NUR 354 Exam 1 Comprehensive Study
Guide on Neurological Pharmacology |
2026/2027 Update with complete solutions.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
143 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses nursing students' mastery of neurological pharmacology, including antiepileptic drugs,
antiparkinson agents, migraine therapies, muscle relaxants, and drugs for neurodegenerative disorders. It
emphasizes mechanism-based reasoning, monitoring parameters, and safe clinical decision-making.
STUDY GUIDE
Recommended duration: 1.5 hours. Passing target: 75%.
HIGHP - Page 1 of 46
,1. A patient with partial seizures is prescribed carbamazepine. Which mechanism best
explains its antiepileptic effect?
[ ] A. Blockade of voltage-gated sodium channels, stabilizing neuronal membranes
[ ] B. Enhancement of GABA-mediated chloride influx
[ ] C. Inhibition of T-type calcium channels in thalamic neurons
[ ] D. Antagonism of NMDA glutamate receptors
CORRECT: A. Blockade of voltage-gated sodium channels, stabilizing neuronal membranes
Carbamazepine blocks voltage-gated sodium channels, reducing high-frequency neuronal firing. GABA
enhancement is characteristic of benzodiazepines and valproate; T-type calcium blockade is ethosuximide;
NMDA antagonism is not its primary action.
2. A patient on carbidopa-levodopa reports new-onset dark urine and increased sweating.
What is the nurse's best interpretation?
[ ] A. These are expected, harmless side effects of levodopa therapy
[ ] B. They indicate early signs of hepatotoxicity
[ ] C. They suggest the patient is developing dyskinesias
[ ] D. They require immediate discontinuation of the drug
CORRECT: A. These are expected, harmless side effects of levodopa therapy
Dark urine and sweating are common, benign side effects of levodopa due to its metabolism. They do not
indicate hepatotoxicity or dyskinesias and do not necessitate stopping the drug.
3. Which medication is most appropriate for acute migraine attack in a patient with known
coronary artery disease?
[ ] A. Sumatriptan
[ ] B. Ergotamine
[ ] C. Acetaminophen
[ ] D. Rizatriptan
CORRECT: C. Acetaminophen
Triptans and ergots are contraindicated in coronary artery disease due to vasoconstrictive effects.
Acetaminophen is safe for pain relief, though less specific for migraine.
4. A patient receiving interferon beta-1a for multiple sclerosis develops flu-like symptoms
after injection. What is the most appropriate nursing action?
[ ] A. Administer acetaminophen or ibuprofen before injection
[ ] B. Hold the medication and notify the provider immediately
[ ] C. Encourage increased fluid intake and rest
HIGHP - Page 2 of 46
, [ ] D. Switch to glatiramer acetate
CORRECT: A. Administer acetaminophen or ibuprofen before injection
Flu-like symptoms are common with interferon beta and can be mitigated by premedication with
acetaminophen or NSAIDs. Holding the drug is unnecessary; switching agents is not first-line.
5. Which assessment finding is most concerning in a patient receiving baclofen for
muscle spasticity?
[ ] A. Drowsiness
[ ] B. Muscle weakness
[ ] C. Sudden onset of confusion and hallucinations
[ ] D. Constipation
CORRECT: C. Sudden onset of confusion and hallucinations
Confusion and hallucinations may indicate baclofen toxicity or withdrawal, especially with abrupt
discontinuation. Drowsiness and constipation are common side effects; muscle weakness may be expected
but not as urgent as neuropsychiatric changes.
6. A patient on phenytoin has a serum level of 25 mcg/mL. Which sign should the nurse
monitor for?
[ ] A. Nystagmus and ataxia
[ ] B. Hypotension and bradycardia
[ ] C. Hyperreflexia and agitation
[ ] D. Respiratory depression
CORRECT: A. Nystagmus and ataxia
The therapeutic range for phenytoin is 10-20 mcg/mL; levels above 20 can cause nystagmus, ataxia, and
sedation. Hypotension and bradycardia are more associated with rapid IV administration; hyperreflexia is not
typical.
7. Which instruction is essential for a patient starting donepezil for Alzheimer's disease?
[ ] A. Take the medication at bedtime to reduce daytime drowsiness
[ ] B. Report any slow heartbeat or fainting
[ ] C. Avoid concurrent use of NSAIDs
[ ] D. Increase intake of potassium-rich foods
CORRECT: B. Report any slow heartbeat or fainting
Donepezil can cause bradycardia and syncope due to increased vagal tone. It is usually taken in the morning;
NSAID interaction is not a primary concern; potassium intake is unrelated.
