NCLEX-RN Pharmacology Neurological
System Part 1 Exam Questions &
Rationales
20 Original NCLEX Next Generation
(NGN) Practice MCQs
ATI Pharmacology Made Easy Nursing
Study Guide
Question 1
Clinical Scenario
A 68-year-old man with newly diagnosed Parkinson disease is
prescribed carbidopa/levodopa. His medical history includes
hypertension and chronic constipation. Current medications
include lisinopril and polyethylene glycol as needed. At a follow-
up visit 2 weeks later, he reports mild improvement in tremors
but complains of dizziness when standing and nausea after
taking his medication. Vital signs are: BP 128/76 mm Hg sitting,
102/64 mm Hg standing, HR 74/min, RR 16/min, and SpO₂ 98%
on room air.
,Question Stem
Which nursing intervention is the priority to reduce this client's
risk of injury?
A. Encourage the client to increase dietary protein with each
medication dose.
B. Instruct the client to rise slowly from lying or sitting
positions.
C. Advise the client to discontinue the medication if nausea
occurs.
D. Recommend taking the medication only at bedtime.
Correct Answer
B. Instruct the client to rise slowly from lying or sitting
positions.
Detailed Rationale
Carbidopa/levodopa is the cornerstone treatment for Parkinson
disease because levodopa is converted to dopamine in the
brain, while carbidopa inhibits peripheral conversion, improving
central nervous system availability and reducing gastrointestinal
adverse effects. Orthostatic hypotension is a common adverse
effect, especially during treatment initiation, increasing the risk
of falls in older adults. Teaching the client to change positions
,slowly, sit briefly before standing, and use assistive devices if
needed is the priority nursing intervention to prevent injury.
Option A is incorrect because high-protein meals can compete
with levodopa for intestinal absorption and transport across the
blood-brain barrier, potentially decreasing medication
effectiveness. Protein intake should be distributed throughout
the day rather than concentrated with medication doses.
Option C is incorrect because mild nausea is a common
transient adverse effect. The medication should not be stopped
abruptly without provider guidance because symptoms may
worsen significantly.
Option D is incorrect because restricting doses to bedtime
would not provide adequate symptom control during waking
hours and does not address orthostatic hypotension.
Nurses should monitor blood pressure in multiple positions,
reinforce fall precautions, evaluate therapeutic improvement in
mobility, and encourage adherence despite mild early adverse
effects unless severe reactions develop.
Learning Objectives
After completing this question, the learner should be able to:
• Identify common adverse effects of carbidopa/levodopa.
• Implement interventions to reduce fall risk.
, • Educate clients regarding proper medication
administration.
• Recognize factors affecting levodopa absorption.
Medication Safety Focus: Monitoring for orthostatic
hypotension and fall prevention.
Question 2
Clinical Scenario
A 32-year-old woman with newly diagnosed epilepsy begins
therapy with phenytoin. During a clinic visit one month later,
the nurse notes swollen, bleeding gums. The client states she
brushes her teeth "only when they hurt." Serum phenytoin
level is within the therapeutic range. She denies recent seizures.
Question Stem
Which nursing teaching is most appropriate?
A. Stop taking phenytoin until the gum swelling resolves.
B. Perform meticulous oral hygiene and schedule regular dental
visits.
C. Increase dietary sodium intake to reduce gum swelling.
D. Avoid drinking water immediately after taking the
medication.
System Part 1 Exam Questions &
Rationales
20 Original NCLEX Next Generation
(NGN) Practice MCQs
ATI Pharmacology Made Easy Nursing
Study Guide
Question 1
Clinical Scenario
A 68-year-old man with newly diagnosed Parkinson disease is
prescribed carbidopa/levodopa. His medical history includes
hypertension and chronic constipation. Current medications
include lisinopril and polyethylene glycol as needed. At a follow-
up visit 2 weeks later, he reports mild improvement in tremors
but complains of dizziness when standing and nausea after
taking his medication. Vital signs are: BP 128/76 mm Hg sitting,
102/64 mm Hg standing, HR 74/min, RR 16/min, and SpO₂ 98%
on room air.
,Question Stem
Which nursing intervention is the priority to reduce this client's
risk of injury?
A. Encourage the client to increase dietary protein with each
medication dose.
B. Instruct the client to rise slowly from lying or sitting
positions.
C. Advise the client to discontinue the medication if nausea
occurs.
D. Recommend taking the medication only at bedtime.
Correct Answer
B. Instruct the client to rise slowly from lying or sitting
positions.
Detailed Rationale
Carbidopa/levodopa is the cornerstone treatment for Parkinson
disease because levodopa is converted to dopamine in the
brain, while carbidopa inhibits peripheral conversion, improving
central nervous system availability and reducing gastrointestinal
adverse effects. Orthostatic hypotension is a common adverse
effect, especially during treatment initiation, increasing the risk
of falls in older adults. Teaching the client to change positions
,slowly, sit briefly before standing, and use assistive devices if
needed is the priority nursing intervention to prevent injury.
Option A is incorrect because high-protein meals can compete
with levodopa for intestinal absorption and transport across the
blood-brain barrier, potentially decreasing medication
effectiveness. Protein intake should be distributed throughout
the day rather than concentrated with medication doses.
Option C is incorrect because mild nausea is a common
transient adverse effect. The medication should not be stopped
abruptly without provider guidance because symptoms may
worsen significantly.
Option D is incorrect because restricting doses to bedtime
would not provide adequate symptom control during waking
hours and does not address orthostatic hypotension.
Nurses should monitor blood pressure in multiple positions,
reinforce fall precautions, evaluate therapeutic improvement in
mobility, and encourage adherence despite mild early adverse
effects unless severe reactions develop.
Learning Objectives
After completing this question, the learner should be able to:
• Identify common adverse effects of carbidopa/levodopa.
• Implement interventions to reduce fall risk.
, • Educate clients regarding proper medication
administration.
• Recognize factors affecting levodopa absorption.
Medication Safety Focus: Monitoring for orthostatic
hypotension and fall prevention.
Question 2
Clinical Scenario
A 32-year-old woman with newly diagnosed epilepsy begins
therapy with phenytoin. During a clinic visit one month later,
the nurse notes swollen, bleeding gums. The client states she
brushes her teeth "only when they hurt." Serum phenytoin
level is within the therapeutic range. She denies recent seizures.
Question Stem
Which nursing teaching is most appropriate?
A. Stop taking phenytoin until the gum swelling resolves.
B. Perform meticulous oral hygiene and schedule regular dental
visits.
C. Increase dietary sodium intake to reduce gum swelling.
D. Avoid drinking water immediately after taking the
medication.
