NCLEX Pharmacology Neurological
System Part 1
20 Original Practice Questions with
Rationales
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old client with newly diagnosed Parkinson disease is
prescribed Carbidopa/Levodopa. The client asks the nurse when
the medication should be taken to achieve the best therapeutic
effect. The client also reports taking a daily multivitamin
containing iron.
Question Stem
Which instruction should the nurse provide regarding
administration of carbidopa/levodopa?
A. Take the medication with a high-protein meal.
B. Take the medication at bedtime only.
,C. Take the medication with iron supplements to improve
absorption.
D. Take the medication on an empty stomach if tolerated.
Correct Answer: D. Take the medication on an empty stomach if
tolerated.
Detailed Rationale
Carbidopa/levodopa is most effectively absorbed when taken
on an empty stomach, typically 30 minutes before or 1 hour
after meals, if tolerated. High-protein foods can interfere with
levodopa absorption by competing for transport across the
intestinal wall and blood-brain barrier, potentially reducing
therapeutic effectiveness. Iron supplements can also decrease
levodopa absorption and should be taken several hours apart
from the medication.
Option A is incorrect because high-protein meals can reduce the
medication’s effectiveness. Option B is incorrect because
carbidopa/levodopa is usually taken multiple times per day, not
only at bedtime. Option C is incorrect because iron supplements
should not be taken simultaneously with levodopa due to
decreased absorption.
Nurses should teach clients to avoid abrupt discontinuation of
carbidopa/levodopa, as this can precipitate a life-threatening
syndrome similar to neuroleptic malignant syndrome.
,Monitoring for dyskinesias, orthostatic hypotension, and
hallucinations is also essential.
Learning Objective
After completing this question, the learner should be able to:
• Explain the optimal administration timing for
carbidopa/levodopa.
• Identify food and drug interactions that affect levodopa
absorption.
• Educate clients about safe use of Parkinson disease
medications.
• Recognize important monitoring parameters for dopamine
replacement therapy.
Medication Safety Focus: Drug interaction
Question 2
Clinical Scenario
A 45-year-old client with epilepsy is receiving Phenytoin for
seizure control. During a routine assessment, the nurse notes
swollen, bleeding gums.
Question Stem
Which action should the nurse take first?
A. Instruct the client to discontinue phenytoin immediately.
, B. Notify the provider and reinforce oral hygiene education.
C. Administer an additional dose of phenytoin.
D. Document the finding as an expected harmless side effect.
Correct Answer: B. Notify the provider and reinforce oral
hygiene education.
Detailed Rationale
Phenytoin commonly causes gingival hyperplasia, characterized
by swollen and bleeding gums. The nurse should notify the
provider and reinforce meticulous oral hygiene, including
regular brushing, flossing, and dental visits, to minimize this
adverse effect.
Option A is incorrect because phenytoin should not be abruptly
discontinued, as this can precipitate status epilepticus. Option C
is incorrect because an additional dose is not indicated and
could increase the risk of toxicity. Option D is incorrect because
gingival hyperplasia requires intervention and monitoring, not
simply documentation.
Phenytoin has a narrow therapeutic range, and serum levels
should be monitored to avoid toxicity. Signs of phenytoin
toxicity include nystagmus, ataxia, slurred speech, and
confusion. Nurses should also monitor for Stevens-Johnson
syndrome, particularly during the initial weeks of therapy.
Learning Objective
System Part 1
20 Original Practice Questions with
Rationales
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old client with newly diagnosed Parkinson disease is
prescribed Carbidopa/Levodopa. The client asks the nurse when
the medication should be taken to achieve the best therapeutic
effect. The client also reports taking a daily multivitamin
containing iron.
Question Stem
Which instruction should the nurse provide regarding
administration of carbidopa/levodopa?
A. Take the medication with a high-protein meal.
B. Take the medication at bedtime only.
,C. Take the medication with iron supplements to improve
absorption.
D. Take the medication on an empty stomach if tolerated.
Correct Answer: D. Take the medication on an empty stomach if
tolerated.
Detailed Rationale
Carbidopa/levodopa is most effectively absorbed when taken
on an empty stomach, typically 30 minutes before or 1 hour
after meals, if tolerated. High-protein foods can interfere with
levodopa absorption by competing for transport across the
intestinal wall and blood-brain barrier, potentially reducing
therapeutic effectiveness. Iron supplements can also decrease
levodopa absorption and should be taken several hours apart
from the medication.
Option A is incorrect because high-protein meals can reduce the
medication’s effectiveness. Option B is incorrect because
carbidopa/levodopa is usually taken multiple times per day, not
only at bedtime. Option C is incorrect because iron supplements
should not be taken simultaneously with levodopa due to
decreased absorption.
Nurses should teach clients to avoid abrupt discontinuation of
carbidopa/levodopa, as this can precipitate a life-threatening
syndrome similar to neuroleptic malignant syndrome.
,Monitoring for dyskinesias, orthostatic hypotension, and
hallucinations is also essential.
Learning Objective
After completing this question, the learner should be able to:
• Explain the optimal administration timing for
carbidopa/levodopa.
• Identify food and drug interactions that affect levodopa
absorption.
• Educate clients about safe use of Parkinson disease
medications.
• Recognize important monitoring parameters for dopamine
replacement therapy.
Medication Safety Focus: Drug interaction
Question 2
Clinical Scenario
A 45-year-old client with epilepsy is receiving Phenytoin for
seizure control. During a routine assessment, the nurse notes
swollen, bleeding gums.
Question Stem
Which action should the nurse take first?
A. Instruct the client to discontinue phenytoin immediately.
, B. Notify the provider and reinforce oral hygiene education.
C. Administer an additional dose of phenytoin.
D. Document the finding as an expected harmless side effect.
Correct Answer: B. Notify the provider and reinforce oral
hygiene education.
Detailed Rationale
Phenytoin commonly causes gingival hyperplasia, characterized
by swollen and bleeding gums. The nurse should notify the
provider and reinforce meticulous oral hygiene, including
regular brushing, flossing, and dental visits, to minimize this
adverse effect.
Option A is incorrect because phenytoin should not be abruptly
discontinued, as this can precipitate status epilepticus. Option C
is incorrect because an additional dose is not indicated and
could increase the risk of toxicity. Option D is incorrect because
gingival hyperplasia requires intervention and monitoring, not
simply documentation.
Phenytoin has a narrow therapeutic range, and serum levels
should be monitored to avoid toxicity. Signs of phenytoin
toxicity include nystagmus, ataxia, slurred speech, and
confusion. Nurses should also monitor for Stevens-Johnson
syndrome, particularly during the initial weeks of therapy.
Learning Objective
