NCLEX-RN Pharmacology Neurological
System Part 1 Exam |
20 Original NGN Practice Questions with
Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted with newly diagnosed focal-
onset epilepsy following a mild ischemic stroke. His medical
history includes hypertension and hyperlipidemia. Current
medications include lisinopril and atorvastatin. The provider
prescribes levetiracetam 500 mg orally twice daily. During
morning medication rounds, the patient asks, "How will I know
if this medicine is working, and what side effects should I
report?"
Question Stem
Which response by the nurse is most appropriate?
,A. "The medication works immediately, so you can stop taking it
if you do not have another seizure for several weeks."
B. "Report any new mood changes, depression, or thoughts of
self-harm, and continue taking the medication exactly as
prescribed."
C. "You should double your next dose if you accidentally miss
one."
D. "Routine blood levels must be checked weekly to determine
whether the medication is effective."
Correct Answer
Correct Answer: B. "Report any new mood changes,
depression, or thoughts of self-harm, and continue taking the
medication exactly as prescribed."
Detailed Rationale
Levetiracetam is a commonly prescribed antiseizure medication
with relatively few drug interactions and no requirement for
routine therapeutic serum level monitoring. However, it carries
an important precaution regarding behavioral and psychiatric
adverse effects, including irritability, depression, anxiety,
aggression, and suicidal ideation. Nurses should educate
patients and caregivers to promptly report these symptoms
while emphasizing that the medication should never be
discontinued abruptly because sudden withdrawal may
,precipitate breakthrough seizures or status epilepticus.
Consistent adherence is essential to maintain therapeutic drug
concentrations and reduce seizure recurrence.
Option A is incorrect because seizure medications should not be
stopped simply because seizures have ceased. Abrupt
discontinuation significantly increases seizure risk.
Option C is incorrect because doubling a missed dose increases
the likelihood of adverse effects without improving seizure
control. Patients should follow prescribed instructions for
missed doses.
Option D is incorrect because routine serum drug-level
monitoring is generally unnecessary with levetiracetam, unlike
medications such as phenytoin or valproic acid. Clinical
response and adverse-effect assessment guide therapy.
Learning Objectives
After completing this question, the learner should be able to:
• Identify essential patient teaching for levetiracetam
therapy.
• Recognize behavioral adverse effects requiring prompt
reporting.
• Explain the importance of medication adherence in seizure
management.
, Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 30-year-old woman with generalized tonic-clonic seizures has
been taking phenytoin for several years. During a follow-up
clinic visit, the nurse observes swollen gums. The patient
reports brushing her teeth only occasionally because "my gums
bleed easily."
Question Stem
Which nursing intervention is the priority?
A. Recommend discontinuing phenytoin immediately.
B. Teach the patient to maintain meticulous oral hygiene and
schedule regular dental care.
C. Advise the patient to avoid all foods containing vitamin K.
D. Instruct the patient to increase sodium intake.
Correct Answer
Correct Answer: B. Teach the patient to maintain meticulous
oral hygiene and schedule regular dental care.
Detailed Rationale
System Part 1 Exam |
20 Original NGN Practice Questions with
Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted with newly diagnosed focal-
onset epilepsy following a mild ischemic stroke. His medical
history includes hypertension and hyperlipidemia. Current
medications include lisinopril and atorvastatin. The provider
prescribes levetiracetam 500 mg orally twice daily. During
morning medication rounds, the patient asks, "How will I know
if this medicine is working, and what side effects should I
report?"
Question Stem
Which response by the nurse is most appropriate?
,A. "The medication works immediately, so you can stop taking it
if you do not have another seizure for several weeks."
B. "Report any new mood changes, depression, or thoughts of
self-harm, and continue taking the medication exactly as
prescribed."
C. "You should double your next dose if you accidentally miss
one."
D. "Routine blood levels must be checked weekly to determine
whether the medication is effective."
Correct Answer
Correct Answer: B. "Report any new mood changes,
depression, or thoughts of self-harm, and continue taking the
medication exactly as prescribed."
Detailed Rationale
Levetiracetam is a commonly prescribed antiseizure medication
with relatively few drug interactions and no requirement for
routine therapeutic serum level monitoring. However, it carries
an important precaution regarding behavioral and psychiatric
adverse effects, including irritability, depression, anxiety,
aggression, and suicidal ideation. Nurses should educate
patients and caregivers to promptly report these symptoms
while emphasizing that the medication should never be
discontinued abruptly because sudden withdrawal may
,precipitate breakthrough seizures or status epilepticus.
Consistent adherence is essential to maintain therapeutic drug
concentrations and reduce seizure recurrence.
Option A is incorrect because seizure medications should not be
stopped simply because seizures have ceased. Abrupt
discontinuation significantly increases seizure risk.
Option C is incorrect because doubling a missed dose increases
the likelihood of adverse effects without improving seizure
control. Patients should follow prescribed instructions for
missed doses.
Option D is incorrect because routine serum drug-level
monitoring is generally unnecessary with levetiracetam, unlike
medications such as phenytoin or valproic acid. Clinical
response and adverse-effect assessment guide therapy.
Learning Objectives
After completing this question, the learner should be able to:
• Identify essential patient teaching for levetiracetam
therapy.
• Recognize behavioral adverse effects requiring prompt
reporting.
• Explain the importance of medication adherence in seizure
management.
, Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 30-year-old woman with generalized tonic-clonic seizures has
been taking phenytoin for several years. During a follow-up
clinic visit, the nurse observes swollen gums. The patient
reports brushing her teeth only occasionally because "my gums
bleed easily."
Question Stem
Which nursing intervention is the priority?
A. Recommend discontinuing phenytoin immediately.
B. Teach the patient to maintain meticulous oral hygiene and
schedule regular dental care.
C. Advise the patient to avoid all foods containing vitamin K.
D. Instruct the patient to increase sodium intake.
Correct Answer
Correct Answer: B. Teach the patient to maintain meticulous
oral hygiene and schedule regular dental care.
Detailed Rationale
