1
NURS 615 PHARM EXAM 2 LATEST 2026 REAL
EXAM QUESTIONS AND CORRECT ANSWERS
COMPLETE EXAM|AGRADE(MARYVILLE
UNIVERSITY
1.
A 42-year-old patient with a newly diagnosed seizure disorder is started
on carbamazepine after the provider reviews the patient's medical
history, current medications, baseline laboratory results, and seizure
characteristics. During follow-up, the patient asks why periodic
laboratory monitoring is necessary even though the medication has
controlled the seizures effectively and has not produced any noticeable
adverse effects. Which laboratory monitoring strategy is most
appropriate for this patient receiving long-term carbamazepine therapy?
A. Monitor serum sodium only during the first week of treatment and
discontinue laboratory monitoring afterward.
B. Monitor CBC, hepatic function, and other appropriate laboratory
parameters periodically because of potential hematologic and hepatic
toxicity.
C. Monitor serum amylase and lipase every week because pancreatitis is
the primary dose-limiting toxicity.
D. Monitor serum calcium and phosphorus because carbamazepine
predictably causes severe hypercalcemia.
Answer: B
2.
A patient receiving carbamazepine for seizure control reports that the
medication initially worked extremely well, but after several weeks the
patient notices that the same prescribed dose does not appear to provide
the same degree of seizure protection. The patient reports taking every
dose exactly as prescribed and denies using alcohol or recreational
,2
drugs. Which pharmacokinetic property of carbamazepine best explains
why serum concentrations may decrease during continued therapy?
A. Carbamazepine inhibits its own metabolism through irreversible
hepatic enzyme inhibition.
B. Carbamazepine undergoes autoinduction of hepatic metabolism,
which can increase its own clearance over time.
C. Carbamazepine becomes permanently bound to plasma proteins after
repeated administration.
D. Carbamazepine progressively decreases renal blood flow, resulting in
unpredictable accumulation.
Answer: B
3.
A 29-year-old woman with generalized tonic-clonic seizures is
prescribed valproic acid after several alternative antiseizure medications
have been considered. During medication counseling, the provider
discusses reproductive considerations because the patient is capable of
becoming pregnant. Which concern is particularly important when
discussing valproic acid therapy with this patient?
A. Valproic acid has no clinically meaningful fetal risks and therefore
requires no reproductive counseling.
B. Valproic acid may cause serious fetal developmental abnormalities
and requires careful pregnancy-risk counseling.
C. Valproic acid is contraindicated only in patients older than 65 years.
D. Valproic acid reliably prevents ovulation and is therefore considered
a contraceptive medication.
Answer: B
4.
A patient taking phenytoin for seizure prevention presents for a routine
follow-up visit and reports that the gums have become enlarged and
,3
bleed occasionally during brushing. The patient also reports inconsistent
dental care and asks whether the oral changes could be related to the
antiseizure medication. Which adverse effect is most characteristic of
chronic phenytoin therapy?
A. Gingival hyperplasia
B. Severe hypoglycemia
C. Persistent urinary retention
D. Acute pulmonary edema
Answer: A
5.
A patient taking phenytoin has a serum drug concentration that appears
lower than expected despite adherence to the prescribed regimen. The
patient has recently developed significant hypoalbuminemia associated
with chronic illness. Which pharmacokinetic principle is most important
when interpreting the phenytoin concentration in this patient?
A. Total phenytoin concentration may underestimate the
pharmacologically active free drug concentration when albumin is low.
B. Hypoalbuminemia eliminates phenytoin from the body through
increased urinary excretion.
C. Phenytoin becomes completely inactive whenever albumin
concentration falls below normal.
D. The free phenytoin concentration is always lower than the total
concentration regardless of albumin status.
Answer: A
6.
A patient with a seizure disorder is prescribed lamotrigine and is
carefully instructed to report any new skin eruption. Several weeks later,
the patient contacts the clinic because a widespread rash has developed
with associated fever and malaise. Which action is most appropriate?
, 4
A. Continue the medication and apply an over-the-counter topical
corticosteroid.
B. Stop the medication and promptly seek medical evaluation because a
serious cutaneous reaction may occur.
C. Double the medication dose because the rash indicates inadequate
therapeutic exposure.
D. Take the next dose with food because food completely prevents
serious dermatologic reactions.
Answer: B
7.
A patient with focal seizures is prescribed levetiracetam and returns for
follow-up after several weeks of treatment. Seizure frequency has
decreased substantially, but the patient's family reports new irritability,
agitation, and unusual mood changes. Which adverse effect should the
provider recognize as potentially associated with levetiracetam?
A. Behavioral and psychiatric changes
B. Severe gingival enlargement
C. Irreversible pulmonary fibrosis in nearly all patients
D. Profound hypercalcemia
Answer: A
8.
A patient with epilepsy is taking phenobarbital and reports significant
daytime sedation that interferes with work and driving. The provider
explains that the medication produces central nervous system depression
and that additional substances may intensify this effect. Which substance
should the patient specifically avoid unless approved by the prescriber?
