MARYVILLE NURS 615 PHARM EXAM 2 / COMPREHENSIVE STUDY GUIDE –
EXPERT STRATEGIES, REVIEW OF ALL QUIZZES, AND PRACTICE QUESTIONS FOR
GUARANTEED SUCCESS / NEWEST 2025/2026(REAL DEAL).
Question 1
A patient on a stable dose of carbamazepine (Tegretol) for seizure control has a blood level
drawn that shows a subtherapeutic range, despite reporting good compliance. What is the most
likely reason for this finding?
A) The patient is not absorbing the medication properly.
B) Carbamazepine auto-induces its own metabolism.
C) The medication has a very short half-life.
D) The patient has developed a tolerance to the drug.
Correct Answer: B) Carbamazepine auto-induces its own metabolism.
Rationale: Carbamazepine is a potent enzyme inducer, including of the enzymes responsible
for its own breakdown. This "auto-induction" means that over time, the drug metabolizes
itself more quickly, leading to lower serum levels, which may require a dose adjustment.
Question 2
Carbamazepine carries a black box warning for which of the following potentially life-
threatening adverse effects?
A) Hepatotoxicity and pancreatitis.
B) Agranulocytosis and aplastic anemia.
C) Stevens-Johnson syndrome and toxic epidermal necrolysis.
D) Suicidal ideation and behavior.
Correct Answer: C) Stevens-Johnson syndrome and toxic epidermal necrolysis.
Rationale: Carbamazepine has a significant risk of causing severe dermatologic reactions like
SJS and TEN, particularly in patients of Asian descent with the HLA-B*1502 allele. Aplastic
anemia and agranulocytosis are also black box warnings, but the question asks for the
dermatologic reactions.
Question 3
Due to the risk of bone marrow suppression, which laboratory test should be monitored
periodically for a patient taking carbamazepine?
,A) Liver function tests (AST, ALT)
B) Renal function tests (BUN, creatinine)
C) Complete blood count (CBC) with differential
D) Serum electrolytes
Correct Answer: C) Complete blood count (CBC) with differential
Rationale: Carbamazepine can cause hematologic side effects, including leukopenia,
thrombocytopenia, and aplastic anemia. A baseline CBC is required, and it should be
monitored periodically (e.g., every 3-4 months) during treatment.
Question 4
When providing education to the family of a child newly diagnosed with a seizure disorder and
starting an antiepileptic drug, what is the most important instruction?
A) "You can skip a dose if the child seems drowsy."
B) "It is safe to drink alcohol with this medication."
C) "Do not stop taking the medication abruptly."
D) "Double the next dose if one is missed."
Correct Answer: C) "Do not stop taking the medication abruptly."
Rationale: Abruptly discontinuing an antiepileptic drug can lower the seizure threshold and
precipitate rebound seizures or status epilepticus, which can be life-threatening.
Question 5
Ethosuximide (Zarontin), an antiepileptic drug primarily used for absence seizures, requires
monitoring for which serious adverse effect?
A) Hepatotoxicity
B) Renal failure
C) Blood dyscrasias
D) Hypertensive crisis
Correct Answer: C) Blood dyscrasias
Rationale: Ethosuximide can cause rare but serious blood dyscrasias, including leukopenia,
agranulocytosis, and aplastic anemia. Patients should be monitored for signs of infection or
bleeding.
,Question 6
A patient taking topiramate (Topamax) should be monitored for which electrolyte imbalance?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Decreased sodium bicarbonate leading to metabolic acidosis.
Correct Answer: D) Decreased sodium bicarbonate leading to metabolic acidosis.
Rationale: Topiramate is a weak carbonic anhydrase inhibitor, which can lead to a decrease in
serum bicarbonate levels and result in a hyperchloremic, non-anion gap metabolic acidosis.
Question 7
A common side effect of topiramate (Topamax), especially at higher doses, which can be a
therapeutic benefit in some patients, is:
A) Weight gain
B) Sedation
C) Weight loss
D) Hypertension
Correct Answer: C) Weight loss
Rationale: Weight loss is a well-documented side effect of topiramate and is one reason it is
also used in combination with phentermine for weight management.