HIGHP - Page 3 of 46
, 8. A patient on valproic acid for bipolar disorder reports nausea and vomiting. Which
laboratory test is most important to monitor?
[ ] A. Serum ammonia levels
[ ] B. Serum creatinine
[ ] C. Thyroid function tests
[ ] D. Urinalysis
CORRECT: A. Serum ammonia levels
Valproic acid can cause hyperammonemia, leading to nausea, vomiting, and lethargy. Renal function and
thyroid are less directly affected; urinalysis is not specific.
9. Which teaching point is most important for a patient prescribed sumatriptan for
migraine?
[ ] A. Take the medication at the first sign of a migraine
[ ] B. Use as prophylaxis daily
[ ] C. Avoid caffeine while taking this drug
[ ] D. Expect immediate relief within 5 minutes
CORRECT: A. Take the medication at the first sign of a migraine
Sumatriptan is most effective when taken early in a migraine attack. It is not for prophylaxis; caffeine
avoidance is not required; relief typically occurs within 30 minutes to 2 hours.
10. A patient with epilepsy is started on a new antiseizure medication. The nurse teaches
the patient to avoid abrupt discontinuation of the drug. Which adverse effect is most likely
if the medication is stopped suddenly?
[ ] A. Status epilepticus
[ ] B. Hypertensive crisis
[ ] C. Serotonin syndrome
[ ] D. Neuroleptic malignant syndrome
CORRECT: A. Status epilepticus
Abrupt withdrawal of antiseizure drugs can lower the seizure threshold and precipitate status epilepticus or
rebound seizures. Hypertensive crisis, serotonin syndrome, and neuroleptic malignant syndrome are not
typical withdrawal effects of antiseizure medications.
11. A patient receiving levodopa-carbidopa for Parkinson's disease reports a sudden
return of tremor and rigidity several hours after each dose. Which term best describes this
phenomenon?
[ ] A. On-off phenomenon
HIGHP - Page 4 of 46
Guide on Neurological Pharmacology |
2026/2027 Update with complete solutions.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
143 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses nursing students' mastery of neurological pharmacology, including antiepileptic drugs,
antiparkinson agents, migraine therapies, muscle relaxants, and drugs for neurodegenerative disorders. It
emphasizes mechanism-based reasoning, monitoring parameters, and safe clinical decision-making.
STUDY GUIDE
Recommended duration: 1.5 hours. Passing target: 75%.
HIGHP - Page 1 of 46
,1. A patient with partial seizures is prescribed carbamazepine. Which mechanism best
explains its antiepileptic effect?
[ ] A. Blockade of voltage-gated sodium channels, stabilizing neuronal membranes
[ ] B. Enhancement of GABA-mediated chloride influx
[ ] C. Inhibition of T-type calcium channels in thalamic neurons
[ ] D. Antagonism of NMDA glutamate receptors
CORRECT: A. Blockade of voltage-gated sodium channels, stabilizing neuronal membranes
Carbamazepine blocks voltage-gated sodium channels, reducing high-frequency neuronal firing. GABA
enhancement is characteristic of benzodiazepines and valproate; T-type calcium blockade is ethosuximide;
NMDA antagonism is not its primary action.
2. A patient on carbidopa-levodopa reports new-onset dark urine and increased sweating.
What is the nurse's best interpretation?
[ ] A. These are expected, harmless side effects of levodopa therapy
[ ] B. They indicate early signs of hepatotoxicity
[ ] C. They suggest the patient is developing dyskinesias
[ ] D. They require immediate discontinuation of the drug
CORRECT: A. These are expected, harmless side effects of levodopa therapy
Dark urine and sweating are common, benign side effects of levodopa due to its metabolism. They do not
indicate hepatotoxicity or dyskinesias and do not necessitate stopping the drug.
3. Which medication is most appropriate for acute migraine attack in a patient with known
coronary artery disease?
[ ] A. Sumatriptan
[ ] B. Ergotamine
[ ] C. Acetaminophen
[ ] D. Rizatriptan
CORRECT: C. Acetaminophen
Triptans and ergots are contraindicated in coronary artery disease due to vasoconstrictive effects.
