N180 | N180 Exam 4: Pharmacology - WCU
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient is prescribed Phenytoin for the management of tonic-clonic seizures. Which
adverse effect should the nurse specifically educate the patient about regarding oral hygiene?
A. Xerostomia
B. Glossitis
C. Oral candidiasis
D. Gingival hyperplasia
Correct Answer: D
Rationale: Phenytoin is a hydantoin anticonvulsant that commonly causes overgrowth of
gum tissue. Regular dental check-ups and thorough oral hygiene are essential to mitigate
this side effect. The nurse should instruct the patient to massage the gums and use a soft
toothbrush. Gingival hyperplasia can often be managed with proper dental care but may
require surgical intervention in severe cases. Other choices like xerostomia or oral
candidiasis are not characteristic side effects of phenytoin therapy.
2. When teaching a patient about Levodopa/Carbidopa therapy for Parkinson’s disease,
which dietary instruction is most critical?
A. Distribute protein intake evenly throughout the day.
B. Avoid foods high in tyramine like aged cheeses.
C. Increase intake of high-protein meals to boost energy.
D. Consume large amounts of Vitamin B6 supplements.
Correct Answer: A
Rationale: Levodopa competes with amino acids for transport across the blood-brain
barrier. High-protein meals can decrease the absorption and effectiveness of the
medication, potentially causing an ‘off’ period. Patients are advised to limit protein intake
at breakfast and lunch and consume more at dinner. Carbidopa is added to prevent
peripheral metabolism of levodopa, but amino acid competition remains a factor. Vitamin
B6 should actually be monitored as it can decrease the efficacy of levodopa if not taken
with carbidopa.
3. A patient taking Lithium Carbonate for Bipolar Disorder reports vomiting, abdominal pain,
and tremors. What is the nurse’s priority action?
A. Hold the medication and notify the provider.
B. Assess the patient’s sodium intake.
,C. Administer the next dose as scheduled.
D. Encourage increased fluid intake immediately.
Correct Answer: A
Rationale: Vomiting, tremors, and abdominal pain are early signs of lithium toxicity. The
therapeutic index for lithium is very narrow, and these symptoms require immediate
medical evaluation. The nurse must hold the dose to prevent further accumulation of the
drug in the system. Serum lithium levels should be drawn to confirm the toxicity level.
While sodium and fluids affect lithium levels, the priority is to stop administration and seek
intervention.
4. A patient is starting Fluoxetine (an SSRI) for depression. Which statement by the patient
indicates a need for further education?
A. ‘I should see a full improvement in my mood by next week.’
B. ‘I need to report any suicidal thoughts to my doctor immediately.’
C. ‘I will not stop taking this medication abruptly.’
D. ‘I should watch for signs of serotonin syndrome like sweating and fever.’
Correct Answer: A
Rationale: SSRIs like fluoxetine typically take 4 to 6 weeks to reach full therapeutic effect.
Expecting results within one week shows a misunderstanding of the medication’s onset of
action. Patients are at an increased risk of suicide during the initial phase as their energy
improves before their mood does. Tapering is necessary to avoid SSRI discontinuation
syndrome. Serotonin syndrome is a life-threatening complication that requires immediate
recognition of symptoms like agitation and hyperreflexia.
5. Which laboratory value is most important for a nurse to monitor in a patient receiving
Clozapine?
A. Platelet count
B. Serum creatinine
C. Liver enzymes
D. White blood cell (WBC) count
Correct Answer: D
Rationale: Clozapine is an atypical antipsychotic associated with a high risk of
agranulocytosis. Agranulocytosis is a severe reduction in the WBC count, specifically
neutrophils, which can lead to fatal infections. Strict monitoring protocols require weekly
blood draws for the first six months of therapy. Treatment must be discontinued if the
absolute neutrophil count (ANC) drops below a specific threshold. While other labs are
important, WBC monitoring is the legal and safety requirement for clozapine.
, 6. A patient with Alzheimer’s disease is prescribed Donepezil. What is the primary mechanism
of action for this drug?
A. Increasing the breakdown of acetylcholine in the synapse.
B. Inhibiting the enzyme acetylcholinesterase.
C. Blocking NMDA receptors to prevent glutamate toxicity.
D. Stimulating the release of dopamine in the CNS.
Correct Answer: B
Rationale: Donepezil works by inhibiting the enzyme responsible for breaking down
acetylcholine. This increases the availability of acetylcholine at the cholinergic synapses,
which helps improve cognitive function. It is used primarily for mild to moderate
Alzheimer’s symptoms. Common side effects are cholinergic in nature, including
bradycardia and diarrhea. NMDA receptor blockers describe the action of Memantine, not
Donepezil.
7. A patient taking Cyclosporine after an organ transplant should be advised to avoid which of
the following?
A. Leafy green vegetables
B. Over-the-counter acetaminophen
C. Caffeinated beverages
D. Grapefruit juice
Correct Answer: D
Rationale: Grapefruit juice inhibits the CYP3A4 enzyme system, which is responsible for
metabolizing cyclosporine. Consuming grapefruit juice can lead to toxic levels of the drug in
the blood, increasing the risk of nephrotoxicity. Patients must be educated to avoid this
juice entirely to maintain stable therapeutic levels. Cyclosporine is a potent
immunosuppressant used to prevent organ rejection. Monitoring blood pressure and renal
function is also a standard part of patient care.
8. The nurse is caring for a patient on Phenelzine (an MAOI). Which food item should the
nurse remove from the patient’s meal tray?
