NCLEX-RN Pharmacology Immune
System Exam Questions
20 MCQs with Rationales
ATI & NGN Nursing Practice Test Bank
Question 1
Clinical Scenario
A 26-year-old woman with rheumatoid arthritis has been
prescribed methotrexate 15 mg orally once weekly. During a
follow-up clinic visit, she reports mild fatigue and occasional
nausea after taking the medication. Her laboratory results
include:
• AST: 28 U/L
• ALT: 31 U/L
• WBC: 6,800/mm³
• Platelets: 245,000/mm³
• Serum creatinine: 0.8 mg/dL
,She asks the nurse how she should take the medication at
home.
Question Stem
Which instruction is most important for the nurse to include in
the teaching plan?
A. Take methotrexate every morning with breakfast.
B. Take methotrexate only on the prescribed day each week.
C. Stop taking methotrexate if mild nausea occurs.
D. Double the next dose if one weekly dose is missed.
Correct Answer
Correct Answer: B. Take methotrexate only on the prescribed
day each week.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. For autoimmune diseases such as
rheumatoid arthritis, it is administered once weekly, not daily.
Accidental daily administration has resulted in severe bone
marrow suppression, mucositis, hepatotoxicity, and fatalities.
Emphasizing the correct weekly schedule is therefore the
highest-priority safety teaching point. Mild nausea is a common
adverse effect and may improve by taking the medication with
,food or in the evening if approved by the prescriber. Ongoing
monitoring includes CBC, liver function tests, and renal function
because toxicity risk increases with impaired elimination.
• Option A: Incorrect. Daily dosing for rheumatoid arthritis is
a serious medication error.
• Option C: Incorrect. Mild nausea alone does not require
stopping therapy; the patient should notify the provider if
symptoms become severe.
• Option D: Incorrect. Patients should never double doses of
methotrexate because toxicity may result.
The nurse should also teach the patient to avoid excessive
alcohol intake, use effective contraception, and report fever,
unusual bruising, mouth sores, or persistent cough promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Explain safe methotrexate administration.
• Recognize the importance of weekly dosing.
• Identify essential laboratory monitoring during
methotrexate therapy.
• Provide patient education to reduce medication errors.
Medication Safety Focus: Medication administration
, Question 2
Clinical Scenario
A 61-year-old man received a kidney transplant 10 days ago.
His medications include tacrolimus, mycophenolate mofetil, and
prednisone. During morning assessment, the nurse notes:
• Temperature: 38.6°C (101.5°F)
• BP: 132/78 mm Hg
• HR: 94/min
• WBC: 3,200/mm³
The client reports chills and burning with urination.
Question Stem
Which nursing action should take priority?
A. Encourage increased oral fluid intake.
B. Administer acetaminophen for fever.
C. Notify the transplant provider immediately.
D. Reassure the patient that mild infections are expected.
Correct Answer
Correct Answer: C. Notify the transplant provider immediately.
Detailed Rationale
System Exam Questions
20 MCQs with Rationales
ATI & NGN Nursing Practice Test Bank
Question 1
Clinical Scenario
A 26-year-old woman with rheumatoid arthritis has been
prescribed methotrexate 15 mg orally once weekly. During a
follow-up clinic visit, she reports mild fatigue and occasional
nausea after taking the medication. Her laboratory results
include:
• AST: 28 U/L
• ALT: 31 U/L
• WBC: 6,800/mm³
• Platelets: 245,000/mm³
• Serum creatinine: 0.8 mg/dL
,She asks the nurse how she should take the medication at
home.
Question Stem
Which instruction is most important for the nurse to include in
the teaching plan?
A. Take methotrexate every morning with breakfast.
B. Take methotrexate only on the prescribed day each week.
C. Stop taking methotrexate if mild nausea occurs.
D. Double the next dose if one weekly dose is missed.
Correct Answer
Correct Answer: B. Take methotrexate only on the prescribed
day each week.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. For autoimmune diseases such as
rheumatoid arthritis, it is administered once weekly, not daily.
Accidental daily administration has resulted in severe bone
marrow suppression, mucositis, hepatotoxicity, and fatalities.
Emphasizing the correct weekly schedule is therefore the
highest-priority safety teaching point. Mild nausea is a common
adverse effect and may improve by taking the medication with
,food or in the evening if approved by the prescriber. Ongoing
monitoring includes CBC, liver function tests, and renal function
because toxicity risk increases with impaired elimination.
• Option A: Incorrect. Daily dosing for rheumatoid arthritis is
a serious medication error.
• Option C: Incorrect. Mild nausea alone does not require
stopping therapy; the patient should notify the provider if
symptoms become severe.
• Option D: Incorrect. Patients should never double doses of
methotrexate because toxicity may result.
The nurse should also teach the patient to avoid excessive
alcohol intake, use effective contraception, and report fever,
unusual bruising, mouth sores, or persistent cough promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Explain safe methotrexate administration.
• Recognize the importance of weekly dosing.
• Identify essential laboratory monitoring during
methotrexate therapy.
• Provide patient education to reduce medication errors.
Medication Safety Focus: Medication administration
, Question 2
Clinical Scenario
A 61-year-old man received a kidney transplant 10 days ago.
His medications include tacrolimus, mycophenolate mofetil, and
prednisone. During morning assessment, the nurse notes:
• Temperature: 38.6°C (101.5°F)
• BP: 132/78 mm Hg
• HR: 94/min
• WBC: 3,200/mm³
The client reports chills and burning with urination.
Question Stem
Which nursing action should take priority?
A. Encourage increased oral fluid intake.
B. Administer acetaminophen for fever.
C. Notify the transplant provider immediately.
D. Reassure the patient that mild infections are expected.
Correct Answer
Correct Answer: C. Notify the transplant provider immediately.
Detailed Rationale
