NURS 8024 Test 4 Study Guide with Questions and
Answers | 2026 Update | 100% Correct.
NURS 8024 Test 4 Study Guide – Practice Exam
PART 1: NEUROPHARMACOLOGY – PARKINSON'S DISEASE
1. A patient with Parkinson's disease is prescribed carbidopa-levodopa
(Sinemet). The nurse understands that carbidopa is combined with levodopa
primarily to:
A) Increase the amount of levodopa that crosses the blood-brain barrier
B) Reduce the peripheral metabolism of levodopa, allowing more to reach the
brain
C) Act as a dopamine receptor agonist
D) Prevent the "on-off" phenomenon
Correct Answer: B) Reduce the peripheral metabolism of levodopa, allowing
more to reach the brain
Explanation: Carbidopa inhibits the enzyme DOPA decarboxylase in the periphery,
preventing the breakdown of levodopa before it can cross the blood-brain barrier.
This allows more levodopa to reach the central nervous system and reduces
peripheral side effects like nausea . Carbidopa does not cross the blood-brain
barrier, so it does not affect dopamine synthesis in the brain .
2. The pathophysiology of Parkinson's disease is best described as:
A) Excess dopamine activity in the basal ganglia
B) Destruction of dopaminergic neurons in the substantia nigra, leading to
reduced dopamine action in the brain
,C) Overactivity of cholinergic neurons in the cerebral cortex
D) Genetic mutation affecting GABA receptors
Correct Answer: B) Destruction of dopaminergic neurons in the substantia nigra,
leading to reduced dopamine action in the brain
Explanation: Parkinson's disease is a progressive neurodegenerative disorder
characterized by the destruction of dopaminergic neurons in the substantia nigra.
This leads to a significant reduction of dopamine in the basal ganglia, affecting
motor control. Symptoms result from an imbalance between excitatory cholinergic
neurons and diminished inhibitory dopaminergic neurons .
3. A patient taking carbidopa-levodopa for Parkinson's disease reports
experiencing sudden, unpredictable loss of mobility, tremors, and cramps. This
phenomenon is known as:
A) Dyskinesia
B) On-off phenomenon
C) Tardive dyskinesia
D) Serotonin syndrome
Correct Answer: B) On-off phenomenon
Explanation: The "on-off phenomenon" is a common complication of long-term
levodopa therapy, typically occurring in the 3rd to 5th year of treatment. It is
characterized by sudden, unpredictable loss of normal mobility (off periods)
alternating with periods of good mobility (on periods) . It is associated with the
short half-life of levodopa and fluctuations in plasma drug levels.
4. Which of the following is a dopamine receptor agonist used in the treatment
of Parkinson's disease?
A) Selegiline
B) Pramipexole
,C) Benztropine
D) Amantadine
Correct Answer: B) Pramipexole
Explanation: Pramipexole and ropinirole are dopamine receptor agonists used in
Parkinson's disease. They directly stimulate dopamine receptors in the brain,
providing symptomatic relief. They are often used as adjuncts to levodopa or as
initial therapy .
PART 2: ANTICONVULSANT THERAPY (Questions 5-15)
5. A patient is prescribed phenytoin (Dilantin) for seizure control. Which adverse
effect is most specifically associated with this medication?
A) Sedation
B) Gingival hyperplasia
C) Weight gain
D) Hepatotoxicity
Correct Answer: B) Gingival hyperplasia
Explanation: Gingival hyperplasia (swelling and overgrowth of gum tissue) is a
distinctive adverse effect of phenytoin. Good oral hygiene and regular dental care
are important for patients on this medication .
6. Phenytoin exhibits zero-order pharmacokinetics. This means that:
A) The drug is excreted unchanged in the urine
B) Small increases in daily dose can produce large increases in plasma
concentration, leading to toxicity
C) The drug has a very short half-life
D) The drug is completely absorbed in the GI tract
Correct Answer: B) Small increases in daily dose can produce large increases in
plasma concentration, leading to toxicity
, Explanation: Zero-order kinetics means that phenytoin is eliminated at a constant
rate regardless of plasma concentration. Once metabolic pathways are saturated,
small increases in dose can cause disproportionate increases in plasma
concentration, making the patient vulnerable to toxicity .
7. A patient with epilepsy is started on valproic acid (Depakote). Which black
box warnings are associated with this medication?
A) Hepatotoxicity, teratogenicity, and pancreatitis
B) Agranulocytosis and cardiomyopathy
C) QT prolongation and torsades de pointes
D) Suicidality and weight gain
Correct Answer: A) Hepatotoxicity, teratogenicity, and pancreatitis
Explanation: Valproic acid carries significant black box warnings including
hepatotoxicity (especially in children under 2 years), teratogenicity (neural tube
defects), and pancreatitis .
8. A patient with epilepsy is prescribed topiramate (Topamax). What teaching
should the nurse include regarding this medication?
A) "Take this medication on an empty stomach for best absorption"
B) "Oral contraceptives may be less effective while taking this medication"
C) "This medication is safe to take during pregnancy"
D) "Avoid eating dairy products while taking this medication"
Correct Answer: B) "Oral contraceptives may be less effective while taking this
medication"
Explanation: Topiramate can reduce the effectiveness of oral contraceptives by
inducing CYP3A4 metabolism. Alternative or additional contraceptive methods
should be considered. Topiramate is also used off-label for migraine prophylaxis .