Acetaminophen is safe for pain relief, though less specific for migraine.
4. A patient receiving interferon beta-1a for multiple sclerosis develops flu-like symptoms
after injection. What is the most appropriate nursing action?
[ ] A. Administer acetaminophen or ibuprofen before injection
[ ] B. Hold the medication and notify the provider immediately
[ ] C. Encourage increased fluid intake and rest
HIGHP - Page 2 of 46
, [ ] D. Switch to glatiramer acetate
CORRECT: A. Administer acetaminophen or ibuprofen before injection
Flu-like symptoms are common with interferon beta and can be mitigated by premedication with
acetaminophen or NSAIDs. Holding the drug is unnecessary; switching agents is not first-line.
5. Which assessment finding is most concerning in a patient receiving baclofen for
muscle spasticity?
[ ] A. Drowsiness
[ ] B. Muscle weakness
[ ] C. Sudden onset of confusion and hallucinations
[ ] D. Constipation
CORRECT: C. Sudden onset of confusion and hallucinations
Confusion and hallucinations may indicate baclofen toxicity or withdrawal, especially with abrupt
discontinuation. Drowsiness and constipation are common side effects; muscle weakness may be expected
but not as urgent as neuropsychiatric changes.
6. A patient on phenytoin has a serum level of 25 mcg/mL. Which sign should the nurse
monitor for?
[ ] A. Nystagmus and ataxia
[ ] B. Hypotension and bradycardia
[ ] C. Hyperreflexia and agitation
[ ] D. Respiratory depression
CORRECT: A. Nystagmus and ataxia
The therapeutic range for phenytoin is 10-20 mcg/mL; levels above 20 can cause nystagmus, ataxia, and
sedation. Hypotension and bradycardia are more associated with rapid IV administration; hyperreflexia is not
typical.
7. Which instruction is essential for a patient starting donepezil for Alzheimer's disease?
[ ] A. Take the medication at bedtime to reduce daytime drowsiness
[ ] B. Report any slow heartbeat or fainting
[ ] C. Avoid concurrent use of NSAIDs
[ ] D. Increase intake of potassium-rich foods
CORRECT: B. Report any slow heartbeat or fainting
Donepezil can cause bradycardia and syncope due to increased vagal tone. It is usually taken in the morning;
NSAID interaction is not a primary concern; potassium intake is unrelated.
HIGHP - Page 3 of 46
, 8. A patient on valproic acid for bipolar disorder reports nausea and vomiting. Which
laboratory test is most important to monitor?
[ ] A. Serum ammonia levels
[ ] B. Serum creatinine
[ ] C. Thyroid function tests
[ ] D. Urinalysis
CORRECT: A. Serum ammonia levels
Valproic acid can cause hyperammonemia, leading to nausea, vomiting, and lethargy. Renal function and
thyroid are less directly affected; urinalysis is not specific.
9. Which teaching point is most important for a patient prescribed sumatriptan for
migraine?
[ ] A. Take the medication at the first sign of a migraine
[ ] B. Use as prophylaxis daily
[ ] C. Avoid caffeine while taking this drug
[ ] D. Expect immediate relief within 5 minutes
CORRECT: A. Take the medication at the first sign of a migraine
Sumatriptan is most effective when taken early in a migraine attack. It is not for prophylaxis; caffeine
avoidance is not required; relief typically occurs within 30 minutes to 2 hours.
10. A patient with epilepsy is started on a new antiseizure medication. The nurse teaches
the patient to avoid abrupt discontinuation of the drug. Which adverse effect is most likely
if the medication is stopped suddenly?
[ ] A. Status epilepticus
[ ] B. Hypertensive crisis
[ ] C. Serotonin syndrome
[ ] D. Neuroleptic malignant syndrome
CORRECT: A. Status epilepticus
Abrupt withdrawal of antiseizure drugs can lower the seizure threshold and precipitate status epilepticus or
rebound seizures. Hypertensive crisis, serotonin syndrome, and neuroleptic malignant syndrome are not
typical withdrawal effects of antiseizure medications.
11. A patient receiving levodopa-carbidopa for Parkinson's disease reports a sudden
return of tremor and rigidity several hours after each dose. Which term best describes this
phenomenon?
[ ] A. On-off phenomenon
HIGHP - Page 4 of 46
