NCLEX-RN Pharmacology Practice Questions:
Neurological System Part 2 |
20 Original NGN-Style MCQs with Detailed
Rationales, Clinical Judgment & Medication
Safety Study Guide
Question 1
Clinical Scenario
A 78-year-old female client is newly diagnosed with mild to
moderate Alzheimer’s disease. The health care provider
prescribes donepezil 5 mg orally once daily. The client’s
daughter asks the nurse when is the best time to give this
medication to minimize side effects.
Question Stem
Which response by the nurse is most appropriate?
Options
A. "Give it in the morning with breakfast to prevent stomach
upset."
B. "Administer it at bedtime to reduce the likelihood of
,dizziness and fainting."
C. "Split the dose, giving half in the morning and half at night."
D. "Give it on an empty stomach 1 hour before the largest meal
of the day."
Correct Answer
Correct Answer: B. "Administer it at bedtime to reduce the
likelihood of dizziness and fainting."
Detailed Rationale
Donepezil is a reversible acetylcholinesterase inhibitor used to
treat mild to moderate Alzheimer’s disease. By increasing
acetylcholine levels in the brain, it can modestly improve or
stabilize cognitive function. However, increased cholinergic
activity can also cause peripheral side effects, including
bradycardia, syncope, dizziness, nausea, and diarrhea.
Administering donepezil at bedtime helps the client sleep
through these potential adverse effects, particularly dizziness
and fainting, thereby enhancing safety and reducing fall risk.
Option A is incorrect because morning administration increases
the risk of daytime dizziness and falls. Option C is incorrect
because donepezil is formulated for once-daily dosing; splitting
the tablet is not recommended unless it is a specifically scored
tablet directed by a provider, and it does not mitigate side
effects better than bedtime dosing. Option D is incorrect
because taking it on an empty stomach may exacerbate
,gastrointestinal distress, and timing it before a meal does not
address the primary safety concern of daytime syncope.
Learning Objective
• Identify the optimal timing for donepezil administration to
minimize adverse effects.
• Recognize the peripheral cholinergic side effects of
acetylcholinesterase inhibitors.
• Educate caregivers on safety measures to prevent falls in
clients with Alzheimer’s disease.
Medication Safety Focus
Adverse effect / Patient education
Question 2
Clinical Scenario
A 45-year-old male client presents to the emergency
department with a severe, throbbing unilateral headache,
photophobia, and nausea, consistent with a migraine. The
health care provider considers prescribing sumatriptan. The
client’s medical history includes hypertension, type 2 diabetes
mellitus, and coronary artery disease (CAD) with a myocardial
infarction 2 years ago.
, Question Stem
Which finding in the client’s history is an absolute
contraindication to the administration of sumatriptan?
Options
A. History of coronary artery disease
B. Type 2 diabetes mellitus
C. Age of 45 years
D. Presence of photophobia
Correct Answer
Correct Answer: A. History of coronary artery disease
Detailed Rationale
Sumatriptan is a selective serotonin (5-HT1B/1D) receptor
agonist used for the acute abortive treatment of migraines. It
works by causing cranial vasoconstriction and inhibiting the
release of pro-inflammatory neuropeptides. Because it also has
the potential to cause coronary vasospasm, it is absolutely
contraindicated in clients with ischemic heart disease, including
a history of coronary artery disease (CAD), myocardial
infarction, Prinzmetal’s angina, or uncontrolled hypertension.
Administering sumatriptan to this client could precipitate a life-
threatening myocardial infarction or severe angina. Option B is
incorrect because diabetes mellitus is not a contraindication to
triptan therapy, though cardiovascular risk factors should be
assessed. Option C is incorrect because age 45 is not a
Neurological System Part 2 |
20 Original NGN-Style MCQs with Detailed
Rationales, Clinical Judgment & Medication
Safety Study Guide
Question 1
Clinical Scenario
A 78-year-old female client is newly diagnosed with mild to
moderate Alzheimer’s disease. The health care provider
prescribes donepezil 5 mg orally once daily. The client’s
daughter asks the nurse when is the best time to give this
medication to minimize side effects.
Question Stem
Which response by the nurse is most appropriate?
Options
A. "Give it in the morning with breakfast to prevent stomach
upset."
B. "Administer it at bedtime to reduce the likelihood of
,dizziness and fainting."
C. "Split the dose, giving half in the morning and half at night."
D. "Give it on an empty stomach 1 hour before the largest meal
of the day."
Correct Answer
Correct Answer: B. "Administer it at bedtime to reduce the
likelihood of dizziness and fainting."
Detailed Rationale
Donepezil is a reversible acetylcholinesterase inhibitor used to
treat mild to moderate Alzheimer’s disease. By increasing
acetylcholine levels in the brain, it can modestly improve or
stabilize cognitive function. However, increased cholinergic
activity can also cause peripheral side effects, including
bradycardia, syncope, dizziness, nausea, and diarrhea.
Administering donepezil at bedtime helps the client sleep
through these potential adverse effects, particularly dizziness
and fainting, thereby enhancing safety and reducing fall risk.
Option A is incorrect because morning administration increases
the risk of daytime dizziness and falls. Option C is incorrect
because donepezil is formulated for once-daily dosing; splitting
the tablet is not recommended unless it is a specifically scored
tablet directed by a provider, and it does not mitigate side
effects better than bedtime dosing. Option D is incorrect
because taking it on an empty stomach may exacerbate
,gastrointestinal distress, and timing it before a meal does not
address the primary safety concern of daytime syncope.
Learning Objective
• Identify the optimal timing for donepezil administration to
minimize adverse effects.
• Recognize the peripheral cholinergic side effects of
acetylcholinesterase inhibitors.
• Educate caregivers on safety measures to prevent falls in
clients with Alzheimer’s disease.
Medication Safety Focus
Adverse effect / Patient education
Question 2
Clinical Scenario
A 45-year-old male client presents to the emergency
department with a severe, throbbing unilateral headache,
photophobia, and nausea, consistent with a migraine. The
health care provider considers prescribing sumatriptan. The
client’s medical history includes hypertension, type 2 diabetes
mellitus, and coronary artery disease (CAD) with a myocardial
infarction 2 years ago.
, Question Stem
Which finding in the client’s history is an absolute
contraindication to the administration of sumatriptan?
Options
A. History of coronary artery disease
B. Type 2 diabetes mellitus
C. Age of 45 years
D. Presence of photophobia
Correct Answer
Correct Answer: A. History of coronary artery disease
Detailed Rationale
Sumatriptan is a selective serotonin (5-HT1B/1D) receptor
agonist used for the acute abortive treatment of migraines. It
works by causing cranial vasoconstriction and inhibiting the
release of pro-inflammatory neuropeptides. Because it also has
the potential to cause coronary vasospasm, it is absolutely
contraindicated in clients with ischemic heart disease, including
a history of coronary artery disease (CAD), myocardial
infarction, Prinzmetal’s angina, or uncontrolled hypertension.
Administering sumatriptan to this client could precipitate a life-
threatening myocardial infarction or severe angina. Option B is
incorrect because diabetes mellitus is not a contraindication to
triptan therapy, though cardiovascular risk factors should be
assessed. Option C is incorrect because age 45 is not a
