NCLEX-RN Pharmacology Neurological
System Part 1 Exam Questions &
Detailed Rationales |
20 Original NGN Practice Questions |
Antiepileptics, Parkinson's Disease,
Alzheimer's, Migraine, Myasthenia
Gravis |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted after experiencing a generalized
tonic-clonic seizure. His medical history includes hypertension
and chronic atrial fibrillation. The provider prescribes phenytoin
for long-term seizure management. Before administering the
first dose, the nurse reviews the client's laboratory results:
• Blood pressure: 132/78 mm Hg
• Heart rate: 76/min
, • Respiratory rate: 18/min
• Temperature: 36.9°C (98.4°F)
• Albumin: 2.6 g/dL (low)
• Creatinine: 0.9 mg/dL
• AST/ALT: Within normal limits
Question Stem
Which finding requires the nurse to notify the provider before
administering the medication?
A. Heart rate of 76/min
B. Serum albumin of 2.6 g/dL
C. Blood pressure of 132/78 mm Hg
D. Normal liver enzymes
Correct Answer
B. Serum albumin of 2.6 g/dL
Detailed Rationale
Phenytoin is highly protein bound, with approximately 90% of
circulating drug attached to albumin. A decreased serum
albumin concentration results in a larger proportion of unbound
(free) phenytoin, increasing the risk of toxicity even when the
measured total phenytoin level appears therapeutic. Toxic
manifestations include nystagmus, ataxia, slurred speech,
,confusion, and decreased level of consciousness. The nurse
should notify the provider because dosage adjustment or free
phenytoin level monitoring may be necessary.
Option A: A heart rate of 76/min is within the normal adult
range and does not contraindicate phenytoin administration.
Option C: The blood pressure is stable and does not require
intervention before giving the medication.
Option D: Normal liver enzymes do not require withholding
therapy. Although phenytoin is metabolized hepatically, normal
liver function supports routine administration.
The nurse should continue monitoring neurologic status, serum
drug concentrations, signs of toxicity, and reinforce adherence
because abrupt discontinuation may precipitate status
epilepticus.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the relationship between albumin and phenytoin
protein binding.
• Recognize factors that increase phenytoin toxicity.
• Identify when provider notification is indicated before
medication administration.
Medication Safety Focus
, Monitoring
Question 2
Clinical Scenario
A 24-year-old woman with newly diagnosed epilepsy is
prescribed levetiracetam. Before discharge, the nurse provides
medication teaching. The client asks how she will know whether
the medication is working.
Question Stem
Which statement by the client demonstrates correct
understanding of the expected therapeutic response?
A. "Once I feel better, I can gradually stop taking the
medication."
B. "The medication should prevent future seizures even if I
don't notice immediate changes."
C. "I should stop taking the medication if I become sleepy."
D. "I'll only take the medication when I feel a seizure coming."
Correct Answer
B. "The medication should prevent future seizures even if I
don't notice immediate changes."
Detailed Rationale
System Part 1 Exam Questions &
Detailed Rationales |
20 Original NGN Practice Questions |
Antiepileptics, Parkinson's Disease,
Alzheimer's, Migraine, Myasthenia
Gravis |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted after experiencing a generalized
tonic-clonic seizure. His medical history includes hypertension
and chronic atrial fibrillation. The provider prescribes phenytoin
for long-term seizure management. Before administering the
first dose, the nurse reviews the client's laboratory results:
• Blood pressure: 132/78 mm Hg
• Heart rate: 76/min
, • Respiratory rate: 18/min
• Temperature: 36.9°C (98.4°F)
• Albumin: 2.6 g/dL (low)
• Creatinine: 0.9 mg/dL
• AST/ALT: Within normal limits
Question Stem
Which finding requires the nurse to notify the provider before
administering the medication?
A. Heart rate of 76/min
B. Serum albumin of 2.6 g/dL
C. Blood pressure of 132/78 mm Hg
D. Normal liver enzymes
Correct Answer
B. Serum albumin of 2.6 g/dL
Detailed Rationale
Phenytoin is highly protein bound, with approximately 90% of
circulating drug attached to albumin. A decreased serum
albumin concentration results in a larger proportion of unbound
(free) phenytoin, increasing the risk of toxicity even when the
measured total phenytoin level appears therapeutic. Toxic
manifestations include nystagmus, ataxia, slurred speech,
,confusion, and decreased level of consciousness. The nurse
should notify the provider because dosage adjustment or free
phenytoin level monitoring may be necessary.
Option A: A heart rate of 76/min is within the normal adult
range and does not contraindicate phenytoin administration.
Option C: The blood pressure is stable and does not require
intervention before giving the medication.
Option D: Normal liver enzymes do not require withholding
therapy. Although phenytoin is metabolized hepatically, normal
liver function supports routine administration.
The nurse should continue monitoring neurologic status, serum
drug concentrations, signs of toxicity, and reinforce adherence
because abrupt discontinuation may precipitate status
epilepticus.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the relationship between albumin and phenytoin
protein binding.
• Recognize factors that increase phenytoin toxicity.
• Identify when provider notification is indicated before
medication administration.
Medication Safety Focus
, Monitoring
Question 2
Clinical Scenario
A 24-year-old woman with newly diagnosed epilepsy is
prescribed levetiracetam. Before discharge, the nurse provides
medication teaching. The client asks how she will know whether
the medication is working.
Question Stem
Which statement by the client demonstrates correct
understanding of the expected therapeutic response?
A. "Once I feel better, I can gradually stop taking the
medication."
B. "The medication should prevent future seizures even if I
don't notice immediate changes."
C. "I should stop taking the medication if I become sleepy."
D. "I'll only take the medication when I feel a seizure coming."
Correct Answer
B. "The medication should prevent future seizures even if I
don't notice immediate changes."
Detailed Rationale
