NCLEX-RN Pharmacology Immune
System Exam Questions & Rationales
20 Original NGN Practice MCQs
Immunosuppressants, Corticosteroids,
Biologics, DMARDs
ATI Pharmacology Made Easy Review
Nursing Study Guide
Question 1
Clinical Scenario
A 52-year-old woman with a history of a kidney transplant 3
months ago is admitted for a routine follow-up visit. She takes
tacrolimus, mycophenolate mofetil, and prednisone. Her
temperature is 37.1°C (98.8°F), blood pressure is 128/76 mm
Hg, and heart rate is 82 beats/min. Laboratory results reveal a
tacrolimus trough level within the prescribed range and a serum
creatinine of 1.1 mg/dL. The client asks the nurse if she can
begin taking an over-the-counter herbal supplement containing
echinacea to "boost her immune system."
,Question Stem
Which response by the nurse is most appropriate?
A. "Echinacea is safe because it prevents infections in transplant
recipients."
B. "You should avoid echinacea because it may interfere with
your immunosuppressive therapy."
C. "Take echinacea only if your temperature rises above 38.3°C
(101°F)."
D. "Echinacea will increase the effectiveness of tacrolimus."
Correct Answer
Correct Answer: B. "You should avoid echinacea because it
may interfere with your immunosuppressive therapy."
Detailed Rationale
Transplant recipients require lifelong immunosuppressive
therapy to prevent organ rejection. Tacrolimus suppresses T-
lymphocyte activation by inhibiting calcineurin, while
mycophenolate suppresses lymphocyte proliferation. Herbal
products such as echinacea stimulate immune activity and may
counteract the intended effects of immunosuppressive
medications. Additionally, herbal supplements can
unpredictably affect drug metabolism, increasing the risk of
rejection or medication toxicity. Patients should always consult
,their healthcare provider before taking any over-the-counter
medications, vitamins, or herbal supplements.
Option A is incorrect because echinacea is not routinely
recommended for transplant recipients and may increase
immune activity, which is undesirable.
Option C is incorrect because echinacea should not be started
for fever management. Fever in immunosuppressed patients
requires prompt medical evaluation rather than self-treatment.
Option D is incorrect because echinacea does not increase
tacrolimus effectiveness and may actually interfere with the
therapeutic goal of immunosuppression.
Nurses should reinforce medication adherence, infection
prevention strategies, avoidance of herbal supplements without
provider approval, and regular monitoring of tacrolimus levels
and renal function.
Learning Objectives
After completing this question, the learner should be able to:
• Explain why transplant recipients should avoid immune-
stimulating herbal supplements.
• Identify patient teaching points for tacrolimus therapy.
• Recognize potential drug-herbal interactions affecting
immunosuppressants.
, Medication Safety Focus
Drug interaction and patient education
Question 2
Clinical Scenario
A 44-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. During a follow-up
visit, she tells the nurse that she has been taking the medication
every morning because she thought "more frequent doses work
better."
Question Stem
Which nursing action is the priority?
A. Instruct the client to stop taking methotrexate and notify the
prescribing provider immediately.
B. Advise the client to continue the medication until the next
scheduled appointment.
C. Recommend taking methotrexate with grapefruit juice to
reduce toxicity.
D. Tell the client to double the dose next week if pain persists.
Correct Answer
System Exam Questions & Rationales
20 Original NGN Practice MCQs
Immunosuppressants, Corticosteroids,
Biologics, DMARDs
ATI Pharmacology Made Easy Review
Nursing Study Guide
Question 1
Clinical Scenario
A 52-year-old woman with a history of a kidney transplant 3
months ago is admitted for a routine follow-up visit. She takes
tacrolimus, mycophenolate mofetil, and prednisone. Her
temperature is 37.1°C (98.8°F), blood pressure is 128/76 mm
Hg, and heart rate is 82 beats/min. Laboratory results reveal a
tacrolimus trough level within the prescribed range and a serum
creatinine of 1.1 mg/dL. The client asks the nurse if she can
begin taking an over-the-counter herbal supplement containing
echinacea to "boost her immune system."
,Question Stem
Which response by the nurse is most appropriate?
A. "Echinacea is safe because it prevents infections in transplant
recipients."
B. "You should avoid echinacea because it may interfere with
your immunosuppressive therapy."
C. "Take echinacea only if your temperature rises above 38.3°C
(101°F)."
D. "Echinacea will increase the effectiveness of tacrolimus."
Correct Answer
Correct Answer: B. "You should avoid echinacea because it
may interfere with your immunosuppressive therapy."
Detailed Rationale
Transplant recipients require lifelong immunosuppressive
therapy to prevent organ rejection. Tacrolimus suppresses T-
lymphocyte activation by inhibiting calcineurin, while
mycophenolate suppresses lymphocyte proliferation. Herbal
products such as echinacea stimulate immune activity and may
counteract the intended effects of immunosuppressive
medications. Additionally, herbal supplements can
unpredictably affect drug metabolism, increasing the risk of
rejection or medication toxicity. Patients should always consult
,their healthcare provider before taking any over-the-counter
medications, vitamins, or herbal supplements.
Option A is incorrect because echinacea is not routinely
recommended for transplant recipients and may increase
immune activity, which is undesirable.
Option C is incorrect because echinacea should not be started
for fever management. Fever in immunosuppressed patients
requires prompt medical evaluation rather than self-treatment.
Option D is incorrect because echinacea does not increase
tacrolimus effectiveness and may actually interfere with the
therapeutic goal of immunosuppression.
Nurses should reinforce medication adherence, infection
prevention strategies, avoidance of herbal supplements without
provider approval, and regular monitoring of tacrolimus levels
and renal function.
Learning Objectives
After completing this question, the learner should be able to:
• Explain why transplant recipients should avoid immune-
stimulating herbal supplements.
• Identify patient teaching points for tacrolimus therapy.
• Recognize potential drug-herbal interactions affecting
immunosuppressants.
, Medication Safety Focus
Drug interaction and patient education
Question 2
Clinical Scenario
A 44-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. During a follow-up
visit, she tells the nurse that she has been taking the medication
every morning because she thought "more frequent doses work
better."
Question Stem
Which nursing action is the priority?
A. Instruct the client to stop taking methotrexate and notify the
prescribing provider immediately.
B. Advise the client to continue the medication until the next
scheduled appointment.
C. Recommend taking methotrexate with grapefruit juice to
reduce toxicity.
D. Tell the client to double the dose next week if pain persists.
Correct Answer
