NCLEX-RN Pharmacology Neurological System
Part 2 Exam Questions with Detailed
Rationales |
20 Original NGN Practice MCQs |
Parkinson's, Alzheimer's, Antiepileptics &
Neurological Medications Study Guide
Question 1
Clinical Scenario A 45-year-old male client is admitted to the
neurologic intensive care unit with status epilepticus. The
provider prescribes intravenous phenytoin 1000 mg to be
administered as a loading dose. The client has a peripheral IV
line in the right forearm.
Question Stem Which action should the nurse take to ensure
safe administration of this medication?
A. Administer the medication via rapid IV push over 1 to 2
minutes to achieve rapid seizure control. B. Dilute the
medication in 5% dextrose in water (D5W) and administer via
an infusion pump. C. Administer the medication through a
,large-bore IV line at a rate not exceeding 50 mg/minute. D. Mix
the medication with normal saline and administer it
concurrently with a continuous dextrose infusion.
Correct Answer C. Administer the medication through a large-
bore IV line at a rate not exceeding 50 mg/minute.
Detailed Rationale Phenytoin is a high-alert antiepileptic
medication that carries significant risks if administered
incorrectly. When given intravenously, it must be administered
slowly, at a rate not exceeding 50 mg/minute in adults, to
prevent severe cardiovascular adverse effects such as
hypotension, bradycardia, and cardiac arrhythmias. Rapid
administration can also cause "purple glove syndrome," a
severe soft tissue injury characterized by edema, discoloration,
and pain at the injection site. Therefore, using a large-bore IV
line and adhering to the strict rate limit is the priority nursing
action. Phenytoin is incompatible with dextrose solutions (it will
precipitate), so it must be diluted only in 0.9% sodium chloride
(normal saline). Concurrent administration with dextrose in the
same line is contraindicated. Rapid IV push is never appropriate
for phenytoin.
Learning Objective
• Identify the safe intravenous administration parameters for
phenytoin.
, • Recognize the incompatibility of phenytoin with dextrose-
containing solutions.
• Prioritize nursing actions to prevent cardiovascular collapse
and tissue injury during antiepileptic administration.
Medication Safety Focus Medication administration (Rate
control and solution compatibility)
Question 2
Clinical Scenario A 68-year-old female client with Parkinson’s
disease is prescribed a combination of levodopa and carbidopa.
During a nutritional assessment, the nurse notes the client
consumes a high-protein diet, including multiple servings of
meat and dairy at each meal.
Question Stem Which statement by the nurse indicates
appropriate patient teaching regarding this medication and
diet?
A. "You should take this medication with a high-protein snack to
prevent stomach upset." B. "High-protein meals can decrease
the absorption of this medication, so take it 30 to 60 minutes
before meals." C. "You must avoid all dairy products while
taking this medication to prevent a hypertensive crisis." D. "Take
this medication with a glass of milk to enhance its therapeutic
effect on your nervous system."
, Correct Answer B. "High-protein meals can decrease the
absorption of this medication, so take it 30 to 60 minutes
before meals."
Detailed Rationale Levodopa competes with dietary amino
acids (from protein) for absorption in the small intestine and for
transport across the blood-brain barrier. A high-protein meal
can significantly decrease the absorption and therapeutic
effectiveness of levodopa, leading to worsening Parkinsonian
symptoms or the "on-off" phenomenon. To maximize
absorption, the medication should be taken 30 to 60 minutes
before meals or 1 to 2 hours after meals. If gastrointestinal
upset occurs, it may be taken with a low-protein snack (e.g.,
crackers or fruit), but not with high-protein foods like meat,
eggs, or dairy. Levodopa/carbidopa does not cause
hypertensive crises with dairy; that is a concern with
monoamine oxidase inhibitors (MAOIs) and tyramine-rich
foods.
Learning Objective
• Explain the drug-food interaction between levodopa and
dietary protein.
• Formulate appropriate dietary teaching for clients taking
antiparkinsonian medications.
• Recognize strategies to optimize the therapeutic response
of levodopa/carbidopa.
