NCLEX-RN Pharmacology Neurological
System Part 1 Practice Questions
20 NGN-Style MCQs with Detailed
Rationales
Nursing Exam Review Study Guide
Question 1
Clinical Scenario
A 68-year-old woman with newly diagnosed Parkinson disease
is prescribed carbidopa/levodopa. She reports increasing
difficulty walking, resting tremors, and muscle rigidity. Her
medical history includes hypertension and osteoporosis. Vital
signs are BP 136/82 mm Hg, HR 76/min, RR 18/min, and
temperature 36.8°C (98.2°F). The nurse is providing medication
education before discharge.
Question Stem
Which statement by the client indicates correct understanding
of carbidopa/levodopa therapy?
,A. "I should stop taking the medication once my tremors
improve."
B. "If my urine becomes darker, I should contact my provider
immediately."
C. "I will take this medication exactly as prescribed and avoid
stopping it suddenly."
D. "I should take this medication only when my symptoms
become severe."
Correct Answer
Correct Answer: C. "I will take this medication exactly as
prescribed and avoid stopping it suddenly."
Detailed Rationale
Carbidopa/levodopa remains the most effective medication for
improving bradykinesia, rigidity, and tremor in Parkinson
disease. Levodopa crosses the blood-brain barrier and is
converted into dopamine within the central nervous system,
while carbidopa inhibits peripheral metabolism of levodopa,
increasing the amount available to the brain and reducing
adverse effects such as nausea.
Clients should take the medication consistently and avoid
abrupt discontinuation because sudden withdrawal may
precipitate severe worsening of Parkinson symptoms or a
neuroleptic malignant syndrome-like reaction characterized by
,fever, rigidity, and altered mental status. Medication adherence
is essential because symptom control depends on maintaining
therapeutic dopamine levels.
Option A is incorrect because Parkinson disease requires
ongoing therapy; symptoms recur if treatment is stopped.
Option B is incorrect because harmless darkening of urine,
sweat, or saliva may occur and does not usually require
provider notification. Option D is incorrect because levodopa
should not be taken on an "as-needed" basis. Regular dosing
provides the most consistent symptom control. The nurse
should also educate the client about orthostatic hypotension,
dyskinesias, and timing doses consistently. High-protein meals
may reduce levodopa absorption, so dietary timing may require
adjustment if symptom control becomes inconsistent.
Learning Objective
After completing this question, the learner should be able to:
• Explain the purpose of carbidopa in combination therapy.
• Identify essential patient teaching for levodopa therapy.
• Recognize the risks associated with abrupt medication
discontinuation.
• Promote medication adherence to optimize symptom
control.
Medication Safety Focus: Patient education
, Question 2
Clinical Scenario
A 32-year-old man with generalized tonic-clonic seizures has
been taking phenytoin for two years. During a follow-up visit,
the nurse notes swollen, bleeding gums. The client reports no
recent seizures and states he brushes his teeth "occasionally."
Question Stem
Which nursing intervention is the highest priority?
A. Recommend discontinuing phenytoin immediately.
B. Teach the client to maintain meticulous oral hygiene and
schedule regular dental visits.
C. Encourage the client to increase dietary sodium intake.
D. Advise the client to take phenytoin only when seizure
symptoms begin.
Correct Answer
Correct Answer: B. Teach the client to maintain meticulous
oral hygiene and schedule regular dental visits.
Detailed Rationale
Gingival hyperplasia is a common adverse effect of long-term
phenytoin therapy. Although the exact mechanism is not fully
System Part 1 Practice Questions
20 NGN-Style MCQs with Detailed
Rationales
Nursing Exam Review Study Guide
Question 1
Clinical Scenario
A 68-year-old woman with newly diagnosed Parkinson disease
is prescribed carbidopa/levodopa. She reports increasing
difficulty walking, resting tremors, and muscle rigidity. Her
medical history includes hypertension and osteoporosis. Vital
signs are BP 136/82 mm Hg, HR 76/min, RR 18/min, and
temperature 36.8°C (98.2°F). The nurse is providing medication
education before discharge.
Question Stem
Which statement by the client indicates correct understanding
of carbidopa/levodopa therapy?
,A. "I should stop taking the medication once my tremors
improve."
B. "If my urine becomes darker, I should contact my provider
immediately."
C. "I will take this medication exactly as prescribed and avoid
stopping it suddenly."
D. "I should take this medication only when my symptoms
become severe."
Correct Answer
Correct Answer: C. "I will take this medication exactly as
prescribed and avoid stopping it suddenly."
Detailed Rationale
Carbidopa/levodopa remains the most effective medication for
improving bradykinesia, rigidity, and tremor in Parkinson
disease. Levodopa crosses the blood-brain barrier and is
converted into dopamine within the central nervous system,
while carbidopa inhibits peripheral metabolism of levodopa,
increasing the amount available to the brain and reducing
adverse effects such as nausea.
Clients should take the medication consistently and avoid
abrupt discontinuation because sudden withdrawal may
precipitate severe worsening of Parkinson symptoms or a
neuroleptic malignant syndrome-like reaction characterized by
,fever, rigidity, and altered mental status. Medication adherence
is essential because symptom control depends on maintaining
therapeutic dopamine levels.
Option A is incorrect because Parkinson disease requires
ongoing therapy; symptoms recur if treatment is stopped.
Option B is incorrect because harmless darkening of urine,
sweat, or saliva may occur and does not usually require
provider notification. Option D is incorrect because levodopa
should not be taken on an "as-needed" basis. Regular dosing
provides the most consistent symptom control. The nurse
should also educate the client about orthostatic hypotension,
dyskinesias, and timing doses consistently. High-protein meals
may reduce levodopa absorption, so dietary timing may require
adjustment if symptom control becomes inconsistent.
Learning Objective
After completing this question, the learner should be able to:
• Explain the purpose of carbidopa in combination therapy.
• Identify essential patient teaching for levodopa therapy.
• Recognize the risks associated with abrupt medication
discontinuation.
• Promote medication adherence to optimize symptom
control.
Medication Safety Focus: Patient education
, Question 2
Clinical Scenario
A 32-year-old man with generalized tonic-clonic seizures has
been taking phenytoin for two years. During a follow-up visit,
the nurse notes swollen, bleeding gums. The client reports no
recent seizures and states he brushes his teeth "occasionally."
Question Stem
Which nursing intervention is the highest priority?
A. Recommend discontinuing phenytoin immediately.
B. Teach the client to maintain meticulous oral hygiene and
schedule regular dental visits.
C. Encourage the client to increase dietary sodium intake.
D. Advise the client to take phenytoin only when seizure
symptoms begin.
Correct Answer
Correct Answer: B. Teach the client to maintain meticulous
oral hygiene and schedule regular dental visits.
Detailed Rationale
Gingival hyperplasia is a common adverse effect of long-term
phenytoin therapy. Although the exact mechanism is not fully
