NCLEX-RN Pharmacology Immune
System Practice Questions
20 ATI & NGN-Style MCQs with
Detailed Rationales, Medication Safety,
Immunosuppressants & Biologics
Question 1
Clinical Scenario
A 34-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. During a follow-up
clinic visit, she reports increased fatigue and mild mouth sores.
Her vital signs are stable. Laboratory results reveal:
• WBC: 3,000/mm³
• Hemoglobin: 11.2 g/dL
• Platelets: 110,000/mm³
• ALT: Mildly elevated
• Serum creatinine: Normal
,The nurse reviews the medication administration record before
providing patient education.
Question Stem
Which nursing action is the priority?
A. Instruct the client to increase dietary protein intake.
B. Notify the provider and withhold the scheduled
methotrexate dose.
C. Encourage the client to continue therapy because these
effects are expected.
D. Recommend taking methotrexate with food to decrease
mouth sores.
Correct Answer
B. Notify the provider and withhold the scheduled
methotrexate dose.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. While effective for autoimmune
disorders, it can cause bone marrow suppression,
hepatotoxicity, and mucositis. This client demonstrates several
signs of potential toxicity, including leukopenia,
thrombocytopenia, oral ulcers, and elevated liver enzymes. The
,priority nursing action is to withhold the medication and
promptly notify the provider to prevent progression to severe
infection or bleeding complications. Additional evaluation,
dosage adjustment, or temporary discontinuation may be
necessary.
Option A is incorrect because increasing dietary protein does
not address the client's bone marrow suppression or potential
toxicity.
Option C is incorrect because these findings are not considered
harmless expected effects. Continuing therapy without
evaluation could worsen cytopenias or liver injury.
Option D is incorrect because taking methotrexate with food
may reduce gastrointestinal upset but does not resolve clinically
significant oral ulcers or laboratory abnormalities indicating
toxicity.
Nurses should reinforce weekly—not daily—administration,
monitor CBC, liver function tests, and renal function regularly,
encourage avoidance of alcohol, assess for infection or
bleeding, and teach clients to report fever, sore throat, bruising,
or persistent mouth sores promptly. Folic acid supplementation
may reduce some adverse effects when prescribed.
Learning Objectives
After completing this question, the learner should be able to:
, • Identify laboratory findings indicating methotrexate
toxicity.
• Prioritize nursing interventions for bone marrow
suppression.
• Recognize when methotrexate should be withheld.
• Educate patients regarding ongoing laboratory monitoring.
Medication Safety Focus
Monitoring for bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 56-year-old client with Crohn disease is beginning therapy
with adalimumab. Before administering the first dose, the
nurse reviews the client's history.
Which assessment finding requires the nurse to notify the
provider before administering the medication?
A. Positive tuberculosis screening test completed today
B. History of seasonal allergic rhinitis
C. Mild osteoarthritis of the knees
D. Controlled hypertension treated with lisinopril
System Practice Questions
20 ATI & NGN-Style MCQs with
Detailed Rationales, Medication Safety,
Immunosuppressants & Biologics
Question 1
Clinical Scenario
A 34-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. During a follow-up
clinic visit, she reports increased fatigue and mild mouth sores.
Her vital signs are stable. Laboratory results reveal:
• WBC: 3,000/mm³
• Hemoglobin: 11.2 g/dL
• Platelets: 110,000/mm³
• ALT: Mildly elevated
• Serum creatinine: Normal
,The nurse reviews the medication administration record before
providing patient education.
Question Stem
Which nursing action is the priority?
A. Instruct the client to increase dietary protein intake.
B. Notify the provider and withhold the scheduled
methotrexate dose.
C. Encourage the client to continue therapy because these
effects are expected.
D. Recommend taking methotrexate with food to decrease
mouth sores.
Correct Answer
B. Notify the provider and withhold the scheduled
methotrexate dose.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. While effective for autoimmune
disorders, it can cause bone marrow suppression,
hepatotoxicity, and mucositis. This client demonstrates several
signs of potential toxicity, including leukopenia,
thrombocytopenia, oral ulcers, and elevated liver enzymes. The
,priority nursing action is to withhold the medication and
promptly notify the provider to prevent progression to severe
infection or bleeding complications. Additional evaluation,
dosage adjustment, or temporary discontinuation may be
necessary.
Option A is incorrect because increasing dietary protein does
not address the client's bone marrow suppression or potential
toxicity.
Option C is incorrect because these findings are not considered
harmless expected effects. Continuing therapy without
evaluation could worsen cytopenias or liver injury.
Option D is incorrect because taking methotrexate with food
may reduce gastrointestinal upset but does not resolve clinically
significant oral ulcers or laboratory abnormalities indicating
toxicity.
Nurses should reinforce weekly—not daily—administration,
monitor CBC, liver function tests, and renal function regularly,
encourage avoidance of alcohol, assess for infection or
bleeding, and teach clients to report fever, sore throat, bruising,
or persistent mouth sores promptly. Folic acid supplementation
may reduce some adverse effects when prescribed.
Learning Objectives
After completing this question, the learner should be able to:
, • Identify laboratory findings indicating methotrexate
toxicity.
• Prioritize nursing interventions for bone marrow
suppression.
• Recognize when methotrexate should be withheld.
• Educate patients regarding ongoing laboratory monitoring.
Medication Safety Focus
Monitoring for bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 56-year-old client with Crohn disease is beginning therapy
with adalimumab. Before administering the first dose, the
nurse reviews the client's history.
Which assessment finding requires the nurse to notify the
provider before administering the medication?
A. Positive tuberculosis screening test completed today
B. History of seasonal allergic rhinitis
C. Mild osteoarthritis of the knees
D. Controlled hypertension treated with lisinopril
