?
A) Complete blood count (CBC)