Question 8
A pregnant patient asks about the safety of continuing her prescription for valproate (Depakote)
for seizure control. The provider should explain that:
A) Valproate is a Category X medication and a known teratogen, especially in the first trimester.
B) Valproate is completely safe to use throughout the entire pregnancy.
C) The dose of valproate should be doubled during pregnancy.
D) Valproate can only be used if the patient also takes folic acid.
Correct Answer: A) Valproate is a Category X medication and a known teratogen, especially in
the first trimester.
Rationale: Valproate has a high risk of causing major congenital malformations, particularly
, neural tube defects. Its use is strongly contraindicated during the first trimester, and the risks
versus benefits must be carefully weighed for the remainder of the pregnancy.
Question 9
In which patient population should tricyclic antidepressants (TCAs) be used with extreme
caution due to their potential for cardiotoxicity?
A) Patients with diabetes
B) Patients with underlying heart disease
C) Patients with asthma
D) Patients with renal impairment
Correct Answer: B) Patients with underlying heart disease
Rationale: TCAs can cause conduction delays (e.g., QRS/QT prolongation) and arrhythmias.
They are relatively contraindicated in patients with pre-existing cardiac conditions, as they
can worsen these conditions and are lethal in overdose.
Question 10
A patient is prescribed the MAOI phenelzine (Nardil). Which instruction is critical for the nurse
practitioner to provide?
A) "Take this medication with a full glass of milk."
B) "You can continue to take your sumatriptan (Imitrex) for migraines."
C) "Avoid foods like aged cheese, soy sauce, and sour cream."
D) "This medication may cause your blood pressure to drop, so rise slowly."
Correct Answer: C) "Avoid foods like aged cheese, soy sauce, and sour cream."
Rationale: MAOIs block the breakdown of tyramine, an amino acid found in aged and
fermented foods. Ingesting tyramine-rich foods while taking an MAOI can lead to a sudden,
severe, and potentially fatal hypertensive crisis.
Question 11
Which of the following is NOT a typical anticholinergic side effect of tricyclic antidepressants?
A) Dry mouth
B) Diarrhea
EXPERT STRATEGIES, REVIEW OF ALL QUIZZES, AND PRACTICE QUESTIONS FOR
GUARANTEED SUCCESS / NEWEST 2025/2026(REAL DEAL).
Question 1
A patient on a stable dose of carbamazepine (Tegretol) for seizure control has a blood level
drawn that shows a subtherapeutic range, despite reporting good compliance. What is the most
likely reason for this finding?
A) The patient is not absorbing the medication properly.
B) Carbamazepine auto-induces its own metabolism.
C) The medication has a very short half-life.
D) The patient has developed a tolerance to the drug.
Correct Answer: B) Carbamazepine auto-induces its own metabolism.
Rationale: Carbamazepine is a potent enzyme inducer, including of the enzymes responsible
for its own breakdown. This "auto-induction" means that over time, the drug metabolizes
itself more quickly, leading to lower serum levels, which may require a dose adjustment.
Question 2
Carbamazepine carries a black box warning for which of the following potentially life-
threatening adverse effects?
A) Hepatotoxicity and pancreatitis.
B) Agranulocytosis and aplastic anemia.
C) Stevens-Johnson syndrome and toxic epidermal necrolysis.
D) Suicidal ideation and behavior.
Correct Answer: C) Stevens-Johnson syndrome and toxic epidermal necrolysis.
Rationale: Carbamazepine has a significant risk of causing severe dermatologic reactions like
SJS and TEN, particularly in patients of Asian descent with the HLA-B*1502 allele. Aplastic
anemia and agranulocytosis are also black box warnings, but the question asks for the
dermatologic reactions.
Question 3
Due to the risk of bone marrow suppression, which laboratory test should be monitored
periodically for a patient taking carbamazepine?
,A) Liver function tests (AST, ALT)
B) Renal function tests (BUN, creatinine)
C) Complete blood count (CBC) with differential
D) Serum electrolytes
Correct Answer: C) Complete blood count (CBC) with differential
Rationale: Carbamazepine can cause hematologic side effects, including leukopenia,
thrombocytopenia, and aplastic anemia. A baseline CBC is required, and it should be
monitored periodically (e.g., every 3-4 months) during treatment.