Part 2 Exam Questions with Detailed
Rationales |
20 Original NGN Practice MCQs |
Parkinson's, Alzheimer's, Antiepileptics &
Neurological Medications Study Guide
Question 1
Clinical Scenario A 45-year-old male client is admitted to the
neurologic intensive care unit with status epilepticus. The
provider prescribes intravenous phenytoin 1000 mg to be
administered as a loading dose. The client has a peripheral IV
line in the right forearm.
Question Stem Which action should the nurse take to ensure
safe administration of this medication?
A. Administer the medication via rapid IV push over 1 to 2
minutes to achieve rapid seizure control. B. Dilute the
medication in 5% dextrose in water (D5W) and administer via
an infusion pump. C. Administer the medication through a
,large-bore IV line at a rate not exceeding 50 mg/minute. D. Mix
the medication with normal saline and administer it
concurrently with a continuous dextrose infusion.
Correct Answer C. Administer the medication through a large-
bore IV line at a rate not exceeding 50 mg/minute.
Detailed Rationale Phenytoin is a high-alert antiepileptic
medication that carries significant risks if administered
incorrectly. When given intravenously, it must be administered
slowly, at a rate not exceeding 50 mg/minute in adults, to
prevent severe cardiovascular adverse effects such as
hypotension, bradycardia, and cardiac arrhythmias. Rapid
administration can also cause "purple glove syndrome," a
severe soft tissue injury characterized by edema, discoloration,
and pain at the injection site. Therefore, using a large-bore IV
line and adhering to the strict rate limit is the priority nursing
action. Phenytoin is incompatible with dextrose solutions (it will
precipitate), so it must be diluted only in 0.9% sodium chloride
(normal saline). Concurrent administration with dextrose in the
same line is contraindicated. Rapid IV push is never appropriate
for phenytoin.
Learning Objective
• Identify the safe intravenous administration parameters for
phenytoin.
, • Recognize the incompatibility of phenytoin with dextrose-
containing solutions.
• Prioritize nursing actions to prevent cardiovascular collapse
and tissue injury during antiepileptic administration.
Medication Safety Focus Medication administration (Rate
control and solution compatibility)
Question 2
Clinical Scenario A 68-year-old female client with Parkinson’s
disease is prescribed a combination of levodopa and carbidopa.
During a nutritional assessment, the nurse notes the client
consumes a high-protein diet, including multiple servings of
meat and dairy at each meal.
Question Stem Which statement by the nurse indicates
appropriate patient teaching regarding this medication and
diet?
A. "You should take this medication with a high-protein snack to
prevent stomach upset." B. "High-protein meals can decrease
the absorption of this medication, so take it 30 to 60 minutes
before meals." C. "You must avoid all dairy products while
taking this medication to prevent a hypertensive crisis." D. "Take
this medication with a glass of milk to enhance its therapeutic
effect on your nervous system."
, Correct Answer B. "High-protein meals can decrease the
absorption of this medication, so take it 30 to 60 minutes
before meals."
Detailed Rationale Levodopa competes with dietary amino
acids (from protein) for absorption in the small intestine and for
transport across the blood-brain barrier. A high-protein meal
can significantly decrease the absorption and therapeutic
effectiveness of levodopa, leading to worsening Parkinsonian
symptoms or the "on-off" phenomenon. To maximize
absorption, the medication should be taken 30 to 60 minutes
before meals or 1 to 2 hours after meals. If gastrointestinal
upset occurs, it may be taken with a low-protein snack (e.g.,
crackers or fruit), but not with high-protein foods like meat,
eggs, or dairy. Levodopa/carbidopa does not cause
hypertensive crises with dairy; that is a concern with
monoamine oxidase inhibitors (MAOIs) and tyramine-rich
foods.
Learning Objective
• Explain the drug-food interaction between levodopa and
dietary protein.
• Formulate appropriate dietary teaching for clients taking
antiparkinsonian medications.
• Recognize strategies to optimize the therapeutic response
of levodopa/carbidopa.