A. Fresh grilled chicken
B. Applesauce
C. Baked potato
D. Aged cheddar cheese
Correct Answer: D
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient is prescribed Phenytoin for the management of tonic-clonic seizures. Which
adverse effect should the nurse specifically educate the patient about regarding oral hygiene?
A. Xerostomia
B. Glossitis
C. Oral candidiasis
D. Gingival hyperplasia
Correct Answer: D
Rationale: Phenytoin is a hydantoin anticonvulsant that commonly causes overgrowth of
gum tissue. Regular dental check-ups and thorough oral hygiene are essential to mitigate
this side effect. The nurse should instruct the patient to massage the gums and use a soft
toothbrush. Gingival hyperplasia can often be managed with proper dental care but may
require surgical intervention in severe cases. Other choices like xerostomia or oral
candidiasis are not characteristic side effects of phenytoin therapy.
2. When teaching a patient about Levodopa/Carbidopa therapy for Parkinson’s disease,
which dietary instruction is most critical?
A. Distribute protein intake evenly throughout the day.
B. Avoid foods high in tyramine like aged cheeses.
C. Increase intake of high-protein meals to boost energy.
D. Consume large amounts of Vitamin B6 supplements.
Correct Answer: A
Rationale: Levodopa competes with amino acids for transport across the blood-brain
barrier. High-protein meals can decrease the absorption and effectiveness of the
medication, potentially causing an ‘off’ period. Patients are advised to limit protein intake
at breakfast and lunch and consume more at dinner. Carbidopa is added to prevent
peripheral metabolism of levodopa, but amino acid competition remains a factor. Vitamin
B6 should actually be monitored as it can decrease the efficacy of levodopa if not taken
with carbidopa.
3. A patient taking Lithium Carbonate for Bipolar Disorder reports vomiting, abdominal pain,
and tremors. What is the nurse’s priority action?
A. Hold the medication and notify the provider.
B. Assess the patient’s sodium intake.
,C. Administer the next dose as scheduled.
D. Encourage increased fluid intake immediately.
Correct Answer: A
Rationale: Vomiting, tremors, and abdominal pain are early signs of lithium toxicity. The
therapeutic index for lithium is very narrow, and these symptoms require immediate
medical evaluation. The nurse must hold the dose to prevent further accumulation of the
drug in the system. Serum lithium levels should be drawn to confirm the toxicity level.
While sodium and fluids affect lithium levels, the priority is to stop administration and seek
intervention.
4. A patient is starting Fluoxetine (an SSRI) for depression. Which statement by the patient
indicates a need for further education?
A. ‘I should see a full improvement in my mood by next week.’
B. ‘I need to report any suicidal thoughts to my doctor immediately.’
C. ‘I will not stop taking this medication abruptly.’
D. ‘I should watch for signs of serotonin syndrome like sweating and fever.’
Correct Answer: A
Rationale: SSRIs like fluoxetine typically take 4 to 6 weeks to reach full therapeutic effect.
Expecting results within one week shows a misunderstanding of the medication’s onset of
action. Patients are at an increased risk of suicide during the initial phase as their energy
improves before their mood does. Tapering is necessary to avoid SSRI discontinuation
syndrome. Serotonin syndrome is a life-threatening complication that requires immediate
recognition of symptoms like agitation and hyperreflexia.
5. Which laboratory value is most important for a nurse to monitor in a patient receiving
Clozapine?
A. Platelet count
B. Serum creatinine
C. Liver enzymes
D. White blood cell (WBC) count
Correct Answer: D
Rationale: Clozapine is an atypical antipsychotic associated with a high risk of
agranulocytosis. Agranulocytosis is a severe reduction in the WBC count, specifically
neutrophils, which can lead to fatal infections. Strict monitoring protocols require weekly
blood draws for the first six months of therapy. Treatment must be discontinued if the
absolute neutrophil count (ANC) drops below a specific threshold. While other labs are
important, WBC monitoring is the legal and safety requirement for clozapine.
, 6. A patient with Alzheimer’s disease is prescribed Donepezil. What is the primary mechanism
of action for this drug?
A. Increasing the breakdown of acetylcholine in the synapse.
B. Inhibiting the enzyme acetylcholinesterase.
C. Blocking NMDA receptors to prevent glutamate toxicity.
D. Stimulating the release of dopamine in the CNS.
Correct Answer: B
Rationale: Donepezil works by inhibiting the enzyme responsible for breaking down
acetylcholine. This increases the availability of acetylcholine at the cholinergic synapses,
which helps improve cognitive function. It is used primarily for mild to moderate
Alzheimer’s symptoms. Common side effects are cholinergic in nature, including
bradycardia and diarrhea. NMDA receptor blockers describe the action of Memantine, not
Donepezil.
7. A patient taking Cyclosporine after an organ transplant should be advised to avoid which of
the following?
A. Leafy green vegetables
B. Over-the-counter acetaminophen
C. Caffeinated beverages
D. Grapefruit juice
Correct Answer: D
Rationale: Grapefruit juice inhibits the CYP3A4 enzyme system, which is responsible for
metabolizing cyclosporine. Consuming grapefruit juice can lead to toxic levels of the drug in
the blood, increasing the risk of nephrotoxicity. Patients must be educated to avoid this
juice entirely to maintain stable therapeutic levels. Cyclosporine is a potent
immunosuppressant used to prevent organ rejection. Monitoring blood pressure and renal
function is also a standard part of patient care.
8. The nurse is caring for a patient on Phenelzine (an MAOI). Which food item should the
nurse remove from the patient’s meal tray?
A. Fresh grilled chicken
B. Applesauce
C. Baked potato
D. Aged cheddar cheese
Correct Answer: D
