NCLEX-RN Pharmacology Neurological System
Part 2 Practice Questions |
20 Original NGN MCQs with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 45-year-old male with a history of generalized tonic-clonic
seizures is admitted for a routine medication evaluation. He has
been taking phenytoin 300 mg daily for the past 6 months. His
current phenytoin serum level is 18 mcg/mL. During the nursing
assessment, the client reports bleeding gums when brushing his
teeth and notes that his gums appear swollen. His vital signs are
stable, and he denies any recent seizures.
Question Stem
Which action should the nurse take first?
A. Hold the next dose of phenytoin and notify the provider of a
suspected toxic level.
B. Instruct the client to use a soft-bristled toothbrush and
,schedule a dental evaluation.
C. Administer the scheduled dose of phenytoin and document
the findings as an expected side effect without further
intervention.
D. Request an order for a complete blood count to evaluate for
phenytoin-induced thrombocytopenia.
Correct Answer
B. Instruct the client to use a soft-bristled toothbrush and
schedule a dental evaluation.
Detailed Rationale
Phenytoin commonly causes gingival hyperplasia (gum
overgrowth), which can lead to bleeding, pain, and poor oral
hygiene. The client's phenytoin serum level of 18 mcg/mL is
well within the standard therapeutic range of 10 to 20 mcg/mL,
indicating that the medication should not be held or adjusted at
this time. The nurse's priority action is to provide proactive
patient teaching on meticulous oral hygiene. This includes
instructing the client to use a soft-bristled toothbrush, floss
gently but regularly, and schedule routine dental evaluations to
professionally manage this expected side effect. Holding the
dose (Option A) is incorrect and potentially dangerous, as
abrupt discontinuation of antiepileptic therapy can precipitate
life-threatening seizures. Administering the dose without
addressing the oral health concern (Option C) represents a
,missed opportunity for crucial patient education. While
phenytoin can rarely cause blood dyscrasias, bleeding gums in
this specific clinical context are overwhelmingly likely due to
gingival hyperplasia, making a complete blood count (Option D)
a lower priority than immediate, practical oral hygiene
education.
Learning Objective
• Identify gingival hyperplasia as an expected side effect of
phenytoin therapy.
• Prioritize patient teaching interventions for managing
phenytoin-induced oral changes.
• Interpret therapeutic phenytoin serum levels (10-20 mcg/mL).
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 68-year-old female is brought to the emergency department
by emergency medical services. She has been experiencing
continuous tonic-clonic seizure activity for the past 8 minutes.
Her airway is patent, and she is receiving 2 L/min of oxygen via
nasal cannula. Her blood pressure is 150/90 mm Hg, heart rate
is 110 beats/min, and respiratory rate is 24 breaths/min.
Intravenous access has been established.
, Question Stem
Which medication should the nurse anticipate administering
first?
A. Lorazepam
B. Phenytoin
C. Levetiracetam
D. Phenobarbital
Correct Answer
A. Lorazepam
Detailed Rationale
The client is in status epilepticus, defined as continuous seizure
activity lasting longer than 5 minutes or recurrent seizures
without regaining consciousness. This is a life-threatening
medical emergency that requires immediate pharmacological
intervention to prevent hypoxic brain injury. The first-line
treatment for status epilepticus is a rapid-acting intravenous
benzodiazepine, such as lorazepam or diazepam, to quickly
terminate the seizure activity. Phenytoin (Option B) and
levetiracetam (Option C) are second-line agents used for
maintenance therapy or to prevent seizure recurrence after the
initial benzodiazepine has successfully aborted the active
seizure. Phenobarbital (Option D) is a third-line agent reserved
for refractory status epilepticus that does not respond to first-
Part 2 Practice Questions |
20 Original NGN MCQs with Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 45-year-old male with a history of generalized tonic-clonic
seizures is admitted for a routine medication evaluation. He has
been taking phenytoin 300 mg daily for the past 6 months. His
current phenytoin serum level is 18 mcg/mL. During the nursing
assessment, the client reports bleeding gums when brushing his
teeth and notes that his gums appear swollen. His vital signs are
stable, and he denies any recent seizures.
Question Stem
Which action should the nurse take first?
A. Hold the next dose of phenytoin and notify the provider of a
suspected toxic level.
B. Instruct the client to use a soft-bristled toothbrush and
,schedule a dental evaluation.
C. Administer the scheduled dose of phenytoin and document
the findings as an expected side effect without further
intervention.
D. Request an order for a complete blood count to evaluate for
phenytoin-induced thrombocytopenia.
Correct Answer
B. Instruct the client to use a soft-bristled toothbrush and
schedule a dental evaluation.
Detailed Rationale
Phenytoin commonly causes gingival hyperplasia (gum
overgrowth), which can lead to bleeding, pain, and poor oral
hygiene. The client's phenytoin serum level of 18 mcg/mL is
well within the standard therapeutic range of 10 to 20 mcg/mL,
indicating that the medication should not be held or adjusted at
this time. The nurse's priority action is to provide proactive
patient teaching on meticulous oral hygiene. This includes
instructing the client to use a soft-bristled toothbrush, floss
gently but regularly, and schedule routine dental evaluations to
professionally manage this expected side effect. Holding the
dose (Option A) is incorrect and potentially dangerous, as
abrupt discontinuation of antiepileptic therapy can precipitate
life-threatening seizures. Administering the dose without
addressing the oral health concern (Option C) represents a
,missed opportunity for crucial patient education. While
phenytoin can rarely cause blood dyscrasias, bleeding gums in
this specific clinical context are overwhelmingly likely due to
gingival hyperplasia, making a complete blood count (Option D)
a lower priority than immediate, practical oral hygiene
education.
Learning Objective
• Identify gingival hyperplasia as an expected side effect of
phenytoin therapy.
• Prioritize patient teaching interventions for managing
phenytoin-induced oral changes.
• Interpret therapeutic phenytoin serum levels (10-20 mcg/mL).
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 68-year-old female is brought to the emergency department
by emergency medical services. She has been experiencing
continuous tonic-clonic seizure activity for the past 8 minutes.
Her airway is patent, and she is receiving 2 L/min of oxygen via
nasal cannula. Her blood pressure is 150/90 mm Hg, heart rate
is 110 beats/min, and respiratory rate is 24 breaths/min.
Intravenous access has been established.
, Question Stem
Which medication should the nurse anticipate administering
first?
A. Lorazepam
B. Phenytoin
C. Levetiracetam
D. Phenobarbital
Correct Answer
A. Lorazepam
Detailed Rationale
The client is in status epilepticus, defined as continuous seizure
activity lasting longer than 5 minutes or recurrent seizures
without regaining consciousness. This is a life-threatening
medical emergency that requires immediate pharmacological
intervention to prevent hypoxic brain injury. The first-line
treatment for status epilepticus is a rapid-acting intravenous
benzodiazepine, such as lorazepam or diazepam, to quickly
terminate the seizure activity. Phenytoin (Option B) and
levetiracetam (Option C) are second-line agents used for
maintenance therapy or to prevent seizure recurrence after the
initial benzodiazepine has successfully aborted the active
seizure. Phenobarbital (Option D) is a third-line agent reserved
for refractory status epilepticus that does not respond to first-
