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Text Mode – Text version of the exam 1. A client with myasthenia gravis has become frequently complaining of weakness and fatigue. The physician plans to identify whether the client is responding to an overdose of the medication or a worsening of the disease. A tensilon test is performed. Which of the following would indicate that the client is experiencing an overdose of the medication? 2. A client with juvenile pilocytic astrocytoma who is receiving Dexamethasone (Decadron) 4mg/IV every 6 hours to relieve symptoms of right arm weakness and headache. Which of the following assessment will concern the nurse most? 3. A client is who is receiving edrophonium chloride suddenly is complaining of abdominal cramps and the nurse observes the client is experiencing increased perspiration and salivation. The nurse makes sure the availability of which of the following? 4. A nurse is instructing a client regarding Carbidopa-levodopa (Sinemet) for the treatment of Parkinson’s disease. The nurse tells the client that which of the following is a side effect of the medication? 5. A nurse is giving dietary instructions to a client receiving levodopa. Which of the following food items should be avoided by the client? 6. Biperiden hydrochloride (Akineton) is added to a list of antiparkinsonian medications that an elderly client is taking. Which of the following instructions made by the nurse that needs further learning? 7. The nurse is giving instructions to a client receiving Phenytoin (Dilantin). The nurse concludes that the client has a sufficient knowledge if the client states that: 8. A 17-year-old client is taking Phenytoin (Dilantin) for the treatment of seizures. Phenytoin blood level reveals to be 25 mcg/ml. Which of the following symptoms would be expected as a result of the laboratory result? 9. A client is prescribed with Carbamazepine (Tegretol) for the treatment of bipolar disorder. Which of the following laboratory results indicates that the client is experiencing a side effect of this medication? 10. A female client who has a history of seizure went to a health care facility to ask the nurse regarding the use of birth control pills while on phenytoin therapy. The nurse correctly states to the client that: 11. Phenobarbital (luminal) is given to a client for a short treatment of anxiety. Which of the following results would indicate a therapeutic serum range of the medication? 12. A pediatric client went to the emergency room complaining of right upper quadrant abdominal pain, nausea, and vomiting. Upon the interview of the nurse to the mother, the client has been taking a long-term use of acetaminophen. An overdosage of the medication is suspected. Which of the following medication should be readily available? 13. A client with bell’s palsy tells the nurse that acetaminophen (Tylenol) is taken daily as prescribed by the physician. Which laboratory value would indicate a toxicity of the medication? 14. A nurse is caring for a client with a history of overdosage of aspirin. The nurse suspects which of the following can be an early sign of aspirin toxicity? 15. Meperidine hydrochloride (Demerol) is given to a client who is experiencing post-operative pain. Which of the following are the side effects of the medication, except? 16. Codeine sulfate is prescribed to a client with a severe back pain. Which of the following side effect is associated with this medication? 17. Mannitol (Osmitrol) an osmotic diuretic which is contraindicated to which conditions? Select all that apply 18. A client with tonic-clonic seizure is receiving Phenobarbital (Luminal) and Valproic acid (Depakene). The nurse tells the client that: 19. A nurse is providing instructions to a client is taking Doxapram (Dopram). Which of the following statements made by the client needs further instructions? 20. Diazepam (Valium) is prescribed to a client with alcohol withdrawal. Which of the following statements made by the client indicates an understanding of the treatment regimen? 1. Answer: A. Temporarily worsening of the condition. Tensilon test/ injection of edrophonium is performed to diagnose cholinergic crisis (overdose with anticholinesterase) or myasthenic crisis (under medication). A tensilon injection makes the client in cholinergic crisis temporarily worse (negative tensilon test). An improvement in the weakness indicates myasthenia crisis. 2. Answer: D. Client still complains of headache. The inability to recognize family members is a new neurologic deficit for this client and indicates a possible increasing intracranial pressure (ICP). 