South University NSG 6001 Advanced
Pharmacology ACTUAL EXAM | Week 3
Quiz Review | 50 Questions | 100% Correct
Answers | Verified Q&A | Pass Guaranteed -
A+ Graded
SECTION 1: NEUROLOGIC PHARMACOLOGY (15
Questions)
Q1: A 70-year-old patient with Parkinson's disease takes carbidopa-levodopa 25/100 mg four times
daily. The patient reports that the medication wears off about 1 hour before the next dose is due,
causing increased tremor and difficulty walking. What is the most appropriate management?
A. Instruct the patient to take an extra dose when symptoms occur
B. Document the response and report to the provider for possible dosing adjustment [CORRECT]
C. Suggest the patient discontinue the medication immediately
D. Administer the medication every 2 hours instead of every 4 hours
,Rationale: "Wearing off" phenomenon is common in advanced Parkinson's disease as
dopaminergic neurons continue to degenerate. The appropriate nursing action is to document the
response and report to the provider for possible adjustments (e.g., shorter dosing intervals,
switching to extended-release formulation, or adding adjunctive therapy such as entacapone or a
dopamine agonist). Extra doses (A) require provider orders. Discontinuing medication (C) would
cause severe symptom exacerbation. Changing frequency (D) is beyond nursing scope without
provider order.
Q2: A patient with epilepsy is started on lamotrigine. What is the most important patient education
regarding this medication?
A. Monitor for weight gain and metabolic changes
B. Report any rash immediately, as it may indicate Stevens-Johnson syndrome [CORRECT]
C. Avoid alcohol completely
D. Take with food to prevent GI upset
Rationale: Lamotrigine carries a black box warning for serious rashes including Stevens-Johnson
syndrome (SJS) and toxic epidermal necrolysis (TEN). The risk is highest during the first 2-8 weeks
of treatment. Slow titration is essential: 25 mg/day for 2 weeks, then 50 mg/day for 2 weeks, then
increase by 50-100 mg every 1-2 weeks. South University Note: Any rash with lamotrigine is a
medical emergency requiring immediate discontinuation and evaluation.
Q3: A patient receiving IV phenytoin (Dilantin) develops nystagmus and ataxia. The nurse checks
the serum level and finds it is 28 μg/mL. What is the priority nursing action?
,A. Slow the infusion rate to 25 mg/min
B. Discontinue the infusion immediately [CORRECT]
C. Administer flumazenil
D. Continue infusion and monitor closely
Rationale: The therapeutic range for phenytoin is 10-20 μg/mL. Levels >20 μg/mL cause
nystagmus; >30 μg/mL cause ataxia and slurred speech; >40 μg/mL cause lethargy and confusion.
At 28 μg/mL with symptoms, the infusion must be stopped immediately to prevent progression to
severe toxicity. Flumazenil (C) reverses benzodiazepines, not phenytoin. Maximum infusion rate is
50 mg/min with cardiac monitoring required.
Q4: Which antiepileptic drug requires HLA-B*1502 screening before initiation in patients of Asian
ancestry?
A. Lamotrigine
B. Carbamazepine [CORRECT]
C. Levetiracetam
D. Gabapentin
Rationale: Carbamazepine carries a black box warning for serious dermatologic reactions
(SJS/TEN) in patients with the HLA-B*1502 allele, found primarily in Asian populations (Han
Chinese, Thai, Indian). Screening is required before starting therapy. This genetic testing helps
identify high-risk patients who should avoid carbamazepine. South University Note: This is a critical
safety measure for Week 3 Quiz.
, Q5: A patient with generalized seizures is prescribed valproate (Depakote). Which laboratory
monitoring is essential?
A. Liver function tests and complete blood count [CORRECT]
B. Serum sodium levels only
C. Thyroid function tests
D. Amylase and lipase only
Rationale: Valproate can cause hepatotoxicity (monitor AST, ALT) and thrombocytopenia (monitor
platelet count on CBC). Other adverse effects include pancreatitis, weight gain, tremor, and neural
tube defects (teratogenic). Therapeutic range is 50-125 μg/mL. South University Note: Valproate is
contraindicated in pregnancy due to 1-2% risk of neural tube defects.
Q6: A patient with partial seizures is started on levetiracetam (Keppra). What is the primary
advantage of this medication compared to older antiepileptics?
