NCLEX-RN Immune System
Pharmacology Practice Questions
20 Original MCQs with Detailed
Rationales
NGN Nursing Exam Prep
ATI-Style Review
Question 1
Clinical Scenario
A 46-year-old woman with severe rheumatoid arthritis is
prescribed methotrexate 15 mg orally once weekly. During a
follow-up clinic visit, she tells the nurse, "I started taking it
every morning because I thought it would work faster." She
reports mouth sores, nausea, fatigue, and decreased appetite.
Laboratory results reveal WBC 2,800/mm³, platelet count
95,000/mm³, ALT 112 U/L, and AST 98 U/L.
Question Stem
Which nursing action is the priority?
,A. Encourage the client to continue taking methotrexate with
meals.
B. Instruct the client to skip the next dose and resume the
weekly schedule afterward.
C. Hold the medication, notify the healthcare provider
immediately, and assess for signs of infection or bleeding.
D. Recommend an over-the-counter mouth rinse for oral
discomfort.
Correct Answer
Correct Answer: C. Hold the medication, notify the healthcare
provider immediately, and assess for signs of infection or
bleeding.
Detailed Rationale
Methotrexate is a conventional disease-modifying
antirheumatic drug (DMARD) that inhibits folate metabolism,
suppressing immune cell proliferation. It is intended to be taken
once weekly, not daily. Daily administration can rapidly lead to
severe toxicity, including bone marrow suppression,
hepatotoxicity, mucositis, and gastrointestinal injury. This client
demonstrates classic toxicity with leukopenia,
thrombocytopenia, elevated liver enzymes, and oral
ulcerations. The priority nursing action is to stop the
medication, notify the provider immediately, and assess for
,complications such as infection, bleeding, or worsening organ
dysfunction. Further treatment may include folinic acid
(leucovorin) rescue depending on severity.
Option A is unsafe because continuing the medication would
worsen toxicity. Option B delays urgent evaluation and ignores
potentially life-threatening laboratory abnormalities. Option D
addresses only one symptom while failing to recognize systemic
toxicity requiring immediate intervention. Nurses should verify
weekly dosing during medication reconciliation, educate
patients carefully about dosing schedules, monitor CBC and
liver function tests regularly, and instruct patients to report
fever, bruising, mouth ulcers, or unusual fatigue promptly.
Learning Objective
After completing this question, the learner should be able to:
• Recognize methotrexate toxicity.
• Identify priority nursing actions for medication overdose.
• Interpret laboratory findings associated with bone marrow
suppression.
• Reinforce safe weekly methotrexate administration.
Medication Safety Focus: Medication administration
Question 2
, Clinical Scenario
A 58-year-old man received a kidney transplant 3 weeks ago
and is taking tacrolimus, mycophenolate mofetil, and
prednisone. During a clinic visit, he reports drinking grapefruit
juice every morning because he believes it is healthy. His
tacrolimus trough level is elevated above the therapeutic range,
and his serum creatinine has increased.
Question Stem
Which statement by the nurse is most appropriate?
A. "Continue drinking grapefruit juice because it improves
medication absorption."
B. "You should avoid grapefruit products because they can
dangerously increase tacrolimus levels."
C. "Switch to orange juice only on medication days."
D. "Reduce your tacrolimus dose whenever you drink grapefruit
juice."
Correct Answer
Correct Answer: B. "You should avoid grapefruit products
because they can dangerously increase tacrolimus levels."
Detailed Rationale
Tacrolimus is a calcineurin inhibitor with a narrow therapeutic
index. Grapefruit inhibits intestinal CYP3A4 enzymes
Pharmacology Practice Questions
20 Original MCQs with Detailed
Rationales
NGN Nursing Exam Prep
ATI-Style Review
Question 1
Clinical Scenario
A 46-year-old woman with severe rheumatoid arthritis is
prescribed methotrexate 15 mg orally once weekly. During a
follow-up clinic visit, she tells the nurse, "I started taking it
every morning because I thought it would work faster." She
reports mouth sores, nausea, fatigue, and decreased appetite.
Laboratory results reveal WBC 2,800/mm³, platelet count
95,000/mm³, ALT 112 U/L, and AST 98 U/L.
Question Stem
Which nursing action is the priority?
,A. Encourage the client to continue taking methotrexate with
meals.
B. Instruct the client to skip the next dose and resume the
weekly schedule afterward.
C. Hold the medication, notify the healthcare provider
immediately, and assess for signs of infection or bleeding.
D. Recommend an over-the-counter mouth rinse for oral
discomfort.
Correct Answer
Correct Answer: C. Hold the medication, notify the healthcare
provider immediately, and assess for signs of infection or
bleeding.
Detailed Rationale
Methotrexate is a conventional disease-modifying
antirheumatic drug (DMARD) that inhibits folate metabolism,
suppressing immune cell proliferation. It is intended to be taken
once weekly, not daily. Daily administration can rapidly lead to
severe toxicity, including bone marrow suppression,
hepatotoxicity, mucositis, and gastrointestinal injury. This client
demonstrates classic toxicity with leukopenia,
thrombocytopenia, elevated liver enzymes, and oral
ulcerations. The priority nursing action is to stop the
medication, notify the provider immediately, and assess for
,complications such as infection, bleeding, or worsening organ
dysfunction. Further treatment may include folinic acid
(leucovorin) rescue depending on severity.
Option A is unsafe because continuing the medication would
worsen toxicity. Option B delays urgent evaluation and ignores
potentially life-threatening laboratory abnormalities. Option D
addresses only one symptom while failing to recognize systemic
toxicity requiring immediate intervention. Nurses should verify
weekly dosing during medication reconciliation, educate
patients carefully about dosing schedules, monitor CBC and
liver function tests regularly, and instruct patients to report
fever, bruising, mouth ulcers, or unusual fatigue promptly.
Learning Objective
After completing this question, the learner should be able to:
• Recognize methotrexate toxicity.
• Identify priority nursing actions for medication overdose.
• Interpret laboratory findings associated with bone marrow
suppression.
• Reinforce safe weekly methotrexate administration.
Medication Safety Focus: Medication administration
Question 2
, Clinical Scenario
A 58-year-old man received a kidney transplant 3 weeks ago
and is taking tacrolimus, mycophenolate mofetil, and
prednisone. During a clinic visit, he reports drinking grapefruit
juice every morning because he believes it is healthy. His
tacrolimus trough level is elevated above the therapeutic range,
and his serum creatinine has increased.
Question Stem
Which statement by the nurse is most appropriate?
A. "Continue drinking grapefruit juice because it improves
medication absorption."
B. "You should avoid grapefruit products because they can
dangerously increase tacrolimus levels."
C. "Switch to orange juice only on medication days."
D. "Reduce your tacrolimus dose whenever you drink grapefruit
juice."
Correct Answer
Correct Answer: B. "You should avoid grapefruit products
because they can dangerously increase tacrolimus levels."
Detailed Rationale
Tacrolimus is a calcineurin inhibitor with a narrow therapeutic
index. Grapefruit inhibits intestinal CYP3A4 enzymes
