NCLEX-RN Pharmacology Neurological
System Part 1 Exam Questions &
Answers
20 Original NCLEX NGN Practice MCQs
with Rationales
ATI Pharmacology Review
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 24-year-old woman is admitted after experiencing two
generalized tonic-clonic seizures. The provider prescribes
phenytoin. The nurse reviews the admission assessment and
laboratory results.
Question Stem
Which finding should the nurse report to the provider before
administering the first dose of phenytoin?
,A. Serum albumin 2.1 g/dL
B. Heart rate 88/min
C. Blood glucose 102 mg/dL
D. Temperature 37°C (98.6°F)
Correct Answer
A. Serum albumin 2.1 g/dL
Detailed Rationale
Phenytoin is highly protein-bound, primarily to albumin. A
significantly low serum albumin level can increase the amount
of free (active) phenytoin circulating in the bloodstream, raising
the risk of toxicity even when total serum phenytoin levels
appear therapeutic. Toxicity can manifest as nystagmus, ataxia,
slurred speech, confusion, and CNS depression. The nurse
should notify the provider because dosage adjustments or
alternative monitoring strategies may be required.
Option B is incorrect because a heart rate of 88/min is within
normal limits and does not contraindicate therapy. Option C is
incorrect because a glucose level of 102 mg/dL is normal.
Option D is incorrect because the temperature is normal and
does not affect phenytoin administration.
Medication safety requires recognition of factors that alter
pharmacokinetics. Low albumin significantly affects phenytoin
distribution and increases the likelihood of adverse reactions.
,Nurses should monitor serum drug levels, neurological status,
and signs of toxicity throughout treatment.
Learning Objective
After completing this question, the learner should be able to:
• Identify factors affecting phenytoin pharmacokinetics.
• Recognize patients at increased risk for phenytoin toxicity.
• Interpret laboratory values relevant to anticonvulsant
therapy.
• Prioritize communication with the provider.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 72-year-old client with Parkinson disease is prescribed
carbidopa/levodopa. During discharge teaching, the nurse
discusses medication administration.
Question Stem
Which statement by the client indicates a need for further
teaching?
, A. "I may notice my urine appears darker."
B. "I should avoid suddenly stopping this medication."
C. "I will take my medication with a high-protein meal every
morning."
D. "I should change positions slowly."
Correct Answer
C. "I will take my medication with a high-protein meal every
morning."
Detailed Rationale
Levodopa competes with dietary amino acids for absorption
and transport across the blood-brain barrier. High-protein meals
can significantly reduce medication effectiveness and worsen
Parkinson symptoms. Patients should distribute protein intake
evenly throughout the day or follow provider
recommendations.
Option A is correct information because darkened urine or
sweat can occur harmlessly. Option B is correct because abrupt
discontinuation may cause severe symptom rebound or
neuroleptic malignant syndrome-like reactions. Option D is
correct because orthostatic hypotension is common and
patients should rise slowly.
Nurses should educate clients regarding dietary interactions,
symptom monitoring, and medication adherence.
System Part 1 Exam Questions &
Answers
20 Original NCLEX NGN Practice MCQs
with Rationales
ATI Pharmacology Review
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 24-year-old woman is admitted after experiencing two
generalized tonic-clonic seizures. The provider prescribes
phenytoin. The nurse reviews the admission assessment and
laboratory results.
Question Stem
Which finding should the nurse report to the provider before
administering the first dose of phenytoin?
,A. Serum albumin 2.1 g/dL
B. Heart rate 88/min
C. Blood glucose 102 mg/dL
D. Temperature 37°C (98.6°F)
Correct Answer
A. Serum albumin 2.1 g/dL
Detailed Rationale
Phenytoin is highly protein-bound, primarily to albumin. A
significantly low serum albumin level can increase the amount
of free (active) phenytoin circulating in the bloodstream, raising
the risk of toxicity even when total serum phenytoin levels
appear therapeutic. Toxicity can manifest as nystagmus, ataxia,
slurred speech, confusion, and CNS depression. The nurse
should notify the provider because dosage adjustments or
alternative monitoring strategies may be required.
Option B is incorrect because a heart rate of 88/min is within
normal limits and does not contraindicate therapy. Option C is
incorrect because a glucose level of 102 mg/dL is normal.
Option D is incorrect because the temperature is normal and
does not affect phenytoin administration.
Medication safety requires recognition of factors that alter
pharmacokinetics. Low albumin significantly affects phenytoin
distribution and increases the likelihood of adverse reactions.
,Nurses should monitor serum drug levels, neurological status,
and signs of toxicity throughout treatment.
Learning Objective
After completing this question, the learner should be able to:
• Identify factors affecting phenytoin pharmacokinetics.
• Recognize patients at increased risk for phenytoin toxicity.
• Interpret laboratory values relevant to anticonvulsant
therapy.
• Prioritize communication with the provider.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 72-year-old client with Parkinson disease is prescribed
carbidopa/levodopa. During discharge teaching, the nurse
discusses medication administration.
Question Stem
Which statement by the client indicates a need for further
teaching?
, A. "I may notice my urine appears darker."
B. "I should avoid suddenly stopping this medication."
C. "I will take my medication with a high-protein meal every
morning."
D. "I should change positions slowly."
Correct Answer
C. "I will take my medication with a high-protein meal every
morning."
Detailed Rationale
Levodopa competes with dietary amino acids for absorption
and transport across the blood-brain barrier. High-protein meals
can significantly reduce medication effectiveness and worsen
Parkinson symptoms. Patients should distribute protein intake
evenly throughout the day or follow provider
recommendations.
Option A is correct information because darkened urine or
sweat can occur harmlessly. Option B is correct because abrupt
discontinuation may cause severe symptom rebound or
neuroleptic malignant syndrome-like reactions. Option D is
correct because orthostatic hypotension is common and
patients should rise slowly.
Nurses should educate clients regarding dietary interactions,
symptom monitoring, and medication adherence.
