# A client with Parkinson disease taking levodopa-carbidopa for 5 years reports that the medication "doesn't last as long anymore" and that he has periods of severe stiffness 1-2 hours before his next dose. Which is the nurse's best interpretation?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with Parkinson disease taking levodopa-carbidopa for 5 years reports that the medication "doesn't last as long anymore" and that he has periods of severe stiffness 1-2 hours before his next dose. Which is the nurse's best interpretation?

## Option

1. This is the wearing-off phenomenon, common with long-term levodopa therapy; the dosing interval may need to be shortened or a COMT inhibitor added. **✔ Correct answer**
2. The medication has reached its maximum benefit; switch to non-pharmacologic therapy.
3. This indicates the disease is cured and the medication can be stopped.
4. The client should take a double dose immediately when stiffness returns.

**Correct answer: 1**

## Explanation

Correct (2): The wearing-off phenomenon is a predictable end-of-dose return of Parkinson symptoms 1-2 hours before the next scheduled dose. Caused by progressive disease and shorter duration of action over years. Management: shorter dosing interval, controlled-release levodopa, adding a COMT inhibitor (entacapone) or MAO-B inhibitor (rasagiline), or dopamine agonist add-on. (1) Not cured. (3) Double-dosing causes dyskinesia. (4) Pharmacologic adjustments still help.

## In-depth explanation

Memory Tip Levodopa long-term complications = "Wearing-off" (predictable) vs "On-off" fluctuations (unpredictable) vs Dyskinesias (involuntary movements). CPG Avoid high-protein meals near doses — amino acids compete with levodopa absorption.

## Clinical scenario

Scenario 68-year-old male with Parkinson disease on levodopa-carbidopa 25/100 mg PO QID × 5 years. Reports "wearing off" between doses with bradykinesia and stiffness in the last 1-2 hours.

## Key concepts

- **Wearing-off phenomenon** — Predictable end-of-dose return of Parkinson symptoms; treated by shortening interval or adding COMT/MAO-B inhibitor.
- **On-off fluctuations** — Unpredictable sudden swings between mobility and immobility; later-stage levodopa complication.
- **COMT inhibitor** — Entacapone, tolcapone — block peripheral levodopa metabolism, extending duration of action.

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=391754&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._