NCLEX-RN Pharmacology Neurological
System Part 1
20 NGN-Style Practice Questions with
Rationales
Nursing Exam Prep 2026
Question 1
Clinical Scenario
A 68-year-old client with Parkinson disease is prescribed
carbidopa/levodopa. During a follow-up visit, the client reports
improved mobility but states, “My urine has become dark
brown, and I'm worried something is wrong.”
Question Stem
Which response by the nurse is most appropriate?
A. "Stop taking the medication and contact the provider
immediately."
B. "This finding may indicate kidney failure."
,C. "Dark urine can occur with this medication and is usually
harmless."
D. "You should increase your fluid intake to reverse this effect."
Correct Answer
Correct Answer: C. "Dark urine can occur with this medication
and is usually harmless."
Detailed Rationale
Carbidopa/levodopa is the cornerstone treatment for Parkinson
disease. Levodopa crosses the blood-brain barrier and is
converted to dopamine, while carbidopa reduces peripheral
conversion and adverse effects. A harmless but often alarming
side effect is darkening of urine, sweat, or saliva.
Option C is correct because this is an expected effect that
should be included in patient education. Reassurance helps
promote medication adherence and reduces unnecessary
discontinuation.
Option A is incorrect because dark urine alone is not an
indication to stop therapy. Abrupt discontinuation may worsen
Parkinson symptoms and can precipitate severe complications.
Option B is incorrect because dark urine associated with
levodopa is not evidence of kidney failure. Renal dysfunction
would require additional findings such as elevated creatinine or
reduced urine output.
,Option D is incorrect because increased fluids do not reverse
medication-induced discoloration and are not the priority
teaching point.
Nurses should educate clients about expected effects, monitor
therapeutic response, and assess for dyskinesias, orthostatic
hypotension, and hallucinations.
Learning Objective
After completing this question, the learner should be able to:
• Identify common adverse effects of carbidopa/levodopa.
• Provide accurate patient teaching regarding expected
medication effects.
• Promote medication adherence through education.
• Differentiate harmless side effects from serious adverse
reactions.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 74-year-old client with Parkinson disease takes
carbidopa/levodopa three times daily. The nurse notes the
, client received a high-protein breakfast immediately before the
morning dose.
Question Stem
Which outcome is most likely if the medication is taken with a
high-protein meal?
A. Increased medication absorption
B. Reduced therapeutic effect of levodopa
C. Increased risk for hypertensive crisis
D. Development of serotonin syndrome
Correct Answer
Correct Answer: B. Reduced therapeutic effect of levodopa
Detailed Rationale
Levodopa competes with dietary amino acids for transport
across the intestinal wall and blood-brain barrier. High-protein
meals can significantly decrease absorption and availability of
levodopa, reducing symptom control.
Option B is correct because diminished absorption may lead to
worsening tremors, rigidity, and bradykinesia.
Option A is incorrect because protein decreases—not
increases—levodopa effectiveness.
System Part 1
20 NGN-Style Practice Questions with
Rationales
Nursing Exam Prep 2026
Question 1
Clinical Scenario
A 68-year-old client with Parkinson disease is prescribed
carbidopa/levodopa. During a follow-up visit, the client reports
improved mobility but states, “My urine has become dark
brown, and I'm worried something is wrong.”
Question Stem
Which response by the nurse is most appropriate?
A. "Stop taking the medication and contact the provider
immediately."
B. "This finding may indicate kidney failure."
,C. "Dark urine can occur with this medication and is usually
harmless."
D. "You should increase your fluid intake to reverse this effect."
Correct Answer
Correct Answer: C. "Dark urine can occur with this medication
and is usually harmless."
Detailed Rationale
Carbidopa/levodopa is the cornerstone treatment for Parkinson
disease. Levodopa crosses the blood-brain barrier and is
converted to dopamine, while carbidopa reduces peripheral
conversion and adverse effects. A harmless but often alarming
side effect is darkening of urine, sweat, or saliva.
Option C is correct because this is an expected effect that
should be included in patient education. Reassurance helps
promote medication adherence and reduces unnecessary
discontinuation.
Option A is incorrect because dark urine alone is not an
indication to stop therapy. Abrupt discontinuation may worsen
Parkinson symptoms and can precipitate severe complications.
Option B is incorrect because dark urine associated with
levodopa is not evidence of kidney failure. Renal dysfunction
would require additional findings such as elevated creatinine or
reduced urine output.
,Option D is incorrect because increased fluids do not reverse
medication-induced discoloration and are not the priority
teaching point.
Nurses should educate clients about expected effects, monitor
therapeutic response, and assess for dyskinesias, orthostatic
hypotension, and hallucinations.
Learning Objective
After completing this question, the learner should be able to:
• Identify common adverse effects of carbidopa/levodopa.
• Provide accurate patient teaching regarding expected
medication effects.
• Promote medication adherence through education.
• Differentiate harmless side effects from serious adverse
reactions.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 74-year-old client with Parkinson disease takes
carbidopa/levodopa three times daily. The nurse notes the
, client received a high-protein breakfast immediately before the
morning dose.
Question Stem
Which outcome is most likely if the medication is taken with a
high-protein meal?
A. Increased medication absorption
B. Reduced therapeutic effect of levodopa
C. Increased risk for hypertensive crisis
D. Development of serotonin syndrome
Correct Answer
Correct Answer: B. Reduced therapeutic effect of levodopa
Detailed Rationale
Levodopa competes with dietary amino acids for transport
across the intestinal wall and blood-brain barrier. High-protein
meals can significantly decrease absorption and availability of
levodopa, reducing symptom control.
Option B is correct because diminished absorption may lead to
worsening tremors, rigidity, and bradykinesia.
Option A is incorrect because protein decreases—not
increases—levodopa effectiveness.