A. Alcohol
B. Plain water
NURS 615 PHARM EXAM 2 LATEST 2026 REAL
EXAM QUESTIONS AND CORRECT ANSWERS
COMPLETE EXAM|AGRADE(MARYVILLE
UNIVERSITY
1.
A 42-year-old patient with a newly diagnosed seizure disorder is started
on carbamazepine after the provider reviews the patient's medical
history, current medications, baseline laboratory results, and seizure
characteristics. During follow-up, the patient asks why periodic
laboratory monitoring is necessary even though the medication has
controlled the seizures effectively and has not produced any noticeable
adverse effects. Which laboratory monitoring strategy is most
appropriate for this patient receiving long-term carbamazepine therapy?
A. Monitor serum sodium only during the first week of treatment and
discontinue laboratory monitoring afterward.
B. Monitor CBC, hepatic function, and other appropriate laboratory
parameters periodically because of potential hematologic and hepatic
toxicity.
C. Monitor serum amylase and lipase every week because pancreatitis is
the primary dose-limiting toxicity.
D. Monitor serum calcium and phosphorus because carbamazepine
predictably causes severe hypercalcemia.
Answer: B
2.
A patient receiving carbamazepine for seizure control reports that the
medication initially worked extremely well, but after several weeks the
patient notices that the same prescribed dose does not appear to provide
the same degree of seizure protection. The patient reports taking every
dose exactly as prescribed and denies using alcohol or recreational
,2
drugs. Which pharmacokinetic property of carbamazepine best explains
why serum concentrations may decrease during continued therapy?
A. Carbamazepine inhibits its own metabolism through irreversible
hepatic enzyme inhibition.
B. Carbamazepine undergoes autoinduction of hepatic metabolism,
which can increase its own clearance over time.
C. Carbamazepine becomes permanently bound to plasma proteins after
repeated administration.
D. Carbamazepine progressively decreases renal blood flow, resulting in
unpredictable accumulation.
Answer: B
3.
A 29-year-old woman with generalized tonic-clonic seizures is
prescribed valproic acid after several alternative antiseizure medications
have been considered. During medication counseling, the provider
discusses reproductive considerations because the patient is capable of
becoming pregnant. Which concern is particularly important when
discussing valproic acid therapy with this patient?
A. Valproic acid has no clinically meaningful fetal risks and therefore
requires no reproductive counseling.
B. Valproic acid may cause serious fetal developmental abnormalities
and requires careful pregnancy-risk counseling.
C. Valproic acid is contraindicated only in patients older than 65 years.
D. Valproic acid reliably prevents ovulation and is therefore considered
a contraceptive medication.
Answer: B
4.
A patient taking phenytoin for seizure prevention presents for a routine
follow-up visit and reports that the gums have become enlarged and
,3
bleed occasionally during brushing. The patient also reports inconsistent
dental care and asks whether the oral changes could be related to the
antiseizure medication. Which adverse effect is most characteristic of
chronic phenytoin therapy?
A. Gingival hyperplasia
B. Severe hypoglycemia
C. Persistent urinary retention
D. Acute pulmonary edema
Answer: A
5.
A patient taking phenytoin has a serum drug concentration that appears
lower than expected despite adherence to the prescribed regimen. The
patient has recently developed significant hypoalbuminemia associated
with chronic illness. Which pharmacokinetic principle is most important
when interpreting the phenytoin concentration in this patient?
A. Total phenytoin concentration may underestimate the
pharmacologically active free drug concentration when albumin is low.
B. Hypoalbuminemia eliminates phenytoin from the body through
increased urinary excretion.
C. Phenytoin becomes completely inactive whenever albumin
concentration falls below normal.
D. The free phenytoin concentration is always lower than the total
concentration regardless of albumin status.
Answer: A
6.
A patient with a seizure disorder is prescribed lamotrigine and is
carefully instructed to report any new skin eruption. Several weeks later,
the patient contacts the clinic because a widespread rash has developed
with associated fever and malaise. Which action is most appropriate?
, 4
A. Continue the medication and apply an over-the-counter topical
corticosteroid.
B. Stop the medication and promptly seek medical evaluation because a
serious cutaneous reaction may occur.
C. Double the medication dose because the rash indicates inadequate
therapeutic exposure.
D. Take the next dose with food because food completely prevents
serious dermatologic reactions.
Answer: B
7.
A patient with focal seizures is prescribed levetiracetam and returns for
follow-up after several weeks of treatment. Seizure frequency has
decreased substantially, but the patient's family reports new irritability,
agitation, and unusual mood changes. Which adverse effect should the
provider recognize as potentially associated with levetiracetam?
A. Behavioral and psychiatric changes
B. Severe gingival enlargement
C. Irreversible pulmonary fibrosis in nearly all patients
D. Profound hypercalcemia
Answer: A
8.
A patient with epilepsy is taking phenobarbital and reports significant
daytime sedation that interferes with work and driving. The provider
explains that the medication produces central nervous system depression
and that additional substances may intensify this effect. Which substance
should the patient specifically avoid unless approved by the prescriber?
A. Alcohol
B. Plain water