Answers | 2026 Update | 100% Correct.
NURS 8024 Test 4 Study Guide – Practice Exam
PART 1: NEUROPHARMACOLOGY – PARKINSON'S DISEASE
1. A patient with Parkinson's disease is prescribed carbidopa-levodopa
(Sinemet). The nurse understands that carbidopa is combined with levodopa
primarily to:
A) Increase the amount of levodopa that crosses the blood-brain barrier
B) Reduce the peripheral metabolism of levodopa, allowing more to reach the
brain
C) Act as a dopamine receptor agonist
D) Prevent the "on-off" phenomenon
Correct Answer: B) Reduce the peripheral metabolism of levodopa, allowing
more to reach the brain
Explanation: Carbidopa inhibits the enzyme DOPA decarboxylase in the periphery,
preventing the breakdown of levodopa before it can cross the blood-brain barrier.
This allows more levodopa to reach the central nervous system and reduces
peripheral side effects like nausea . Carbidopa does not cross the blood-brain
barrier, so it does not affect dopamine synthesis in the brain .
2. The pathophysiology of Parkinson's disease is best described as:
A) Excess dopamine activity in the basal ganglia
B) Destruction of dopaminergic neurons in the substantia nigra, leading to
reduced dopamine action in the brain
,C) Overactivity of cholinergic neurons in the cerebral cortex
D) Genetic mutation affecting GABA receptors
Correct Answer: B) Destruction of dopaminergic neurons in the substantia nigra,
leading to reduced dopamine action in the brain
Explanation: Parkinson's disease is a progressive neurodegenerative disorder
characterized by the destruction of dopaminergic neurons in the substantia nigra.
This leads to a significant reduction of dopamine in the basal ganglia, affecting
motor control. Symptoms result from an imbalance between excitatory cholinergic
neurons and diminished inhibitory dopaminergic neurons .
3. A patient taking carbidopa-levodopa for Parkinson's disease reports
experiencing sudden, unpredictable loss of mobility, tremors, and cramps. This
phenomenon is known as:
A) Dyskinesia
B) On-off phenomenon
C) Tardive dyskinesia
D) Serotonin syndrome
Correct Answer: B) On-off phenomenon
Explanation: The "on-off phenomenon" is a common complication of long-term
levodopa therapy, typically occurring in the 3rd to 5th year of treatment. It is
characterized by sudden, unpredictable loss of normal mobility (off periods)
alternating with periods of good mobility (on periods) . It is associated with the
short half-life of levodopa and fluctuations in plasma drug levels.
4. Which of the following is a dopamine receptor agonist used in the treatment
of Parkinson's disease?
A) Selegiline
B) Pramipexole
,C) Benztropine
D) Amantadine
Correct Answer: B) Pramipexole
Explanation: Pramipexole and ropinirole are dopamine receptor agonists used in
Parkinson's disease. They directly stimulate dopamine receptors in the brain,
providing symptomatic relief. They are often used as adjuncts to levodopa or as
initial therapy .
PART 2: ANTICONVULSANT THERAPY (Questions 5-15)
5. A patient is prescribed phenytoin (Dilantin) for seizure control. Which adverse
effect is most specifically associated with this medication?
A) Sedation
B) Gingival hyperplasia
C) Weight gain
D) Hepatotoxicity
Correct Answer: B) Gingival hyperplasia
Explanation: Gingival hyperplasia (swelling and overgrowth of gum tissue) is a
distinctive adverse effect of phenytoin. Good oral hygiene and regular dental care
are important for patients on this medication .
6. Phenytoin exhibits zero-order pharmacokinetics. This means that:
A) The drug is excreted unchanged in the urine
B) Small increases in daily dose can produce large increases in plasma
concentration, leading to toxicity
C) The drug has a very short half-life
D) The drug is completely absorbed in the GI tract
Correct Answer: B) Small increases in daily dose can produce large increases in
plasma concentration, leading to toxicity
, Explanation: Zero-order kinetics means that phenytoin is eliminated at a constant
rate regardless of plasma concentration. Once metabolic pathways are saturated,
small increases in dose can cause disproportionate increases in plasma
concentration, making the patient vulnerable to toxicity .
7. A patient with epilepsy is started on valproic acid (Depakote). Which black
box warnings are associated with this medication?
A) Hepatotoxicity, teratogenicity, and pancreatitis
B) Agranulocytosis and cardiomyopathy
C) QT prolongation and torsades de pointes
D) Suicidality and weight gain
Correct Answer: A) Hepatotoxicity, teratogenicity, and pancreatitis
Explanation: Valproic acid carries significant black box warnings including
hepatotoxicity (especially in children under 2 years), teratogenicity (neural tube
defects), and pancreatitis .
8. A patient with epilepsy is prescribed topiramate (Topamax). What teaching
should the nurse include regarding this medication?
A) "Take this medication on an empty stomach for best absorption"
B) "Oral contraceptives may be less effective while taking this medication"
C) "This medication is safe to take during pregnancy"
D) "Avoid eating dairy products while taking this medication"
Correct Answer: B) "Oral contraceptives may be less effective while taking this
medication"
Explanation: Topiramate can reduce the effectiveness of oral contraceptives by
inducing CYP3A4 metabolism. Alternative or additional contraceptive methods
should be considered. Topiramate is also used off-label for migraine prophylaxis .
