NCLEX-RN Pharmacology Neurological
System Part 1 Exam Questions with
Rationales
20 Original NGN & ATI-Style Practice
MCQs
Question 1
Clinical Scenario
A 68-year-old woman with newly diagnosed focal-onset
epilepsy is prescribed levetiracetam 500 mg orally twice daily.
Her medical history includes hypertension and stage 3 chronic
kidney disease (eGFR 42 mL/min/1.73 m²). During a follow-up
visit 2 weeks later, her spouse reports that she has become
unusually irritable and withdrawn. She has not experienced
additional seizures. Vital signs are stable, and laboratory studies
show no electrolyte abnormalities.
Question Stem
Which nursing action is the priority?
,A. Reassure the family that mood changes are expected and
usually require no intervention.
B. Assess the client for depression, suicidal thoughts, and
behavioral changes before notifying the provider.
C. Discontinue levetiracetam immediately to prevent worsening
symptoms.
D. Advise the client to double the medication dose if another
seizure occurs.
Correct Answer
Correct Answer: B. Assess the client for depression, suicidal
thoughts, and behavioral changes before notifying the
provider.
Detailed Rationale
Levetiracetam is an effective broad-spectrum antiseizure
medication but is associated with behavioral adverse effects,
including irritability, anxiety, depression, aggression, and
suicidal ideation. The nurse's priority is to perform a focused
mental health assessment, including screening for suicidal
thoughts and significant behavioral changes, before
communicating findings to the healthcare provider. Early
recognition allows prompt intervention while minimizing
unnecessary interruption of seizure control.
,Option A is incorrect because behavioral changes should never
be dismissed. Even mild symptoms warrant assessment because
they may progress. Option C is incorrect because antiseizure
medications should not be stopped abruptly unless directed by
the provider, as sudden discontinuation increases seizure risk,
including status epilepticus. Option D is unsafe because clients
should never independently increase medication doses after
breakthrough seizures. Breakthrough seizures require provider
evaluation for adherence, dosing, interactions, or disease
progression.
Nursing care includes monitoring seizure frequency, assessing
medication adherence, evaluating mood at each visit,
reinforcing seizure precautions, and educating family members
to report personality changes promptly. Because the client has
chronic kidney disease, renal function should also be monitored
since levetiracetam is primarily eliminated unchanged by the
kidneys and dosage adjustments may be necessary.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize behavioral adverse effects associated with
levetiracetam.
• Prioritize assessment before implementing interventions.
, • Educate patients and caregivers regarding mental health
monitoring.
• Understand the impact of renal impairment on medication
therapy.
Medication Safety Focus
Monitoring for neuropsychiatric adverse effects
Question 2
Clinical Scenario
A 29-year-old woman with generalized tonic-clonic seizures
takes valproic acid. She tells the nurse she recently learned she
is 8 weeks pregnant and asks whether she should continue
taking the medication until her next prenatal appointment.
Question Stem
Which response by the nurse is most appropriate?
A. "Stop taking the medication immediately to protect your
baby."
B. "Continue taking the medication exactly as prescribed and
contact your healthcare provider as soon as possible."
C. "Reduce the dose by half until you are evaluated."
D. "Switch to an over-the-counter anticonvulsant supplement."
System Part 1 Exam Questions with
Rationales
20 Original NGN & ATI-Style Practice
MCQs
Question 1
Clinical Scenario
A 68-year-old woman with newly diagnosed focal-onset
epilepsy is prescribed levetiracetam 500 mg orally twice daily.
Her medical history includes hypertension and stage 3 chronic
kidney disease (eGFR 42 mL/min/1.73 m²). During a follow-up
visit 2 weeks later, her spouse reports that she has become
unusually irritable and withdrawn. She has not experienced
additional seizures. Vital signs are stable, and laboratory studies
show no electrolyte abnormalities.
Question Stem
Which nursing action is the priority?
,A. Reassure the family that mood changes are expected and
usually require no intervention.
B. Assess the client for depression, suicidal thoughts, and
behavioral changes before notifying the provider.
C. Discontinue levetiracetam immediately to prevent worsening
symptoms.
D. Advise the client to double the medication dose if another
seizure occurs.
Correct Answer
Correct Answer: B. Assess the client for depression, suicidal
thoughts, and behavioral changes before notifying the
provider.
Detailed Rationale
Levetiracetam is an effective broad-spectrum antiseizure
medication but is associated with behavioral adverse effects,
including irritability, anxiety, depression, aggression, and
suicidal ideation. The nurse's priority is to perform a focused
mental health assessment, including screening for suicidal
thoughts and significant behavioral changes, before
communicating findings to the healthcare provider. Early
recognition allows prompt intervention while minimizing
unnecessary interruption of seizure control.
,Option A is incorrect because behavioral changes should never
be dismissed. Even mild symptoms warrant assessment because
they may progress. Option C is incorrect because antiseizure
medications should not be stopped abruptly unless directed by
the provider, as sudden discontinuation increases seizure risk,
including status epilepticus. Option D is unsafe because clients
should never independently increase medication doses after
breakthrough seizures. Breakthrough seizures require provider
evaluation for adherence, dosing, interactions, or disease
progression.
Nursing care includes monitoring seizure frequency, assessing
medication adherence, evaluating mood at each visit,
reinforcing seizure precautions, and educating family members
to report personality changes promptly. Because the client has
chronic kidney disease, renal function should also be monitored
since levetiracetam is primarily eliminated unchanged by the
kidneys and dosage adjustments may be necessary.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize behavioral adverse effects associated with
levetiracetam.
• Prioritize assessment before implementing interventions.
, • Educate patients and caregivers regarding mental health
monitoring.
• Understand the impact of renal impairment on medication
therapy.
Medication Safety Focus
Monitoring for neuropsychiatric adverse effects
Question 2
Clinical Scenario
A 29-year-old woman with generalized tonic-clonic seizures
takes valproic acid. She tells the nurse she recently learned she
is 8 weeks pregnant and asks whether she should continue
taking the medication until her next prenatal appointment.
Question Stem
Which response by the nurse is most appropriate?
A. "Stop taking the medication immediately to protect your
baby."
B. "Continue taking the medication exactly as prescribed and
contact your healthcare provider as soon as possible."
C. "Reduce the dose by half until you are evaluated."
D. "Switch to an over-the-counter anticonvulsant supplement."