3. Answer: C. Atropine sulfate. The client is experiencing signs of cholinergic crisis. When administering edrophonium chloride, have emergency resuscitation equipment on hand and atropine sulfate available. 4. Answer: A. Difficulty performing a voluntary movement. Dyskinesia (difficulty performing a voluntary movement) is one of the symptoms of a levodopa overdose. Other side effects include nausea, diarrhea, vomiting, hypotension, bradycardia, confusion and hallucinations. 5. Answer: B. Whole grain cereal. When administering levodopa, the client should avoid excessive intake of foods rich in pyridoxine (vitamin B6) which has been found to reduce the effects of levodopa. Large amounts of pyridoxine are also contained in some foods such as bananas, egg yolks, lima beans, meats, peanuts, and whole grain cereals. 6. Answer: C. Walking in the morning to have a daily source of sunlight. Biperiden hydrochloride (Akineton) is an anticholinergic antiparkinson agent used to treat the stiffness, tremors, spasms, and poor muscle control of Parkinson’s disease. Photophobia is one of the side effects of this medication so instruct the client to use sunglasses in direct sunlight. 7. Answer: D. “Have the serum phenytoin level taken before giving the medication”. Taking the prescribed daily dosage to keep the blood level of the drug constant and having a sample drawn for serum drug level before taking the morning dose. 8. Answer: D. Nystagmus. The therapeutic level of phenytoin is 10-20mcg/ml. Higher than 20mcg/ml results in nystagmus (Involuntary eye movement). 9. Answer: A. Neutrophil count of 1,200/mm3. Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It causes a decreased level of platelet count, white blood cells, and neutrophil count. The normal range for neutrophil is 1,500 to 8,000/mm3). 10. Answer: A. Taking phenytoin decreases the effectivity of the birth control pills. Clients taking oral contraceptive are known to suffer contraceptive failure while taking anticonvulsants such as phenobarbitone, phenytoin, and carbamazepine because they decrease the effectiveness of the birth control pills. 11. Answer: B. 15-40 mcg/ml. The therapeutic serum range of phenobarbital is 15-40 ng/ml. 12. Answer: C. Acetylcysteine (Mucomyst). Acetylcysteine (Mucomyst) is the antidote for acetaminophen toxicity. 13. Answer: A. Blood urea nitrogen of 60 mg/dl. Acetaminophen is hepatotoxic. Among the choices, the blood urea nitrogen is elevated. The normal value of BUA is between 7 to 20 mg/dL (2.5 to 7.1 mmol/L). 14. Answer: D. Tinnitus. The earliest symptoms of acute aspirin poisoning may include ringing in the ears (tinnitus) and impaired hearing. 15. Answer: B. Diarrhea. Meperidine hydrochloride is an opioid analgesic. Side effects of this medication are as follows: nausea, vomiting, tremors, hypotension, urinary retention, confusion and respiratory depression 16. Answer: C. Constipation. Codeine Sulfate is an opioid analgesic indicated for the relief of mild to moderately severe pain. Side effects include drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, sweating, and constipation. 17. Answer: A. Pulmonary edema, C. Heart failure, and E. Hyponatremia. Too rapid infusion of large amounts of mannitol injection will cause a shift of intracellular water into the extracellular compartment resulting in cellular dehydration and overexpansion of the intravascular space with hyponatremia, congestive heart failure, and pulmonary edema. 18. Answer: A. Valproic acid decreases phenobarbital metabolism. Valproic acid appear to decrease phenobarbital metabolism, thus there is increase levels of phenobarbital in the body. Therefore, phenobarbital blood levels should be monitored and appropriate dosage adjustments made as indicated. 19. Answer: B. “I need to take the medicaton at bedtime”. Doxapram (Dopram) is a central nervous system stimulant. One of the side effects is insomnia so instruct the client to take it at least 6 hours before bedtime to prevent it. 20. Answer: “Drinking grapefruit can decrease the side effects with this medication”. Diazepam (Valium) can cause side effects such as sleepiness and drowsiness. Meanwhile, grapefruit can reduce the metabolism of this drug. This can result in increased pharmacologic effect of Valium as well as its side effects.Practice Mode
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NCLEX Practice Exam for Pharmacology: Neurological Medications
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