NCLEX-RN Pharmacology Neurological
System Part 1 Exam Prep
20 Original NGN-Style Practice
Questions with Detailed Rationales
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old man with newly diagnosed focal-onset epilepsy is
admitted after experiencing two unprovoked seizures. His
medical history includes hypertension and chronic kidney
disease stage 3. The provider prescribes levetiracetam 500 mg
orally twice daily. During morning rounds, the client tells the
nurse, "Since starting this medicine, I've been feeling unusually
irritable and angry." Vital signs are stable, and laboratory values
are within expected limits for his condition.
Question Stem
Which nursing action is the priority?
,A. Reassure the client that mood changes are expected and will
resolve without intervention.
B. Notify the provider about the client's behavioral changes
while continuing to monitor for worsening symptoms.
C. Hold the medication immediately and administer the next
dose only after laboratory confirmation.
D. Encourage the client to double the fluid intake because
dehydration commonly causes irritability.
Correct Answer
Correct Answer: B. Notify the provider about the client's
behavioral changes while continuing to monitor for worsening
symptoms.
Detailed Rationale
Levetiracetam is an effective antiseizure medication with
minimal drug interactions, making it a common first-line
therapy. However, one of its clinically significant adverse effects
is behavioral and psychiatric changes, including irritability,
agitation, aggression, anxiety, depression, and, rarely, suicidal
ideation. The nurse should promptly notify the provider while
continuing therapy unless severe symptoms or safety concerns
warrant immediate discontinuation. Ongoing assessment of
mood, behavior, and suicide risk is an essential nursing
responsibility.
,Option A is incorrect because behavioral changes should never
be dismissed as insignificant. Early recognition allows timely
intervention and reduces the risk of harm.
Option C is incorrect because abrupt discontinuation of
antiseizure medications may increase seizure frequency or
precipitate status epilepticus unless specifically directed by the
provider.
Option D is incorrect because increased hydration does not
address medication-induced behavioral adverse effects.
Although maintaining hydration is generally healthy, it is not the
appropriate intervention for this clinical presentation.
Nurses should educate clients and caregivers to report mood
changes immediately and monitor older adults closely because
behavioral symptoms may be subtle initially.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize behavioral adverse effects associated with
levetiracetam.
• Prioritize nursing interventions for psychiatric medication
reactions.
• Educate clients regarding symptoms that require prompt
reporting.
, Medication Safety Focus
Adverse Effect Monitoring
Question 2
Clinical Scenario
A 24-year-old woman is prescribed carbamazepine for
trigeminal neuralgia. During discharge teaching, she asks about
adverse effects that should be reported immediately. She has
no known drug allergies and takes a combined oral
contraceptive daily.
Question Stem
Which statement by the client indicates the need for immediate
follow-up with the healthcare provider?
A. "I notice mild drowsiness after taking my medication."
B. "I developed a fever and a sore throat yesterday."
C. "I sometimes have a dry mouth."
D. "I feel hungry before lunch."
Correct Answer
Correct Answer: B. "I developed a fever and a sore throat
yesterday."
Detailed Rationale
System Part 1 Exam Prep
20 Original NGN-Style Practice
Questions with Detailed Rationales
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old man with newly diagnosed focal-onset epilepsy is
admitted after experiencing two unprovoked seizures. His
medical history includes hypertension and chronic kidney
disease stage 3. The provider prescribes levetiracetam 500 mg
orally twice daily. During morning rounds, the client tells the
nurse, "Since starting this medicine, I've been feeling unusually
irritable and angry." Vital signs are stable, and laboratory values
are within expected limits for his condition.
Question Stem
Which nursing action is the priority?
,A. Reassure the client that mood changes are expected and will
resolve without intervention.
B. Notify the provider about the client's behavioral changes
while continuing to monitor for worsening symptoms.
C. Hold the medication immediately and administer the next
dose only after laboratory confirmation.
D. Encourage the client to double the fluid intake because
dehydration commonly causes irritability.
Correct Answer
Correct Answer: B. Notify the provider about the client's
behavioral changes while continuing to monitor for worsening
symptoms.
Detailed Rationale
Levetiracetam is an effective antiseizure medication with
minimal drug interactions, making it a common first-line
therapy. However, one of its clinically significant adverse effects
is behavioral and psychiatric changes, including irritability,
agitation, aggression, anxiety, depression, and, rarely, suicidal
ideation. The nurse should promptly notify the provider while
continuing therapy unless severe symptoms or safety concerns
warrant immediate discontinuation. Ongoing assessment of
mood, behavior, and suicide risk is an essential nursing
responsibility.
,Option A is incorrect because behavioral changes should never
be dismissed as insignificant. Early recognition allows timely
intervention and reduces the risk of harm.
Option C is incorrect because abrupt discontinuation of
antiseizure medications may increase seizure frequency or
precipitate status epilepticus unless specifically directed by the
provider.
Option D is incorrect because increased hydration does not
address medication-induced behavioral adverse effects.
Although maintaining hydration is generally healthy, it is not the
appropriate intervention for this clinical presentation.
Nurses should educate clients and caregivers to report mood
changes immediately and monitor older adults closely because
behavioral symptoms may be subtle initially.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize behavioral adverse effects associated with
levetiracetam.
• Prioritize nursing interventions for psychiatric medication
reactions.
• Educate clients regarding symptoms that require prompt
reporting.
, Medication Safety Focus
Adverse Effect Monitoring
Question 2
Clinical Scenario
A 24-year-old woman is prescribed carbamazepine for
trigeminal neuralgia. During discharge teaching, she asks about
adverse effects that should be reported immediately. She has
no known drug allergies and takes a combined oral
contraceptive daily.
Question Stem
Which statement by the client indicates the need for immediate
follow-up with the healthcare provider?
A. "I notice mild drowsiness after taking my medication."
B. "I developed a fever and a sore throat yesterday."
C. "I sometimes have a dry mouth."
D. "I feel hungry before lunch."
Correct Answer
Correct Answer: B. "I developed a fever and a sore throat
yesterday."
Detailed Rationale
