NCLEX-RN Pharmacology
Neurological System Part 1
20 NGN-Style MCQs with
Rationales & Clinical Judgment
Focus
Question 1
Clinical Scenario
A 72-year-old client with newly diagnosed Parkinson disease is
prescribed carbidopa/levodopa 25/100 mg orally three times
daily. The client asks the nurse, “How will I know if this
medication is working?”
Question Stem
Which response by the nurse is most appropriate?
A. “You should notice less tremor and improved ability to
move.” B. “The medication will cure Parkinson disease within
,several weeks.” C. “You will no longer need assistance with
activities of daily living.” D. “The medication works only when
taken with a high-protein meal.”
Correct Answer
Correct Answer: A. “You should notice less tremor and
improved ability to move.”
Detailed Rationale
Carbidopa/levodopa is the cornerstone therapy for Parkinson
disease. Levodopa is converted to dopamine in the brain,
improving motor symptoms such as resting tremor, rigidity,
bradykinesia, and difficulty initiating movement. Carbidopa
prevents peripheral breakdown of levodopa, allowing more
drug to reach the central nervous system and reducing adverse
effects such as nausea and vomiting. Improvement in
movement and reduction in tremor are expected therapeutic
responses.
Option B is incorrect because Parkinson disease is not curable,
and the medication manages symptoms rather than eliminating
the disease. Option C is incorrect because functional
improvement varies among clients; many still require assistance
despite therapy. Option D is incorrect because high-protein
meals can decrease levodopa absorption, and clients are often
instructed to distribute protein intake evenly throughout the
day rather than take the medication with a protein-rich meal.
,Nursing care includes monitoring for orthostatic hypotension,
dyskinesias, hallucinations, and “wearing-off” effects. Teaching
should emphasize taking the medication consistently and not
stopping it abruptly, as sudden withdrawal can cause severe
rigidity and other complications.
Learning Objective
After completing this question, the learner should be able to:
• Identify the expected therapeutic effects of
carbidopa/levodopa.
• Explain the role of carbidopa in Parkinson therapy.
• Provide accurate patient teaching regarding medication
administration.
• Recognize common nursing monitoring parameters.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 24-year-old client with a generalized tonic-clonic seizure
disorder receives phenytoin 100 mg orally three times daily.
During a follow-up visit, the nurse notes swollen, bleeding
gums.
, Question Stem
Which nursing action is most appropriate?
A. Instruct the client to stop taking phenytoin immediately. B.
Encourage meticulous oral hygiene and regular dental care. C.
Restrict fluid intake to reduce gum swelling. D. Administer the
medication with milk to prevent irritation.
Correct Answer
Correct Answer: B. Encourage meticulous oral hygiene and
regular dental care.
Detailed Rationale
Gingival hyperplasia is a well-known adverse effect of
phenytoin. The priority nursing intervention is to teach the
client to practice careful oral hygiene, including brushing,
flossing, and obtaining regular dental examinations. These
measures can reduce the severity of gum overgrowth and
bleeding.
Option A is incorrect because abruptly discontinuing phenytoin
can precipitate status epilepticus, a medical emergency. Any
medication changes must be directed by the healthcare
provider. Option C is incorrect because fluid restriction does not
treat gingival hyperplasia and could lead to dehydration. Option
D is incorrect because milk does not prevent this adverse effect.
Neurological System Part 1
20 NGN-Style MCQs with
Rationales & Clinical Judgment
Focus
Question 1
Clinical Scenario
A 72-year-old client with newly diagnosed Parkinson disease is
prescribed carbidopa/levodopa 25/100 mg orally three times
daily. The client asks the nurse, “How will I know if this
medication is working?”
Question Stem
Which response by the nurse is most appropriate?
A. “You should notice less tremor and improved ability to
move.” B. “The medication will cure Parkinson disease within
,several weeks.” C. “You will no longer need assistance with
activities of daily living.” D. “The medication works only when
taken with a high-protein meal.”
Correct Answer
Correct Answer: A. “You should notice less tremor and
improved ability to move.”
Detailed Rationale
Carbidopa/levodopa is the cornerstone therapy for Parkinson
disease. Levodopa is converted to dopamine in the brain,
improving motor symptoms such as resting tremor, rigidity,
bradykinesia, and difficulty initiating movement. Carbidopa
prevents peripheral breakdown of levodopa, allowing more
drug to reach the central nervous system and reducing adverse
effects such as nausea and vomiting. Improvement in
movement and reduction in tremor are expected therapeutic
responses.
Option B is incorrect because Parkinson disease is not curable,
and the medication manages symptoms rather than eliminating
the disease. Option C is incorrect because functional
improvement varies among clients; many still require assistance
despite therapy. Option D is incorrect because high-protein
meals can decrease levodopa absorption, and clients are often
instructed to distribute protein intake evenly throughout the
day rather than take the medication with a protein-rich meal.
,Nursing care includes monitoring for orthostatic hypotension,
dyskinesias, hallucinations, and “wearing-off” effects. Teaching
should emphasize taking the medication consistently and not
stopping it abruptly, as sudden withdrawal can cause severe
rigidity and other complications.
Learning Objective
After completing this question, the learner should be able to:
• Identify the expected therapeutic effects of
carbidopa/levodopa.
• Explain the role of carbidopa in Parkinson therapy.
• Provide accurate patient teaching regarding medication
administration.
• Recognize common nursing monitoring parameters.
Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 24-year-old client with a generalized tonic-clonic seizure
disorder receives phenytoin 100 mg orally three times daily.
During a follow-up visit, the nurse notes swollen, bleeding
gums.
, Question Stem
Which nursing action is most appropriate?
A. Instruct the client to stop taking phenytoin immediately. B.
Encourage meticulous oral hygiene and regular dental care. C.
Restrict fluid intake to reduce gum swelling. D. Administer the
medication with milk to prevent irritation.
Correct Answer
Correct Answer: B. Encourage meticulous oral hygiene and
regular dental care.
Detailed Rationale
Gingival hyperplasia is a well-known adverse effect of
phenytoin. The priority nursing intervention is to teach the
client to practice careful oral hygiene, including brushing,
flossing, and obtaining regular dental examinations. These
measures can reduce the severity of gum overgrowth and
bleeding.
Option A is incorrect because abruptly discontinuing phenytoin
can precipitate status epilepticus, a medical emergency. Any
medication changes must be directed by the healthcare
provider. Option C is incorrect because fluid restriction does not
treat gingival hyperplasia and could lead to dehydration. Option
D is incorrect because milk does not prevent this adverse effect.
