NR 566 Advanced Pharmacology Final
Exam
Comprehensive Practice
Exam (2025/2026
Updated)
100 Questions with Verified
Answers and Rationales
,SECTION 1: Central Nervous System
Pharmacology
Parkinson's Disease Medications (Questions 1-8)
Question 1
A 68-year-old patient is newly diagnosed with early-stage
Parkinson's disease. The NP is considering initiating pramipexole.
Which statement from the patient would require additional
teaching?
A) "I will come back next week to get started on levodopa"
B) "It will take several weeks to see the benefit of this medication"
C) "If I start to have addictions such as gambling, excessive
shopping, or increased alcohol use, I should notify my doctor right
away"
D) "I am taking cimetidine for heartburn; I should discuss this with
my provider"
Correct Answer: A
Rationale: Pramipexole is a dopamine agonist used as initial
therapy for early Parkinson's disease. Levodopa is typically
reserved for later stages when symptoms are more disabling. The
statement about returning next week to start levodopa indicates
misunderstanding, as pramipexole is appropriate first-line therapy.
Dopamine agonists can cause impulse control disorders (gambling,
shopping, hypersexuality) requiring monitoring, and cimetidine can
interact by reducing pramipexole clearance .
Question 2
Match each Parkinson's medication with its corresponding
mechanism of action:
,1. Levodopa
2. Selegiline
3. Amantadine
4. Ropinirole
A) Dopamine precursor that is converted to dopamine in the brain
B) Selective MAO-B inhibitor that prevents dopamine breakdown
C) Increases dopamine release and blocks NMDA receptors
D) Dopamine agonist that mimics the effects of dopamine in the
brain
Correct Answers:
1 → A
2 → B
3 → C
4 → D
Rationale: Levodopa is converted to dopamine in the brain,
replenishing depleted levels. Selegiline inhibits MAO-B, preventing
dopamine breakdown. Amantadine enhances dopamine release and
modulates glutamate activity via NMDA receptor blockade.
Ropinirole directly stimulates dopamine receptors .
Question 3
A patient with Parkinson's disease has been on carbidopa-levodopa
for several months and now reports experiencing "off" periods
where medication effectiveness wears off before the next dose.
Which intervention should the NP consider?
A) Discontinue carbidopa-levodopa and switch to a dopamine
agonist
B) Increase the dose of carbidopa-levodopa
C) Shorten the dosing interval or consider adding a COMT inhibitor
D) Add an antipsychotic medication
Correct Answer: C
Rationale: "Off" periods (wearing-off phenomenon) are common
with chronic levodopa therapy. Management includes shortening the
, dosing interval, adding a COMT inhibitor (entacapone) to prolong
levodopa's effect, or considering other adjunctive therapies. Abrupt
discontinuation is inappropriate, and antipsychotics may worsen
symptoms .
Question 4
Which of the following is a serious adverse effect associated with
MAO-B inhibitors used in Parkinson's disease?
A) Hypertension
B) Serotonin syndrome when combined with SSRIs
C) Hyperglycemia
D) Nephrotoxicity
Correct Answer: B
Rationale: MAO-B inhibitors (selegiline, rasagiline) can cause
serotonin syndrome when combined with serotonergic drugs
including SSRIs, SNRIs, and some antidepressants. Symptoms
include confusion, agitation, hyperthermia, diaphoresis, and muscle
rigidity. This combination should be used with extreme caution or
avoided .
Question 5
A 72-year-old patient with Parkinson's disease is experiencing
significant tremors and rigidity despite optimal dosing of carbidopa-
levodopa. The NP considers adding a dopamine agonist. What
important patient education should be provided?
A) "This medication will work immediately"
B) "You may experience sudden sleep episodes, so use caution
when driving"
C) "There are no significant side effects with this class of
medication"
D) "You can stop your levodopa once you start the new medication"
Exam
Comprehensive Practice
Exam (2025/2026
Updated)
100 Questions with Verified
Answers and Rationales
,SECTION 1: Central Nervous System
Pharmacology
Parkinson's Disease Medications (Questions 1-8)
Question 1
A 68-year-old patient is newly diagnosed with early-stage
Parkinson's disease. The NP is considering initiating pramipexole.
Which statement from the patient would require additional
teaching?
A) "I will come back next week to get started on levodopa"
B) "It will take several weeks to see the benefit of this medication"
C) "If I start to have addictions such as gambling, excessive
shopping, or increased alcohol use, I should notify my doctor right
away"
D) "I am taking cimetidine for heartburn; I should discuss this with
my provider"
Correct Answer: A
Rationale: Pramipexole is a dopamine agonist used as initial
therapy for early Parkinson's disease. Levodopa is typically
reserved for later stages when symptoms are more disabling. The
statement about returning next week to start levodopa indicates
misunderstanding, as pramipexole is appropriate first-line therapy.
Dopamine agonists can cause impulse control disorders (gambling,
shopping, hypersexuality) requiring monitoring, and cimetidine can
interact by reducing pramipexole clearance .
Question 2
Match each Parkinson's medication with its corresponding
mechanism of action:
,1. Levodopa
2. Selegiline
3. Amantadine
4. Ropinirole
A) Dopamine precursor that is converted to dopamine in the brain
B) Selective MAO-B inhibitor that prevents dopamine breakdown
C) Increases dopamine release and blocks NMDA receptors
D) Dopamine agonist that mimics the effects of dopamine in the
brain
Correct Answers:
1 → A
2 → B
3 → C
4 → D
Rationale: Levodopa is converted to dopamine in the brain,
replenishing depleted levels. Selegiline inhibits MAO-B, preventing
dopamine breakdown. Amantadine enhances dopamine release and
modulates glutamate activity via NMDA receptor blockade.
Ropinirole directly stimulates dopamine receptors .
Question 3
A patient with Parkinson's disease has been on carbidopa-levodopa
for several months and now reports experiencing "off" periods
where medication effectiveness wears off before the next dose.
Which intervention should the NP consider?
A) Discontinue carbidopa-levodopa and switch to a dopamine
agonist
B) Increase the dose of carbidopa-levodopa
C) Shorten the dosing interval or consider adding a COMT inhibitor
D) Add an antipsychotic medication
Correct Answer: C
Rationale: "Off" periods (wearing-off phenomenon) are common
with chronic levodopa therapy. Management includes shortening the
, dosing interval, adding a COMT inhibitor (entacapone) to prolong
levodopa's effect, or considering other adjunctive therapies. Abrupt
discontinuation is inappropriate, and antipsychotics may worsen
symptoms .
Question 4
Which of the following is a serious adverse effect associated with
MAO-B inhibitors used in Parkinson's disease?
A) Hypertension
B) Serotonin syndrome when combined with SSRIs
C) Hyperglycemia
D) Nephrotoxicity
Correct Answer: B
Rationale: MAO-B inhibitors (selegiline, rasagiline) can cause
serotonin syndrome when combined with serotonergic drugs
including SSRIs, SNRIs, and some antidepressants. Symptoms
include confusion, agitation, hyperthermia, diaphoresis, and muscle
rigidity. This combination should be used with extreme caution or
avoided .
Question 5
A 72-year-old patient with Parkinson's disease is experiencing
significant tremors and rigidity despite optimal dosing of carbidopa-
levodopa. The NP considers adding a dopamine agonist. What
important patient education should be provided?
A) "This medication will work immediately"
B) "You may experience sudden sleep episodes, so use caution
when driving"
C) "There are no significant side effects with this class of
medication"
D) "You can stop your levodopa once you start the new medication"
