ATI Pharmacology Made Easy Immune
System NCLEX-RN Practice Questions &
Rationales
20 Original NGN Exam-Style MCQs
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 32-year-old woman with rheumatoid arthritis has been
receiving methotrexate 15 mg orally once weekly for 3 months.
During a follow-up visit, she reports increasing fatigue, painful
mouth sores, and a sore throat. Assessment findings include
temperature 38.2°C (100.8°F), HR 96/min, BP 118/72 mmHg,
and RR 18/min. Laboratory results reveal:
• WBC: 2,300/mm³
• Hemoglobin: 10.8 g/dL
• Platelets: 118,000/mm³
• ALT: Mildly elevated
,The nurse reviews the medication administration record before
administering the next scheduled dose.
Question Stem
Which nursing action is the priority?
Options
A. Administer the methotrexate as prescribed.
B. Hold the methotrexate and notify the healthcare provider
immediately.
C. Encourage increased oral fluid intake before giving the
medication.
D. Administer folic acid after giving the methotrexate dose.
Correct Answer
Correct Answer: B. Hold the methotrexate and notify the
healthcare provider immediately.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. Although effective for
autoimmune diseases, it can cause serious bone marrow
,suppression, increasing the risk for infection, anemia, and
bleeding. This client demonstrates multiple warning signs of
toxicity, including leukopenia, thrombocytopenia, fever, sore
throat, and oral ulcerations. These findings require withholding
the medication and immediately notifying the healthcare
provider for further evaluation and possible dose adjustment or
discontinuation.
Option A is unsafe because administering another dose could
worsen life-threatening myelosuppression.
Option C promotes hydration but does not address the
immediate safety concern of severe immunosuppression.
Option D is incorrect because folic acid helps reduce some
adverse effects of methotrexate but is not an appropriate
intervention when significant toxicity has already developed.
The scheduled methotrexate dose should first be withheld.
Nursing care includes monitoring CBC, liver function tests, renal
function, signs of infection, bleeding, and oral mucosal changes.
Patients should be instructed to report fever, sore throat,
unusual bruising, or persistent mouth sores promptly and avoid
exposure to infectious illnesses.
Learning Objectives
After completing this question, the learner should be able to:
, • Recognize manifestations of methotrexate toxicity.
• Prioritize nursing interventions for immunosuppressed
patients.
• Interpret laboratory findings indicating bone marrow
suppression.
• Identify situations requiring withholding
immunosuppressive therapy.
Medication Safety Focus
Monitoring for bone marrow suppression
Question 2
Clinical Scenario
A 45-year-old man is prescribed prednisone 40 mg orally daily
for an acute exacerbation of systemic lupus erythematosus.
During discharge teaching, the nurse reviews medication
administration and safety instructions. The client asks several
questions regarding long-term corticosteroid therapy.
Question Stem
Which statement by the client indicates correct understanding
of the teaching?
Options
System NCLEX-RN Practice Questions &
Rationales
20 Original NGN Exam-Style MCQs
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 32-year-old woman with rheumatoid arthritis has been
receiving methotrexate 15 mg orally once weekly for 3 months.
During a follow-up visit, she reports increasing fatigue, painful
mouth sores, and a sore throat. Assessment findings include
temperature 38.2°C (100.8°F), HR 96/min, BP 118/72 mmHg,
and RR 18/min. Laboratory results reveal:
• WBC: 2,300/mm³
• Hemoglobin: 10.8 g/dL
• Platelets: 118,000/mm³
• ALT: Mildly elevated
,The nurse reviews the medication administration record before
administering the next scheduled dose.
Question Stem
Which nursing action is the priority?
Options
A. Administer the methotrexate as prescribed.
B. Hold the methotrexate and notify the healthcare provider
immediately.
C. Encourage increased oral fluid intake before giving the
medication.
D. Administer folic acid after giving the methotrexate dose.
Correct Answer
Correct Answer: B. Hold the methotrexate and notify the
healthcare provider immediately.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. Although effective for
autoimmune diseases, it can cause serious bone marrow
,suppression, increasing the risk for infection, anemia, and
bleeding. This client demonstrates multiple warning signs of
toxicity, including leukopenia, thrombocytopenia, fever, sore
throat, and oral ulcerations. These findings require withholding
the medication and immediately notifying the healthcare
provider for further evaluation and possible dose adjustment or
discontinuation.
Option A is unsafe because administering another dose could
worsen life-threatening myelosuppression.
Option C promotes hydration but does not address the
immediate safety concern of severe immunosuppression.
Option D is incorrect because folic acid helps reduce some
adverse effects of methotrexate but is not an appropriate
intervention when significant toxicity has already developed.
The scheduled methotrexate dose should first be withheld.
Nursing care includes monitoring CBC, liver function tests, renal
function, signs of infection, bleeding, and oral mucosal changes.
Patients should be instructed to report fever, sore throat,
unusual bruising, or persistent mouth sores promptly and avoid
exposure to infectious illnesses.
Learning Objectives
After completing this question, the learner should be able to:
, • Recognize manifestations of methotrexate toxicity.
• Prioritize nursing interventions for immunosuppressed
patients.
• Interpret laboratory findings indicating bone marrow
suppression.
• Identify situations requiring withholding
immunosuppressive therapy.
Medication Safety Focus
Monitoring for bone marrow suppression
Question 2
Clinical Scenario
A 45-year-old man is prescribed prednisone 40 mg orally daily
for an acute exacerbation of systemic lupus erythematosus.
During discharge teaching, the nurse reviews medication
administration and safety instructions. The client asks several
questions regarding long-term corticosteroid therapy.
Question Stem
Which statement by the client indicates correct understanding
of the teaching?
Options
