NCLEX-RN Pharmacology Neurological System Part
2 Exam Questions with Detailed Rationales |
20 Original NGN-Style Practice MCQs |
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 78-year-old female with a history of mild Alzheimer’s disease
and atrial fibrillation is prescribed a new medication, donepezil,
to help manage her cognitive symptoms. Her baseline vital signs
reveal a blood pressure of 138/88 mm Hg and a heart rate of 52
beats per minute. She reports occasional mild nausea but no
chest pain or dizziness.
Question Stem
Which assessment finding requires the nurse to contact the
provider before administering the first dose of this medication?
A. Heart rate of 52 beats per minute
B. Blood pressure of 138/88 mm Hg
,C. Reports of occasional mild nausea
D. History of atrial fibrillation
Correct Answer
A. Heart rate of 52 beats per minute
Detailed Rationale
Donepezil is a reversible acetylcholinesterase inhibitor used to
treat mild to severe Alzheimer’s disease. By increasing
acetylcholine levels, it enhances cholinergic transmission, which
can inadvertently increase vagal tone. This pharmacodynamic
effect can lead to bradycardia and heart block. Therefore, a
heart rate of 52 bpm is a significant finding that requires the
nurse to contact the provider before administering the first
dose, as pre-existing bradycardia or conduction defects are
relative contraindications. Mild nausea and occasional
headaches are common, expected side effects of donepezil that
typically resolve with continued therapy and do not require
withholding the medication. A blood pressure of 138/88 mm Hg
is within acceptable limits for an older adult and does not
preclude administration. The nurse must always assess baseline
vital signs, particularly heart rate, in patients prescribed
cholinergic medications to prevent severe adverse
cardiovascular events. Patient teaching should include reporting
dizziness, fainting, or a slow pulse.
Learning Objective
, • Identify bradycardia as a potential adverse effect of
acetylcholinesterase inhibitors.
• Prioritize nursing assessments before administering
cholinergic medications.
• Recognize relative contraindications for donepezil therapy.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
An 82-year-old male with moderate-to-severe Alzheimer’s
disease is being discharged with a new prescription for
memantine. His daughter, who is his primary caregiver, is
receiving discharge teaching regarding the new medication.
Question Stem
Which statement by the client's caregiver indicates
understanding of the medication teaching?
A. "I will give this medication only on an empty stomach."
B. "I should report any new confusion or dizziness to the
provider."
C. "This medication will cure his memory loss within a month."
D. "I will crush the extended-release capsules and mix them
with applesauce."
, Correct Answer
B. "I should report any new confusion or dizziness to the
provider."
Detailed Rationale
Memantine is an N-methyl-D-aspartate (NMDA) receptor
antagonist used for moderate to severe Alzheimer’s disease. It
works by regulating glutamate activity, which may help slow
cognitive decline, though it does not cure the disease. Dizziness
and confusion are potential adverse effects that the caregiver
should report to the healthcare provider. Memantine can be
administered with or without food, making the statement about
giving it only on an empty stomach incorrect. Furthermore,
extended-release capsules must never be crushed, chewed, or
divided, as this disrupts the extended-release mechanism and
can lead to toxicity. Caregivers should be educated that while
the medication may stabilize symptoms or slow progression, it
will not cure memory loss. Regular monitoring of renal function
is also recommended, as memantine is excreted unchanged by
the kidneys, and dosage adjustments may be necessary for
patients with severe renal impairment. Recognizing and
reporting new neurological symptoms promotes medication
safety.
Learning Objective
2 Exam Questions with Detailed Rationales |
20 Original NGN-Style Practice MCQs |
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 78-year-old female with a history of mild Alzheimer’s disease
and atrial fibrillation is prescribed a new medication, donepezil,
to help manage her cognitive symptoms. Her baseline vital signs
reveal a blood pressure of 138/88 mm Hg and a heart rate of 52
beats per minute. She reports occasional mild nausea but no
chest pain or dizziness.
Question Stem
Which assessment finding requires the nurse to contact the
provider before administering the first dose of this medication?
A. Heart rate of 52 beats per minute
B. Blood pressure of 138/88 mm Hg
,C. Reports of occasional mild nausea
D. History of atrial fibrillation
Correct Answer
A. Heart rate of 52 beats per minute
Detailed Rationale
Donepezil is a reversible acetylcholinesterase inhibitor used to
treat mild to severe Alzheimer’s disease. By increasing
acetylcholine levels, it enhances cholinergic transmission, which
can inadvertently increase vagal tone. This pharmacodynamic
effect can lead to bradycardia and heart block. Therefore, a
heart rate of 52 bpm is a significant finding that requires the
nurse to contact the provider before administering the first
dose, as pre-existing bradycardia or conduction defects are
relative contraindications. Mild nausea and occasional
headaches are common, expected side effects of donepezil that
typically resolve with continued therapy and do not require
withholding the medication. A blood pressure of 138/88 mm Hg
is within acceptable limits for an older adult and does not
preclude administration. The nurse must always assess baseline
vital signs, particularly heart rate, in patients prescribed
cholinergic medications to prevent severe adverse
cardiovascular events. Patient teaching should include reporting
dizziness, fainting, or a slow pulse.
Learning Objective
, • Identify bradycardia as a potential adverse effect of
acetylcholinesterase inhibitors.
• Prioritize nursing assessments before administering
cholinergic medications.
• Recognize relative contraindications for donepezil therapy.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
An 82-year-old male with moderate-to-severe Alzheimer’s
disease is being discharged with a new prescription for
memantine. His daughter, who is his primary caregiver, is
receiving discharge teaching regarding the new medication.
Question Stem
Which statement by the client's caregiver indicates
understanding of the medication teaching?
A. "I will give this medication only on an empty stomach."
B. "I should report any new confusion or dizziness to the
provider."
C. "This medication will cure his memory loss within a month."
D. "I will crush the extended-release capsules and mix them
with applesauce."
, Correct Answer
B. "I should report any new confusion or dizziness to the
provider."
Detailed Rationale
Memantine is an N-methyl-D-aspartate (NMDA) receptor
antagonist used for moderate to severe Alzheimer’s disease. It
works by regulating glutamate activity, which may help slow
cognitive decline, though it does not cure the disease. Dizziness
and confusion are potential adverse effects that the caregiver
should report to the healthcare provider. Memantine can be
administered with or without food, making the statement about
giving it only on an empty stomach incorrect. Furthermore,
extended-release capsules must never be crushed, chewed, or
divided, as this disrupts the extended-release mechanism and
can lead to toxicity. Caregivers should be educated that while
the medication may stabilize symptoms or slow progression, it
will not cure memory loss. Regular monitoring of renal function
is also recommended, as memantine is excreted unchanged by
the kidneys, and dosage adjustments may be necessary for
patients with severe renal impairment. Recognizing and
reporting new neurological symptoms promotes medication
safety.
Learning Objective
