NCLEX-RN Pharmacology Neurological
System Part 1 Exam Questions &
Rationales
20 NGN-Style Nursing MCQs
ATI Pharmacology Review
Question 1
Clinical Scenario
A 72-year-old woman with newly diagnosed focal seizures is
prescribed levetiracetam 500 mg orally twice daily. Her
medical history includes hypertension and stage 3 chronic
kidney disease. During discharge teaching, the nurse assesses
the client's understanding of the medication regimen.
Question Stem
Which statement by the client indicates correct understanding
of levetiracetam therapy?
A. "If I miss a dose, I'll stop taking the medication until my next
clinic visit."
,B. "I'll stop taking this medication once I have been seizure-free
for a few weeks."
C. "I'll notify my provider if I notice mood changes or thoughts
of self-harm."
D. "I should avoid drinking water before taking this medication."
Correct Answer
Correct Answer: C. "I'll notify my provider if I notice mood
changes or thoughts of self-harm."
Detailed Rationale
Levetiracetam is a commonly prescribed antiseizure medication
that helps reduce abnormal neuronal firing. Although generally
well tolerated, it has been associated with behavioral changes,
including irritability, depression, aggression, and suicidal
ideation. Patients and caregivers should be instructed to
promptly report significant mood or behavioral changes so that
the healthcare provider can evaluate the need for therapy
modification. Early recognition improves patient safety and may
prevent serious psychiatric complications.
• Option A: Incorrect. Missing a dose should not lead to
discontinuation of therapy. Abrupt interruption of
antiseizure medications increases the risk of breakthrough
seizures and, in some cases, status epilepticus.
, • Option B: Incorrect. Antiseizure medications should never
be discontinued without provider guidance, even if
seizures are well controlled. Therapy is often continued for
years depending on seizure type and recurrence risk.
• Option D: Incorrect. Hydration is not restricted with
levetiracetam. Patients should maintain normal fluid intake
unless another condition requires restriction.
For older adults and patients with renal impairment, dosage
adjustments may be required because levetiracetam is primarily
eliminated by the kidneys. Nurses should monitor renal
function, assess adherence, reinforce seizure precautions, and
emphasize consistent dosing.
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 why antiseizure medications should not be stopped
abruptly.
Medication Safety Focus
Patient education
, Question 2
Clinical Scenario
A 65-year-old man with Parkinson disease receives his
scheduled dose of carbidopa/levodopa. Thirty minutes later,
breakfast arrives containing scrambled eggs, bacon, and a
protein shake. The patient asks whether he should eat
immediately.
Question Stem
Which nursing response is most appropriate?
A. "Take your medication with the protein shake to improve
absorption."
B. "High-protein meals may reduce the medication's
effectiveness, so discuss meal timing with your provider."
C. "Protein has no effect on this medication."
D. "Skip breakfast whenever you take this medication."
Correct Answer
Correct Answer: B. High-protein meals may reduce the
medication's effectiveness, so discuss meal timing with your
provider.
System Part 1 Exam Questions &
Rationales
20 NGN-Style Nursing MCQs
ATI Pharmacology Review
Question 1
Clinical Scenario
A 72-year-old woman with newly diagnosed focal seizures is
prescribed levetiracetam 500 mg orally twice daily. Her
medical history includes hypertension and stage 3 chronic
kidney disease. During discharge teaching, the nurse assesses
the client's understanding of the medication regimen.
Question Stem
Which statement by the client indicates correct understanding
of levetiracetam therapy?
A. "If I miss a dose, I'll stop taking the medication until my next
clinic visit."
,B. "I'll stop taking this medication once I have been seizure-free
for a few weeks."
C. "I'll notify my provider if I notice mood changes or thoughts
of self-harm."
D. "I should avoid drinking water before taking this medication."
Correct Answer
Correct Answer: C. "I'll notify my provider if I notice mood
changes or thoughts of self-harm."
Detailed Rationale
Levetiracetam is a commonly prescribed antiseizure medication
that helps reduce abnormal neuronal firing. Although generally
well tolerated, it has been associated with behavioral changes,
including irritability, depression, aggression, and suicidal
ideation. Patients and caregivers should be instructed to
promptly report significant mood or behavioral changes so that
the healthcare provider can evaluate the need for therapy
modification. Early recognition improves patient safety and may
prevent serious psychiatric complications.
• Option A: Incorrect. Missing a dose should not lead to
discontinuation of therapy. Abrupt interruption of
antiseizure medications increases the risk of breakthrough
seizures and, in some cases, status epilepticus.
, • Option B: Incorrect. Antiseizure medications should never
be discontinued without provider guidance, even if
seizures are well controlled. Therapy is often continued for
years depending on seizure type and recurrence risk.
• Option D: Incorrect. Hydration is not restricted with
levetiracetam. Patients should maintain normal fluid intake
unless another condition requires restriction.
For older adults and patients with renal impairment, dosage
adjustments may be required because levetiracetam is primarily
eliminated by the kidneys. Nurses should monitor renal
function, assess adherence, reinforce seizure precautions, and
emphasize consistent dosing.
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 why antiseizure medications should not be stopped
abruptly.
Medication Safety Focus
Patient education
, Question 2
Clinical Scenario
A 65-year-old man with Parkinson disease receives his
scheduled dose of carbidopa/levodopa. Thirty minutes later,
breakfast arrives containing scrambled eggs, bacon, and a
protein shake. The patient asks whether he should eat
immediately.
Question Stem
Which nursing response is most appropriate?
A. "Take your medication with the protein shake to improve
absorption."
B. "High-protein meals may reduce the medication's
effectiveness, so discuss meal timing with your provider."
C. "Protein has no effect on this medication."
D. "Skip breakfast whenever you take this medication."
Correct Answer
Correct Answer: B. High-protein meals may reduce the
medication's effectiveness, so discuss meal timing with your
provider.