Question 4
When providing education to the family of a child newly diagnosed with a seizure disorder and
starting an antiepileptic drug, what is the most important instruction?
A) "You can skip a dose if the child seems drowsy."
B) "It is safe to drink alcohol with this medication."
C) "Do not stop taking the medication abruptly."
D) "Double the next dose if one is missed."
Correct Answer: C) "Do not stop taking the medication abruptly."
Rationale: Abruptly discontinuing an antiepileptic drug can lower the seizure threshold and
precipitate rebound seizures or status epilepticus, which can be life-threatening.
Question 5
Ethosuximide (Zarontin), an antiepileptic drug primarily used for absence seizures, requires
monitoring for which serious adverse effect?
A) Hepatotoxicity
B) Renal failure
C) Blood dyscrasias
D) Hypertensive crisis
Correct Answer: C) Blood dyscrasias
Rationale: Ethosuximide can cause rare but serious blood dyscrasias, including leukopenia,
agranulocytosis, and aplastic anemia. Patients should be monitored for signs of infection or
bleeding.
,Question 6
A patient taking topiramate (Topamax) should be monitored for which electrolyte imbalance?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Decreased sodium bicarbonate leading to metabolic acidosis.
Correct Answer: D) Decreased sodium bicarbonate leading to metabolic acidosis.
Rationale: Topiramate is a weak carbonic anhydrase inhibitor, which can lead to a decrease in
serum bicarbonate levels and result in a hyperchloremic, non-anion gap metabolic acidosis.
Question 7
A common side effect of topiramate (Topamax), especially at higher doses, which can be a
therapeutic benefit in some patients, is:
A) Weight gain
B) Sedation
C) Weight loss
D) Hypertension
Correct Answer: C) Weight loss
Rationale: Weight loss is a well-documented side effect of topiramate and is one reason it is
also used in combination with phentermine for weight management.
Question 8
A pregnant patient asks about the safety of continuing her prescription for valproate (Depakote)
for seizure control. The provider should explain that:
A) Valproate is a Category X medication and a known teratogen, especially in the first trimester.
B) Valproate is completely safe to use throughout the entire pregnancy.
C) The dose of valproate should be doubled during pregnancy.
D) Valproate can only be used if the patient also takes folic acid.
Correct Answer: A) Valproate is a Category X medication and a known teratogen, especially in
the first trimester.
Rationale: Valproate has a high risk of causing major congenital malformations, particularly
, neural tube defects. Its use is strongly contraindicated during the first trimester, and the risks
versus benefits must be carefully weighed for the remainder of the pregnancy.
Question 9
In which patient population should tricyclic antidepressants (TCAs) be used with extreme
caution due to their potential for cardiotoxicity?
A) Patients with diabetes
B) Patients with underlying heart disease
C) Patients with asthma
D) Patients with renal impairment
Correct Answer: B) Patients with underlying heart disease
Rationale: TCAs can cause conduction delays (e.g., QRS/QT prolongation) and arrhythmias.
They are relatively contraindicated in patients with pre-existing cardiac conditions, as they
can worsen these conditions and are lethal in overdose.
Question 10
A patient is prescribed the MAOI phenelzine (Nardil). Which instruction is critical for the nurse
practitioner to provide?
A) "Take this medication with a full glass of milk."
B) "You can continue to take your sumatriptan (Imitrex) for migraines."
C) "Avoid foods like aged cheese, soy sauce, and sour cream."
D) "This medication may cause your blood pressure to drop, so rise slowly."
Correct Answer: C) "Avoid foods like aged cheese, soy sauce, and sour cream."
Rationale: MAOIs block the breakdown of tyramine, an amino acid found in aged and
fermented foods. Ingesting tyramine-rich foods while taking an MAOI can lead to a sudden,
severe, and potentially fatal hypertensive crisis.
Question 11
Which of the following is NOT a typical anticholinergic side effect of tricyclic antidepressants?
A) Dry mouth
B) Diarrhea
