1It is end-of-dose wearing off; document the timing and notify the prescriber for possible regimen adjustment.✓ Correct answer
2It is peak-dose dyskinesia; reduce the next carbidopa-levodopa dose without contacting the prescriber.
3It is an unpredictable on-off episode; take an extra tablet whenever stiffness begins.
4It proves permanent drug tolerance; stop carbidopa-levodopa and replace it with a dopamine agonist.
Explanation
Predictable recurrence of Parkinson motor symptoms near the end of a carbidopa-levodopa dosing interval is the wearing-off phenomenon. The nurse should document symptom and dose timing and report the pattern so the prescriber can evaluate the regimen. Peak-dose dyskinesia causes involuntary movement when levodopa effect is greatest, while on-off fluctuations are less predictable. The client should not alter or stop therapy independently.
Clinical reasoning The timing distinguishes motor fluctuations. Wearing off is linked to the end of a dosing interval and improves after the next dose; dyskinesia occurs during higher drug effect.
Decision rule Track medication times against mobility changes, report lifestyle-limiting end-of-dose symptoms, and leave dose or interval changes to the prescribing plan.
Scenario A client with Parkinson disease takes carbidopa-levodopa at scheduled intervals. Bradykinesia and rigidity return predictably during the hour before each dose and improve after the next dose.
Wearing-off phenomenon — Predictable return of Parkinson symptoms as the effect of a levodopa dose declines near the end of the dosing interval.
Motor fluctuation diary — A record matching dose times, meals, mobility, and involuntary movements to support medication adjustment.