NCLEX-RN Pharmacology Neurological
System Part 1 Exam Questions &
Answers
20 Original NCLEX NGN Practice MCQs
with Detailed Rationales
Nursing Pharmacology Study Guide
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 68-year-old woman with newly diagnosed focal epilepsy is
prescribed levetiracetam 500 mg orally twice daily. Her history
includes hypertension and chronic kidney disease stage 3 (eGFR
42 mL/min/1.73 m²). During discharge teaching, she asks what
adverse effects she should expect. Her vital signs are stable, and
she has no history of psychiatric illness.
Question Stem
,Which information is the nurse's priority to include during
patient education?
A. Stop taking the medication immediately if mild dizziness
occurs.
B. Report new depression, irritability, or suicidal thoughts
promptly.
C. Take the medication only when seizure symptoms begin.
D. Double the next dose if one dose is missed.
Correct Answer
Correct Answer: B. Report new depression, irritability, or
suicidal thoughts promptly.
Detailed Rationale
Levetiracetam is a broad-spectrum antiseizure medication
commonly prescribed for focal and generalized seizures.
Although it has relatively few drug interactions compared with
older antiepileptic drugs, one of its clinically significant adverse
effects is the potential for behavioral and mood changes,
including irritability, depression, aggression, and suicidal
ideation. Nurses should emphasize early recognition and
prompt reporting of these symptoms because timely
intervention can prevent serious psychiatric complications.
Since this patient also has chronic kidney disease, renal function
should be monitored because levetiracetam is primarily
,eliminated unchanged by the kidneys and dosage adjustments
may be required.
Option A is incorrect because mild dizziness commonly occurs
during initiation and does not usually require abrupt
discontinuation. Sudden withdrawal may actually precipitate
seizures.
Option C is incorrect because levetiracetam must be taken
consistently to maintain therapeutic drug concentrations; it is
not a rescue medication.
Option D is incorrect because doubling doses increases the risk
of adverse effects. If a dose is missed, patients should follow
prescribed instructions rather than taking extra medication.
Patient education should also include avoiding abrupt
discontinuation, exercising caution with activities requiring
alertness until drug effects are known, and maintaining
adherence even when seizure-free.
Learning Objectives
After completing this question, the learner should be able to:
• Identify important adverse psychiatric effects of
levetiracetam.
• Educate patients regarding adherence to antiseizure
medications.
, • Recognize the need for renal monitoring during therapy.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 27-year-old man arrives in the emergency department
actively experiencing generalized tonic-clonic seizures lasting
longer than 6 minutes. Oxygen has been applied, intravenous
access has been established, and bedside glucose is normal.
Question Stem
Which medication should the nurse anticipate administering
first?
A. Phenytoin IV
B. Levetiracetam IV
C. Lorazepam IV
D. Carbamazepine orally
Correct Answer
Correct Answer: C. Lorazepam IV
Detailed Rationale
System Part 1 Exam Questions &
Answers
20 Original NCLEX NGN Practice MCQs
with Detailed Rationales
Nursing Pharmacology Study Guide
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 68-year-old woman with newly diagnosed focal epilepsy is
prescribed levetiracetam 500 mg orally twice daily. Her history
includes hypertension and chronic kidney disease stage 3 (eGFR
42 mL/min/1.73 m²). During discharge teaching, she asks what
adverse effects she should expect. Her vital signs are stable, and
she has no history of psychiatric illness.
Question Stem
,Which information is the nurse's priority to include during
patient education?
A. Stop taking the medication immediately if mild dizziness
occurs.
B. Report new depression, irritability, or suicidal thoughts
promptly.
C. Take the medication only when seizure symptoms begin.
D. Double the next dose if one dose is missed.
Correct Answer
Correct Answer: B. Report new depression, irritability, or
suicidal thoughts promptly.
Detailed Rationale
Levetiracetam is a broad-spectrum antiseizure medication
commonly prescribed for focal and generalized seizures.
Although it has relatively few drug interactions compared with
older antiepileptic drugs, one of its clinically significant adverse
effects is the potential for behavioral and mood changes,
including irritability, depression, aggression, and suicidal
ideation. Nurses should emphasize early recognition and
prompt reporting of these symptoms because timely
intervention can prevent serious psychiatric complications.
Since this patient also has chronic kidney disease, renal function
should be monitored because levetiracetam is primarily
,eliminated unchanged by the kidneys and dosage adjustments
may be required.
Option A is incorrect because mild dizziness commonly occurs
during initiation and does not usually require abrupt
discontinuation. Sudden withdrawal may actually precipitate
seizures.
Option C is incorrect because levetiracetam must be taken
consistently to maintain therapeutic drug concentrations; it is
not a rescue medication.
Option D is incorrect because doubling doses increases the risk
of adverse effects. If a dose is missed, patients should follow
prescribed instructions rather than taking extra medication.
Patient education should also include avoiding abrupt
discontinuation, exercising caution with activities requiring
alertness until drug effects are known, and maintaining
adherence even when seizure-free.
Learning Objectives
After completing this question, the learner should be able to:
• Identify important adverse psychiatric effects of
levetiracetam.
• Educate patients regarding adherence to antiseizure
medications.
, • Recognize the need for renal monitoring during therapy.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 27-year-old man arrives in the emergency department
actively experiencing generalized tonic-clonic seizures lasting
longer than 6 minutes. Oxygen has been applied, intravenous
access has been established, and bedside glucose is normal.
Question Stem
Which medication should the nurse anticipate administering
first?
A. Phenytoin IV
B. Levetiracetam IV
C. Lorazepam IV
D. Carbamazepine orally
Correct Answer
Correct Answer: C. Lorazepam IV
Detailed Rationale
