NCLEX-RN Neurological System Part 2
Pharmacology Exam Questions with Rationales
| 20 Original NGN Practice MCQs |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old male with Parkinson’s disease is taking
levodopa/carbidopa. During a follow-up visit, he reports that
the medication works well in the morning but its effects seem
to "wear off" by late afternoon. He mentions that he typically
eats a high-protein breakfast consisting of eggs and bacon. His
vital signs are stable, and his current neurological assessment
shows mild resting tremors.
Question Stem
Which instruction should the nurse provide to improve the
medication's effectiveness?
A. Take the medication with a high-protein snack to prevent
nausea.
B. Divide the daily protein intake evenly throughout the day.
,C. Crush the tablets and mix them with applesauce for faster
absorption.
D. Double the afternoon dose if symptoms return before the
next scheduled dose.
Correct Answer
Correct Answer: B. Divide the daily protein intake evenly
throughout the day.
Detailed Rationale
Levodopa competes with dietary amino acids (protein) for
absorption in the small intestine and for transport across the
blood-brain barrier. Consuming high-protein meals, especially
close to medication administration, can significantly decrease
the drug's bioavailability and clinical effectiveness, leading to a
"wearing-off" phenomenon. Distributing protein intake evenly
throughout the day or taking the medication 30 to 60 minutes
before meals optimizes absorption and therapeutic response.
Option A is incorrect because a high-protein snack would
exacerbate the wearing-off effect. Option C is incorrect because
crushing tablets (especially if they are controlled-release
formulations) can alter absorption rates and is not a solution to
protein interaction. Option D is unsafe; patients should never
independently double doses due to the high risk of levodopa-
induced dyskinesia, hallucinations, or cardiovascular instability.
Learning Objective
, • Explain the interaction between levodopa/carbidopa and
dietary protein.
• Educate patients on dietary modifications to optimize
Parkinson’s disease medication efficacy.
• Recognize the signs of the "wearing-off" phenomenon in
Parkinson’s disease.
Medication Safety Focus
Patient education / Medication administration
Question 2
Clinical Scenario
A 76-year-old female with moderate Alzheimer’s disease is
brought to the clinic by her daughter. She was recently started
on donepezil 5 mg daily. The nurse obtains the following vital
signs: Blood pressure 118/72 mm Hg, Heart rate 52 beats/min,
Respiratory rate 16 breaths/min, Temperature 37.0°C (98.6°F).
The client appears alert but has mild short-term memory
deficits.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled morning dose of donepezil.
B. Hold the medication and notify the healthcare provider.
C. Encourage the client to drink 500 mL of water immediately.
, D. Assess the client’s short-term memory using a standardized
tool.
Correct Answer
Correct Answer: B. Hold the medication and notify the
healthcare provider.
Detailed Rationale
Donepezil is a cholinesterase inhibitor that increases
acetylcholine levels in the brain. A well-known adverse effect of
cholinergic medications is vagotonic action on the sinoatrial
node, which can cause bradycardia and potentially lead to
syncope or heart block. A heart rate of 52 beats/min is below
the normal adult range (60-100 beats/min) and warrants
holding the medication and notifying the provider before
administration to prevent severe bradyarrhythmias. Option A is
unsafe because administering the drug could worsen the
bradycardia. Option C is unrelated to the immediate
cardiovascular risk. Option D, while part of routine Alzheimer’s
care, is not the priority when a potentially dangerous adverse
effect (bradycardia) is present. Clinical judgment dictates
addressing physiological stability first.
Learning Objective
• Recognize bradycardia as a potential adverse effect of
cholinesterase inhibitors.
Pharmacology Exam Questions with Rationales
| 20 Original NGN Practice MCQs |
Nursing Study Guide
Question 1
Clinical Scenario
A 68-year-old male with Parkinson’s disease is taking
levodopa/carbidopa. During a follow-up visit, he reports that
the medication works well in the morning but its effects seem
to "wear off" by late afternoon. He mentions that he typically
eats a high-protein breakfast consisting of eggs and bacon. His
vital signs are stable, and his current neurological assessment
shows mild resting tremors.
Question Stem
Which instruction should the nurse provide to improve the
medication's effectiveness?
A. Take the medication with a high-protein snack to prevent
nausea.
B. Divide the daily protein intake evenly throughout the day.
,C. Crush the tablets and mix them with applesauce for faster
absorption.
D. Double the afternoon dose if symptoms return before the
next scheduled dose.
Correct Answer
Correct Answer: B. Divide the daily protein intake evenly
throughout the day.
Detailed Rationale
Levodopa competes with dietary amino acids (protein) for
absorption in the small intestine and for transport across the
blood-brain barrier. Consuming high-protein meals, especially
close to medication administration, can significantly decrease
the drug's bioavailability and clinical effectiveness, leading to a
"wearing-off" phenomenon. Distributing protein intake evenly
throughout the day or taking the medication 30 to 60 minutes
before meals optimizes absorption and therapeutic response.
Option A is incorrect because a high-protein snack would
exacerbate the wearing-off effect. Option C is incorrect because
crushing tablets (especially if they are controlled-release
formulations) can alter absorption rates and is not a solution to
protein interaction. Option D is unsafe; patients should never
independently double doses due to the high risk of levodopa-
induced dyskinesia, hallucinations, or cardiovascular instability.
Learning Objective
, • Explain the interaction between levodopa/carbidopa and
dietary protein.
• Educate patients on dietary modifications to optimize
Parkinson’s disease medication efficacy.
• Recognize the signs of the "wearing-off" phenomenon in
Parkinson’s disease.
Medication Safety Focus
Patient education / Medication administration
Question 2
Clinical Scenario
A 76-year-old female with moderate Alzheimer’s disease is
brought to the clinic by her daughter. She was recently started
on donepezil 5 mg daily. The nurse obtains the following vital
signs: Blood pressure 118/72 mm Hg, Heart rate 52 beats/min,
Respiratory rate 16 breaths/min, Temperature 37.0°C (98.6°F).
The client appears alert but has mild short-term memory
deficits.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled morning dose of donepezil.
B. Hold the medication and notify the healthcare provider.
C. Encourage the client to drink 500 mL of water immediately.
, D. Assess the client’s short-term memory using a standardized
tool.
Correct Answer
Correct Answer: B. Hold the medication and notify the
healthcare provider.
Detailed Rationale
Donepezil is a cholinesterase inhibitor that increases
acetylcholine levels in the brain. A well-known adverse effect of
cholinergic medications is vagotonic action on the sinoatrial
node, which can cause bradycardia and potentially lead to
syncope or heart block. A heart rate of 52 beats/min is below
the normal adult range (60-100 beats/min) and warrants
holding the medication and notifying the provider before
administration to prevent severe bradyarrhythmias. Option A is
unsafe because administering the drug could worsen the
bradycardia. Option C is unrelated to the immediate
cardiovascular risk. Option D, while part of routine Alzheimer’s
care, is not the priority when a potentially dangerous adverse
effect (bradycardia) is present. Clinical judgment dictates
addressing physiological stability first.
Learning Objective
• Recognize bradycardia as a potential adverse effect of
cholinesterase inhibitors.
