NCLEX-RN Pharmacology Immune
System Practice Questions & Rationales
20 NGN-Style MCQs
Methotrexate, Prednisone, Biologics &
Immunosuppressants
Question 1
Clinical Scenario
A 32-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. She is attending a
follow-up clinic visit. Assessment findings include mild morning
stiffness and improved joint pain. Laboratory results show AST
24 U/L, ALT 28 U/L, WBC 6,800/mm³, and platelet count
230,000/mm³. The nurse reviews her understanding of the
medication regimen.
Question Stem
Which statement by the client indicates correct understanding
of methotrexate therapy?
A. "I will take this medication every morning with breakfast."
,B. "I should avoid alcohol while taking this medication."
C. "Once my symptoms improve, I can stop having blood tests."
D. "Live vaccines are recommended while taking this
medication."
Correct Answer
Correct Answer: B. "I should avoid alcohol while taking this
medication."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) commonly used to treat rheumatoid arthritis and
other autoimmune disorders. One of its major adverse effects is
hepatotoxicity. Alcohol consumption increases the risk of liver
damage; therefore, clients should avoid or significantly limit
alcohol intake while receiving methotrexate.
Option A is incorrect because methotrexate for rheumatoid
arthritis is typically administered once weekly, not daily. Daily
administration is a serious medication error that can result in
severe bone marrow suppression, mucositis, hepatotoxicity, and
even death. Option C is incorrect because routine laboratory
monitoring, including liver function tests, CBC, and renal
function tests, is required throughout therapy regardless of
symptom improvement. Option D is incorrect because
methotrexate suppresses immune function, and live vaccines
,may pose an infection risk unless specifically approved by the
healthcare provider.
Nurses should emphasize medication scheduling, infection
prevention, and the importance of regular laboratory
monitoring. Clients should also report unusual bruising,
bleeding, fever, or persistent fatigue.
Learning Objective
After completing this question, the learner should be able to:
• Identify key safety precautions associated with
methotrexate therapy.
• Recognize factors that increase hepatotoxicity risk.
• Explain the importance of ongoing laboratory monitoring.
• Educate patients regarding immunosuppressive medication
use.
Medication Safety Focus
Medication Administration
Question 2
Clinical Scenario
A 54-year-old man with Crohn disease arrives at the infusion
center to receive infliximab. During the pre-infusion
, assessment, he reports a persistent cough, night sweats,
fatigue, and an unintentional 10-pound weight loss over the
past month. His temperature is 38.1°C (100.6°F).
Question Stem
Which action should the nurse take first?
A. Administer the infliximab infusion as prescribed
B. Encourage increased fluid intake and reassess later
C. Notify the provider and hold the infusion
D. Administer acetaminophen before the infusion
Correct Answer
Correct Answer: C. Notify the provider and hold the infusion
Detailed Rationale
Infliximab is a TNF-alpha inhibitor that suppresses immune
function and increases the risk of serious infections, including
reactivation of latent tuberculosis. Symptoms such as chronic
cough, night sweats, weight loss, and fever are concerning for
tuberculosis and require immediate evaluation before the
medication is administered.
Option A is unsafe because giving infliximab could worsen an
active infection. Option B delays necessary intervention and
does not address the potential infection. Option D may help
System Practice Questions & Rationales
20 NGN-Style MCQs
Methotrexate, Prednisone, Biologics &
Immunosuppressants
Question 1
Clinical Scenario
A 32-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. She is attending a
follow-up clinic visit. Assessment findings include mild morning
stiffness and improved joint pain. Laboratory results show AST
24 U/L, ALT 28 U/L, WBC 6,800/mm³, and platelet count
230,000/mm³. The nurse reviews her understanding of the
medication regimen.
Question Stem
Which statement by the client indicates correct understanding
of methotrexate therapy?
A. "I will take this medication every morning with breakfast."
,B. "I should avoid alcohol while taking this medication."
C. "Once my symptoms improve, I can stop having blood tests."
D. "Live vaccines are recommended while taking this
medication."
Correct Answer
Correct Answer: B. "I should avoid alcohol while taking this
medication."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) commonly used to treat rheumatoid arthritis and
other autoimmune disorders. One of its major adverse effects is
hepatotoxicity. Alcohol consumption increases the risk of liver
damage; therefore, clients should avoid or significantly limit
alcohol intake while receiving methotrexate.
Option A is incorrect because methotrexate for rheumatoid
arthritis is typically administered once weekly, not daily. Daily
administration is a serious medication error that can result in
severe bone marrow suppression, mucositis, hepatotoxicity, and
even death. Option C is incorrect because routine laboratory
monitoring, including liver function tests, CBC, and renal
function tests, is required throughout therapy regardless of
symptom improvement. Option D is incorrect because
methotrexate suppresses immune function, and live vaccines
,may pose an infection risk unless specifically approved by the
healthcare provider.
Nurses should emphasize medication scheduling, infection
prevention, and the importance of regular laboratory
monitoring. Clients should also report unusual bruising,
bleeding, fever, or persistent fatigue.
Learning Objective
After completing this question, the learner should be able to:
• Identify key safety precautions associated with
methotrexate therapy.
• Recognize factors that increase hepatotoxicity risk.
• Explain the importance of ongoing laboratory monitoring.
• Educate patients regarding immunosuppressive medication
use.
Medication Safety Focus
Medication Administration
Question 2
Clinical Scenario
A 54-year-old man with Crohn disease arrives at the infusion
center to receive infliximab. During the pre-infusion
, assessment, he reports a persistent cough, night sweats,
fatigue, and an unintentional 10-pound weight loss over the
past month. His temperature is 38.1°C (100.6°F).
Question Stem
Which action should the nurse take first?
A. Administer the infliximab infusion as prescribed
B. Encourage increased fluid intake and reassess later
C. Notify the provider and hold the infusion
D. Administer acetaminophen before the infusion
Correct Answer
Correct Answer: C. Notify the provider and hold the infusion
Detailed Rationale
Infliximab is a TNF-alpha inhibitor that suppresses immune
function and increases the risk of serious infections, including
reactivation of latent tuberculosis. Symptoms such as chronic
cough, night sweats, weight loss, and fever are concerning for
tuberculosis and require immediate evaluation before the
medication is administered.
Option A is unsafe because giving infliximab could worsen an
active infection. Option B delays necessary intervention and
does not address the potential infection. Option D may help
