NCLEX-RN Pharmacology Neurological
System Practice Questions |
20 Original NGN-Style MCQs with
Detailed Rationales |
Nursing Exam Prep |
ATI Pharmacology Made Easy Review |
RN Nursing Study Guide
Question 1
Clinical Scenario
A 67-year-old man is admitted to the emergency department
after experiencing a generalized tonic-clonic seizure lasting
approximately 4 minutes. His seizure has resolved, but he
remains confused and lethargic. His medical history includes
epilepsy and hypertension. Current medications include
levetiracetam 500 mg twice daily and lisinopril 20 mg daily. Vital
signs are BP 138/82 mm Hg, HR 88/min, RR 18/min, SpO₂ 97%
,on room air. The provider prescribes an IV loading dose of
fosphenytoin.
Question Stem
Which assessment is the nurse's priority before administering
the prescribed medication?
A. Assess bowel sounds
B. Assess cardiac rhythm and blood pressure
C. Assess hearing acuity
D. Assess visual acuity
Correct Answer
B. Assess cardiac rhythm and blood pressure
Detailed Rationale
Fosphenytoin is a prodrug of phenytoin commonly used for
rapid seizure control. Although it is generally safer than IV
phenytoin, it can still cause significant cardiovascular adverse
effects, including hypotension, bradycardia, and cardiac
dysrhythmias, particularly if administered too rapidly. Before
and during administration, the nurse should assess blood
pressure, heart rate, and cardiac rhythm and ensure continuous
ECG monitoring when appropriate. Frequent monitoring allows
early identification of life-threatening cardiovascular
complications and supports safe medication administration.
,Option A is incorrect because bowel sounds are unrelated to
the immediate safety concerns associated with fosphenytoin
administration.
Option C is incorrect because hearing changes are not expected
adverse effects of fosphenytoin and are not a priority
assessment.
Option D is incorrect because visual disturbances may occur
with chronic phenytoin therapy but are not the priority before
IV administration.
Medication safety requires administering fosphenytoin at the
recommended infusion rate while continuously monitoring
cardiovascular status. The nurse should also verify IV patency,
monitor neurologic status, and observe for therapeutic seizure
control.
Learning Objectives
After completing this question, the learner should be able to:
• Identify priority assessments before IV fosphenytoin
administration.
• Recognize cardiovascular adverse effects associated with
antiepileptic medications.
• Prioritize nursing interventions that promote medication
safety.
, Medication Safety Focus: Monitoring during administration
Question 2
Clinical Scenario
A 24-year-old woman recently diagnosed with epilepsy is
prescribed lamotrigine. During discharge teaching, she asks
what adverse effects should be reported immediately. She has
no significant medical history and takes no other medications.
Question Stem
Which statement by the patient indicates the need for
immediate evaluation?
A. "I have occasional mild headaches."
B. "I developed a widespread rash with blisters yesterday."
C. "My appetite has decreased slightly."
D. "I sometimes feel sleepy after taking the medication."
Correct Answer
B. "I developed a widespread rash with blisters yesterday."
Detailed Rationale
Lamotrigine is an effective antiseizure medication but carries a
risk of severe dermatologic reactions, including Stevens-
Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
System Practice Questions |
20 Original NGN-Style MCQs with
Detailed Rationales |
Nursing Exam Prep |
ATI Pharmacology Made Easy Review |
RN Nursing Study Guide
Question 1
Clinical Scenario
A 67-year-old man is admitted to the emergency department
after experiencing a generalized tonic-clonic seizure lasting
approximately 4 minutes. His seizure has resolved, but he
remains confused and lethargic. His medical history includes
epilepsy and hypertension. Current medications include
levetiracetam 500 mg twice daily and lisinopril 20 mg daily. Vital
signs are BP 138/82 mm Hg, HR 88/min, RR 18/min, SpO₂ 97%
,on room air. The provider prescribes an IV loading dose of
fosphenytoin.
Question Stem
Which assessment is the nurse's priority before administering
the prescribed medication?
A. Assess bowel sounds
B. Assess cardiac rhythm and blood pressure
C. Assess hearing acuity
D. Assess visual acuity
Correct Answer
B. Assess cardiac rhythm and blood pressure
Detailed Rationale
Fosphenytoin is a prodrug of phenytoin commonly used for
rapid seizure control. Although it is generally safer than IV
phenytoin, it can still cause significant cardiovascular adverse
effects, including hypotension, bradycardia, and cardiac
dysrhythmias, particularly if administered too rapidly. Before
and during administration, the nurse should assess blood
pressure, heart rate, and cardiac rhythm and ensure continuous
ECG monitoring when appropriate. Frequent monitoring allows
early identification of life-threatening cardiovascular
complications and supports safe medication administration.
,Option A is incorrect because bowel sounds are unrelated to
the immediate safety concerns associated with fosphenytoin
administration.
Option C is incorrect because hearing changes are not expected
adverse effects of fosphenytoin and are not a priority
assessment.
Option D is incorrect because visual disturbances may occur
with chronic phenytoin therapy but are not the priority before
IV administration.
Medication safety requires administering fosphenytoin at the
recommended infusion rate while continuously monitoring
cardiovascular status. The nurse should also verify IV patency,
monitor neurologic status, and observe for therapeutic seizure
control.
Learning Objectives
After completing this question, the learner should be able to:
• Identify priority assessments before IV fosphenytoin
administration.
• Recognize cardiovascular adverse effects associated with
antiepileptic medications.
• Prioritize nursing interventions that promote medication
safety.
, Medication Safety Focus: Monitoring during administration
Question 2
Clinical Scenario
A 24-year-old woman recently diagnosed with epilepsy is
prescribed lamotrigine. During discharge teaching, she asks
what adverse effects should be reported immediately. She has
no significant medical history and takes no other medications.
Question Stem
Which statement by the patient indicates the need for
immediate evaluation?
A. "I have occasional mild headaches."
B. "I developed a widespread rash with blisters yesterday."
C. "My appetite has decreased slightly."
D. "I sometimes feel sleepy after taking the medication."
Correct Answer
B. "I developed a widespread rash with blisters yesterday."
Detailed Rationale
Lamotrigine is an effective antiseizure medication but carries a
risk of severe dermatologic reactions, including Stevens-
Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