A. It has no adverse effects
B. It has minimal drug interactions [CORRECT]
C. It does not require dose adjustment in renal impairment
D. It is safe during pregnancy
Pharmacology ACTUAL EXAM | Week 3
Quiz Review | 50 Questions | 100% Correct
Answers | Verified Q&A | Pass Guaranteed -
A+ Graded
SECTION 1: NEUROLOGIC PHARMACOLOGY (15
Questions)
Q1: A 70-year-old patient with Parkinson's disease takes carbidopa-levodopa 25/100 mg four times
daily. The patient reports that the medication wears off about 1 hour before the next dose is due,
causing increased tremor and difficulty walking. What is the most appropriate management?
A. Instruct the patient to take an extra dose when symptoms occur
B. Document the response and report to the provider for possible dosing adjustment [CORRECT]
C. Suggest the patient discontinue the medication immediately
D. Administer the medication every 2 hours instead of every 4 hours
,Rationale: "Wearing off" phenomenon is common in advanced Parkinson's disease as
dopaminergic neurons continue to degenerate. The appropriate nursing action is to document the
response and report to the provider for possible adjustments (e.g., shorter dosing intervals,
switching to extended-release formulation, or adding adjunctive therapy such as entacapone or a
dopamine agonist). Extra doses (A) require provider orders. Discontinuing medication (C) would
cause severe symptom exacerbation. Changing frequency (D) is beyond nursing scope without
provider order.
Q2: A patient with epilepsy is started on lamotrigine. What is the most important patient education
regarding this medication?
A. Monitor for weight gain and metabolic changes
B. Report any rash immediately, as it may indicate Stevens-Johnson syndrome [CORRECT]
C. Avoid alcohol completely
D. Take with food to prevent GI upset
Rationale: Lamotrigine carries a black box warning for serious rashes including Stevens-Johnson
syndrome (SJS) and toxic epidermal necrolysis (TEN). The risk is highest during the first 2-8 weeks
of treatment. Slow titration is essential: 25 mg/day for 2 weeks, then 50 mg/day for 2 weeks, then
increase by 50-100 mg every 1-2 weeks. South University Note: Any rash with lamotrigine is a
medical emergency requiring immediate discontinuation and evaluation.
Q3: A patient receiving IV phenytoin (Dilantin) develops nystagmus and ataxia. The nurse checks
the serum level and finds it is 28 μg/mL. What is the priority nursing action?
,A. Slow the infusion rate to 25 mg/min
B. Discontinue the infusion immediately [CORRECT]
C. Administer flumazenil
D. Continue infusion and monitor closely
Rationale: The therapeutic range for phenytoin is 10-20 μg/mL. Levels >20 μg/mL cause
nystagmus; >30 μg/mL cause ataxia and slurred speech; >40 μg/mL cause lethargy and confusion.
At 28 μg/mL with symptoms, the infusion must be stopped immediately to prevent progression to
severe toxicity. Flumazenil (C) reverses benzodiazepines, not phenytoin. Maximum infusion rate is
50 mg/min with cardiac monitoring required.
Q4: Which antiepileptic drug requires HLA-B*1502 screening before initiation in patients of Asian
ancestry?
A. Lamotrigine
B. Carbamazepine [CORRECT]
C. Levetiracetam
D. Gabapentin
Rationale: Carbamazepine carries a black box warning for serious dermatologic reactions
(SJS/TEN) in patients with the HLA-B*1502 allele, found primarily in Asian populations (Han
Chinese, Thai, Indian). Screening is required before starting therapy. This genetic testing helps
identify high-risk patients who should avoid carbamazepine. South University Note: This is a critical
safety measure for Week 3 Quiz.
, Q5: A patient with generalized seizures is prescribed valproate (Depakote). Which laboratory
monitoring is essential?
A. Liver function tests and complete blood count [CORRECT]
B. Serum sodium levels only
C. Thyroid function tests
D. Amylase and lipase only
Rationale: Valproate can cause hepatotoxicity (monitor AST, ALT) and thrombocytopenia (monitor
platelet count on CBC). Other adverse effects include pancreatitis, weight gain, tremor, and neural
tube defects (teratogenic). Therapeutic range is 50-125 μg/mL. South University Note: Valproate is
contraindicated in pregnancy due to 1-2% risk of neural tube defects.
Q6: A patient with partial seizures is started on levetiracetam (Keppra). What is the primary
advantage of this medication compared to older antiepileptics?
A. It has no adverse effects
B. It has minimal drug interactions [CORRECT]
C. It does not require dose adjustment in renal impairment
D. It is safe during pregnancy
