Neurology Medication Case Studies Practice Exam

Case Study 1: Dilantin (Phenytoin) for Seizure Control

Patient: 35-year-old female with a history of tonic-clonic seizures, started on phenytoin (Dilantin) 100 mg PO TID for seizure control.

Q1. Highlight the assessment findings that are most concerning for a patient on phenytoin:

Q2. Which order should the nurse question?

Q3. Select all teaching points for phenytoin:

Q4. Place the following nursing actions in order of priority if the patient develops a rash and confusion:

1. --Select--Stop phenytoinNotify the providerAssess airway and vital signsDocument findings
2. --Select--Stop phenytoinNotify the providerAssess airway and vital signsDocument findings
3. --Select--Stop phenytoinNotify the providerAssess airway and vital signsDocument findings
4. --Select--Stop phenytoinNotify the providerAssess airway and vital signsDocument findings

Q5. Matrix: Indicate if each is a common or serious side effect of phenytoin:

Side Effect	Common	Serious
Gingival hyperplasia
Stevens-Johnson syndrome
Ataxia

Q6. Which finding requires immediate provider notification?

Case Study 2: Tegretol (Carbamazepine) for Seizure Control

Patient: 42-year-old male with new-onset partial seizures, started on carbamazepine (Tegretol) 200 mg PO BID.

Q7. Highlight the assessment findings that are most concerning for a patient on carbamazepine:

Q8. Which order should the nurse question?

Q9. Select all teaching points for carbamazepine:

Q10. Place the following nursing actions in order of priority if the patient develops fever and sore throat:

1. --Select--Hold carbamazepineNotify the providerAssess for infectionDocument findings
2. --Select--Hold carbamazepineNotify the providerAssess for infectionDocument findings
3. --Select--Hold carbamazepineNotify the providerAssess for infectionDocument findings
4. --Select--Hold carbamazepineNotify the providerAssess for infectionDocument findings

Q11. Matrix: Indicate if each is a common or serious side effect of carbamazepine:

Side Effect	Common	Serious
Dizziness
Leukopenia
Rash

Q12. Which finding requires immediate provider notification?

Case Study 3: Lamictal (Lamotrigine) for Seizure Control

Patient: 28-year-old female with generalized epilepsy, started on lamotrigine (Lamictal) 25 mg PO daily, titrated upward.

Q13. Highlight the assessment findings that are most concerning for a patient on lamotrigine:

Q14. Which order should the nurse question?

Q15. Select all teaching points for lamotrigine:

Q16. Place the following nursing actions in order of priority if the patient develops a rash and fever:

1. --Select--Hold lamotrigineNotify the providerAssess airway and vital signsDocument findings
2. --Select--Hold lamotrigineNotify the providerAssess airway and vital signsDocument findings
3. --Select--Hold lamotrigineNotify the providerAssess airway and vital signsDocument findings
4. --Select--Hold lamotrigineNotify the providerAssess airway and vital signsDocument findings

Q17. Matrix: Indicate if each is a common or serious side effect of lamotrigine:

Side Effect	Common	Serious
Headache
Rash
Diplopia

Q18. Which finding requires immediate provider notification?

Case Study 4: Sinemet (Carbidopa/Levodopa) for Parkinson's Disease

Patient: 70-year-old male with Parkinson’s disease, prescribed Sinemet (carbidopa/levodopa) three times daily.

Q19. Highlight the assessment findings that are most concerning for a patient on Sinemet:

Q20. Which order should the nurse question?
Monitor for dyskinesias
Administer with high-protein meal
Monitor for orthostatic hypotension
Assess for changes in mental status

Q21. Select all teaching points for Sinemet:
Change positions slowly to prevent dizziness
Report involuntary movements or mental changes
Urine and sweat may turn dark
Avoid taking with high-protein meals

Q22. Place the following nursing actions in order of priority if the patient develops new confusion and involuntary facial movements:

1. --Select--Hold the next Sinemet doseAssess mental status and movementNotify the providerDocument findings
2. --Select--Hold the next Sinemet doseAssess mental status and movementNotify the providerDocument findings
3. --Select--Hold the next Sinemet doseAssess mental status and movementNotify the providerDocument findings
4. --Select--Hold the next Sinemet doseAssess mental status and movementNotify the providerDocument findings

Q23. Matrix: Indicate if each is a common or serious side effect of Sinemet:

Side Effect	Common	Serious
Mild nausea
Dyskinesias (involuntary movements)
Hallucinations/confusion

Q24. Which finding requires immediate provider notification?
New confusion and involuntary movements
Mild nausea
Dark urine

Case Study 5: Ritalin (Methylphenidate) for ADHD

Patient: 10-year-old male diagnosed with ADHD, prescribed Ritalin (methylphenidate) 10 mg twice daily.

Q25. Highlight the assessment findings that are most concerning for a patient on Ritalin:

Q26. Which order should the nurse question?
Give Ritalin after 4 pm
Monitor growth and weight
Monitor blood pressure and heart rate
Give medication with breakfast

Q27. Select all teaching points for Ritalin:
Take dose early in the day
Monitor for appetite and weight changes
Report rapid heartbeat or hallucinations
Do not stop medication abruptly

Q28. Place the following nursing actions in order of priority if the patient develops hallucinations and rapid heart rate:

1. --Select--Hold the next Ritalin doseAssess vital signs and mental statusNotify the providerDocument findings
2. --Select--Hold the next Ritalin doseAssess vital signs and mental statusNotify the providerDocument findings
3. --Select--Hold the next Ritalin doseAssess vital signs and mental statusNotify the providerDocument findings
4. --Select--Hold the next Ritalin doseAssess vital signs and mental statusNotify the providerDocument findings

Q29. Matrix: Indicate if each is a common or serious side effect of Ritalin:

Side Effect	Common	Serious
Trouble falling asleep
Hallucinations
Loss of appetite/weight loss

Q30. Which finding requires immediate provider notification?
Hallucinations and rapid heart rate
Trouble falling asleep
Loss of appetite

Case Study 6: Ambien (Zolpidem) for Insomnia

Patient: 56-year-old female with chronic insomnia, prescribed Ambien (zolpidem) 10 mg at bedtime as needed.

Q31. Highlight the assessment findings that are most concerning for a patient on Ambien:

Q32. Which order should the nurse question?
Instruct patient to take Ambien right before bed
Monitor for sleep behaviors such as sleepwalking
Allow patient to get up and walk around after taking Ambien
Assess for dizziness or confusion

Q33. Select all teaching points for Ambien:
Take only when able to get a full night’s sleep
Do not take with alcohol or other sedatives
Report sleepwalking or unusual behaviors
Avoid driving until you know how Ambien affects you

Q34. Place the following nursing actions in order of priority if the patient experiences sleepwalking and hallucinations:

1. --Select--Ensure patient safetyHold further Ambien dosesNotify the providerDocument findings
2. --Select--Ensure patient safetyHold further Ambien dosesNotify the providerDocument findings
3. --Select--Ensure patient safetyHold further Ambien dosesNotify the providerDocument findings
4. --Select--Ensure patient safetyHold further Ambien dosesNotify the providerDocument findings

Q35. Matrix: Indicate if each is a common or serious side effect of Ambien:

Side Effect	Common	Serious
Somnolence
Sleepwalking
Hallucinations

Q36. Which finding requires immediate provider notification?
Sleepwalking and hallucinations
Dizziness
Somnolence the next morning