Neurological System Pharmacology
NCLEX-RN Practice Questions
20 Original Case-Based MCQs with
Rationales
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 72-year-old man is admitted with newly diagnosed Parkinson
disease. His medical history includes hypertension and chronic
constipation. The provider prescribes carbidopa/levodopa 25
mg/100 mg orally three times daily. During morning
medication administration, the patient asks why he has been
instructed to take the medication consistently and not skip
doses when he feels better.
Question Stem
Which response by the nurse is most appropriate?
A. "Take the medication only when your tremors become
severe."
,B. "Stopping the medication suddenly can worsen your
symptoms and interfere with movement control."
C. "The medication permanently cures Parkinson disease after
several weeks."
D. "You should double the next dose if you miss a scheduled
dose."
Correct Answer
Correct Answer: B. Stopping the medication suddenly can
worsen your symptoms and interfere with movement control.
Detailed Rationale
Carbidopa/levodopa is considered the most effective
medication for improving the motor symptoms of Parkinson
disease. Levodopa is converted to dopamine in the brain, while
carbidopa inhibits peripheral metabolism of levodopa, allowing
more medication to reach the central nervous system and
reducing adverse effects such as nausea. Because Parkinson
disease is chronic and progressive, maintaining consistent
plasma concentrations helps optimize symptom control. Abrupt
discontinuation may result in severe rigidity, immobility,
worsening motor symptoms, and rarely a neuroleptic malignant
syndrome-like reaction characterized by fever, muscle rigidity,
and autonomic instability. Patients should take the medication
,exactly as prescribed and avoid abruptly stopping therapy
without provider guidance.
Option A is incorrect because medication should be taken on a
regular schedule rather than only when symptoms worsen.
Option C is incorrect because the medication manages
symptoms but does not cure Parkinson disease. Option D is
unsafe because doubling doses increases the risk for
dyskinesias, hypotension, hallucinations, and nausea. If a dose
is missed, patients should follow provider or package
instructions rather than automatically doubling the next dose.
The nurse should also educate patients about orthostatic
hypotension, possible dyskinesias, hallucinations, and the
importance of reporting changes in mobility or mental status.
Consistent medication adherence supports safer symptom
management and reduces complications.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the therapeutic purpose of carbidopa/levodopa.
• Teach patients the importance of medication adherence.
• Recognize risks associated with abrupt discontinuation.
• Identify key adverse effects requiring monitoring.
Medication Safety Focus
, Patient education
Question 2
Clinical Scenario
A 65-year-old woman with Parkinson disease has been taking
carbidopa/levodopa for 18 months. During assessment, the
nurse observes repetitive involuntary twisting movements of
the arms and face. The patient reports her tremor has improved
but these movements have become increasingly bothersome.
Question Stem
Which nursing interpretation is most appropriate?
A. The medication is ineffective and should be discontinued
immediately.
B. The patient is experiencing levodopa-induced dyskinesias.
C. The patient is developing serotonin syndrome.
D. These findings indicate worsening muscle weakness from
myasthenia gravis.
Correct Answer
Correct Answer: B. The patient is experiencing levodopa-
induced dyskinesias.
Detailed Rationale
NCLEX-RN Practice Questions
20 Original Case-Based MCQs with
Rationales
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 72-year-old man is admitted with newly diagnosed Parkinson
disease. His medical history includes hypertension and chronic
constipation. The provider prescribes carbidopa/levodopa 25
mg/100 mg orally three times daily. During morning
medication administration, the patient asks why he has been
instructed to take the medication consistently and not skip
doses when he feels better.
Question Stem
Which response by the nurse is most appropriate?
A. "Take the medication only when your tremors become
severe."
,B. "Stopping the medication suddenly can worsen your
symptoms and interfere with movement control."
C. "The medication permanently cures Parkinson disease after
several weeks."
D. "You should double the next dose if you miss a scheduled
dose."
Correct Answer
Correct Answer: B. Stopping the medication suddenly can
worsen your symptoms and interfere with movement control.
Detailed Rationale
Carbidopa/levodopa is considered the most effective
medication for improving the motor symptoms of Parkinson
disease. Levodopa is converted to dopamine in the brain, while
carbidopa inhibits peripheral metabolism of levodopa, allowing
more medication to reach the central nervous system and
reducing adverse effects such as nausea. Because Parkinson
disease is chronic and progressive, maintaining consistent
plasma concentrations helps optimize symptom control. Abrupt
discontinuation may result in severe rigidity, immobility,
worsening motor symptoms, and rarely a neuroleptic malignant
syndrome-like reaction characterized by fever, muscle rigidity,
and autonomic instability. Patients should take the medication
,exactly as prescribed and avoid abruptly stopping therapy
without provider guidance.
Option A is incorrect because medication should be taken on a
regular schedule rather than only when symptoms worsen.
Option C is incorrect because the medication manages
symptoms but does not cure Parkinson disease. Option D is
unsafe because doubling doses increases the risk for
dyskinesias, hypotension, hallucinations, and nausea. If a dose
is missed, patients should follow provider or package
instructions rather than automatically doubling the next dose.
The nurse should also educate patients about orthostatic
hypotension, possible dyskinesias, hallucinations, and the
importance of reporting changes in mobility or mental status.
Consistent medication adherence supports safer symptom
management and reduces complications.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the therapeutic purpose of carbidopa/levodopa.
• Teach patients the importance of medication adherence.
• Recognize risks associated with abrupt discontinuation.
• Identify key adverse effects requiring monitoring.
Medication Safety Focus
, Patient education
Question 2
Clinical Scenario
A 65-year-old woman with Parkinson disease has been taking
carbidopa/levodopa for 18 months. During assessment, the
nurse observes repetitive involuntary twisting movements of
the arms and face. The patient reports her tremor has improved
but these movements have become increasingly bothersome.
Question Stem
Which nursing interpretation is most appropriate?
A. The medication is ineffective and should be discontinued
immediately.
B. The patient is experiencing levodopa-induced dyskinesias.
C. The patient is developing serotonin syndrome.
D. These findings indicate worsening muscle weakness from
myasthenia gravis.
Correct Answer
Correct Answer: B. The patient is experiencing levodopa-
induced dyskinesias.
Detailed Rationale
