NCLEX-RN Pharmacology Neurological
System Part 1
20 Original NGN Practice Questions with
Detailed Rationales
ATI Pharmacology Made Easy Aligned
Nursing Exam 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 docusate sodium. During discharge
teaching, he asks when he should expect improvement and
what adverse effects to report. His vital signs are BP 132/78 mm
Hg, HR 74/min, RR 16/min, and temperature 36.8°C (98.2°F).
Question Stem
Which instruction should the nurse include as the priority
teaching regarding carbidopa/levodopa therapy?
,A. Stop taking the medication immediately if symptoms
improve.
B. Change positions slowly because the medication may cause
orthostatic hypotension.
C. Double the next dose if a scheduled dose is missed.
D. Restrict fluid intake to reduce urinary frequency.
Correct Answer
B. Change positions slowly because the medication may cause
orthostatic hypotension.
Detailed Rationale
Carbidopa/levodopa remains the most effective pharmacologic
treatment for Parkinson disease by replenishing dopamine
within the central nervous system. Levodopa crosses the blood-
brain barrier and is converted to dopamine, while carbidopa
inhibits peripheral conversion, allowing more levodopa to reach
the brain and reducing nausea and cardiovascular adverse
effects.
Orthostatic hypotension is a common adverse effect,
particularly in older adults, increasing the risk for falls and
injury. Nurses should teach patients to rise slowly from sitting or
lying positions, use assistive devices if needed, and report
dizziness or fainting. Patients should also understand that
therapeutic improvement may take days to weeks and that
,abrupt discontinuation may precipitate severe rigidity or
neuroleptic malignant syndrome-like symptoms. Medication
adherence is essential for maintaining symptom control.
• Option A: Incorrect. Abrupt discontinuation can cause
serious complications; therapy should never be stopped
without provider guidance.
• Option C: Incorrect. Doubling doses increases the risk for
dyskinesias, hypotension, and nausea.
• Option D: Incorrect. Adequate hydration is encouraged,
especially because constipation is common in Parkinson
disease.
Nurses should also monitor for dyskinesias, hallucinations,
confusion, and fluctuations in motor control as therapy
progresses.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the mechanism of action of carbidopa/levodopa.
• Identify priority safety teaching for preventing orthostatic
hypotension.
• Recognize the importance of medication adherence in
Parkinson disease.
• Educate patients regarding common adverse effects.
, Medication Safety Focus: Patient education
Question 2
Clinical Scenario
A 72-year-old woman with Parkinson disease has been taking
pramipexole for six months. During a follow-up visit, her
daughter reports that the patient has recently developed
compulsive gambling and excessive shopping. The patient
denies feeling ill and reports that her tremors have improved.
Question Stem
Which nursing action is the priority?
A. Reassure the family that these behaviors are expected with
aging.
B. Instruct the patient to stop taking the medication
immediately.
C. Notify the healthcare provider because these behaviors may
be medication related.
D. Encourage the patient to increase caffeine intake.
Correct Answer
C. Notify the healthcare provider because these behaviors
may be medication related.
System Part 1
20 Original NGN Practice Questions with
Detailed Rationales
ATI Pharmacology Made Easy Aligned
Nursing Exam 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 docusate sodium. During discharge
teaching, he asks when he should expect improvement and
what adverse effects to report. His vital signs are BP 132/78 mm
Hg, HR 74/min, RR 16/min, and temperature 36.8°C (98.2°F).
Question Stem
Which instruction should the nurse include as the priority
teaching regarding carbidopa/levodopa therapy?
,A. Stop taking the medication immediately if symptoms
improve.
B. Change positions slowly because the medication may cause
orthostatic hypotension.
C. Double the next dose if a scheduled dose is missed.
D. Restrict fluid intake to reduce urinary frequency.
Correct Answer
B. Change positions slowly because the medication may cause
orthostatic hypotension.
Detailed Rationale
Carbidopa/levodopa remains the most effective pharmacologic
treatment for Parkinson disease by replenishing dopamine
within the central nervous system. Levodopa crosses the blood-
brain barrier and is converted to dopamine, while carbidopa
inhibits peripheral conversion, allowing more levodopa to reach
the brain and reducing nausea and cardiovascular adverse
effects.
Orthostatic hypotension is a common adverse effect,
particularly in older adults, increasing the risk for falls and
injury. Nurses should teach patients to rise slowly from sitting or
lying positions, use assistive devices if needed, and report
dizziness or fainting. Patients should also understand that
therapeutic improvement may take days to weeks and that
,abrupt discontinuation may precipitate severe rigidity or
neuroleptic malignant syndrome-like symptoms. Medication
adherence is essential for maintaining symptom control.
• Option A: Incorrect. Abrupt discontinuation can cause
serious complications; therapy should never be stopped
without provider guidance.
• Option C: Incorrect. Doubling doses increases the risk for
dyskinesias, hypotension, and nausea.
• Option D: Incorrect. Adequate hydration is encouraged,
especially because constipation is common in Parkinson
disease.
Nurses should also monitor for dyskinesias, hallucinations,
confusion, and fluctuations in motor control as therapy
progresses.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the mechanism of action of carbidopa/levodopa.
• Identify priority safety teaching for preventing orthostatic
hypotension.
• Recognize the importance of medication adherence in
Parkinson disease.
• Educate patients regarding common adverse effects.
, Medication Safety Focus: Patient education
Question 2
Clinical Scenario
A 72-year-old woman with Parkinson disease has been taking
pramipexole for six months. During a follow-up visit, her
daughter reports that the patient has recently developed
compulsive gambling and excessive shopping. The patient
denies feeling ill and reports that her tremors have improved.
Question Stem
Which nursing action is the priority?
A. Reassure the family that these behaviors are expected with
aging.
B. Instruct the patient to stop taking the medication
immediately.
C. Notify the healthcare provider because these behaviors may
be medication related.
D. Encourage the patient to increase caffeine intake.
Correct Answer
C. Notify the healthcare provider because these behaviors
may be medication related.
