NCLEX-RN Pharmacology Immune
System Practice Questions with
Rationales
20 Original NGN-Style Nursing MCQs
Immunosuppressants, Biologics &
Corticosteroids Exam Prep
Question 1
Clinical Scenario
A 32-year-old woman with rheumatoid arthritis has been taking
methotrexate 15 mg orally once weekly for 3 months. During a
follow-up visit, she reports increasing fatigue, mouth sores, and
mild nausea. Laboratory results show:
• WBC: 2,900/mm³
• Hemoglobin: 10.4 g/dL
• Platelets: 118,000/mm³
• ALT: 62 U/L
• AST: 58 U/L
,The nurse reviews her medication history and notes that she
has been taking folic acid as prescribed.
Question Stem
Which nursing action is the priority?
A. Encourage the client to continue the medication because
mild bone marrow suppression is expected.
B. Administer the next scheduled dose and repeat laboratory
tests in one month.
C. Hold methotrexate and notify the healthcare provider
immediately.
D. Recommend increasing dietary iron intake.
Correct Answer
C. Hold methotrexate and notify the healthcare provider
immediately.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits dihydrofolate reductase, reducing DNA
synthesis in rapidly dividing cells. Although effective for
autoimmune diseases, it carries significant risks of bone
marrow suppression, hepatotoxicity, and mucositis. This client
demonstrates multiple signs of toxicity: leukopenia,
thrombocytopenia, anemia, elevated liver enzymes, and oral
,ulcers. Continuing therapy could place the client at high risk for
severe infection or bleeding. The nurse should withhold the
medication and promptly notify the provider for further
evaluation, dosage adjustment, or discontinuation. Additional
interventions may include repeat CBC, liver function
monitoring, and assessment for infection.
Option A is incorrect because these laboratory abnormalities
are not considered acceptable or expected. Option B delays
intervention and exposes the client to worsening toxicity.
Option D may address anemia over time but ignores the
immediate medication-related cause. Folic acid
supplementation helps reduce some adverse effects but does
not prevent significant myelosuppression or hepatotoxicity.
Nurses should educate clients to report fever, unusual bruising,
persistent sore throat, or mouth ulcers promptly and emphasize
that methotrexate is administered once weekly, not daily, to
avoid potentially fatal dosing errors.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of methotrexate toxicity.
• Prioritize nursing interventions for bone marrow
suppression.
• Interpret laboratory findings indicating medication toxicity.
, • Reinforce safe methotrexate administration practices.
Medication Safety Focus
Monitoring – Bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 56-year-old man received a kidney transplant two weeks ago.
He is prescribed tacrolimus, mycophenolate mofetil, and
prednisone. During discharge teaching, he asks which foods
should be avoided while taking tacrolimus.
Question Stem
Which response by the nurse is most appropriate?
A. "You may safely consume grapefruit because it improves
medication absorption."
B. "Avoid grapefruit and grapefruit juice while taking
tacrolimus."
C. "Only avoid dairy products because they reduce tacrolimus
effectiveness."
D. "There are no significant food interactions with tacrolimus."
Correct Answer
System Practice Questions with
Rationales
20 Original NGN-Style Nursing MCQs
Immunosuppressants, Biologics &
Corticosteroids Exam Prep
Question 1
Clinical Scenario
A 32-year-old woman with rheumatoid arthritis has been taking
methotrexate 15 mg orally once weekly for 3 months. During a
follow-up visit, she reports increasing fatigue, mouth sores, and
mild nausea. Laboratory results show:
• WBC: 2,900/mm³
• Hemoglobin: 10.4 g/dL
• Platelets: 118,000/mm³
• ALT: 62 U/L
• AST: 58 U/L
,The nurse reviews her medication history and notes that she
has been taking folic acid as prescribed.
Question Stem
Which nursing action is the priority?
A. Encourage the client to continue the medication because
mild bone marrow suppression is expected.
B. Administer the next scheduled dose and repeat laboratory
tests in one month.
C. Hold methotrexate and notify the healthcare provider
immediately.
D. Recommend increasing dietary iron intake.
Correct Answer
C. Hold methotrexate and notify the healthcare provider
immediately.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits dihydrofolate reductase, reducing DNA
synthesis in rapidly dividing cells. Although effective for
autoimmune diseases, it carries significant risks of bone
marrow suppression, hepatotoxicity, and mucositis. This client
demonstrates multiple signs of toxicity: leukopenia,
thrombocytopenia, anemia, elevated liver enzymes, and oral
,ulcers. Continuing therapy could place the client at high risk for
severe infection or bleeding. The nurse should withhold the
medication and promptly notify the provider for further
evaluation, dosage adjustment, or discontinuation. Additional
interventions may include repeat CBC, liver function
monitoring, and assessment for infection.
Option A is incorrect because these laboratory abnormalities
are not considered acceptable or expected. Option B delays
intervention and exposes the client to worsening toxicity.
Option D may address anemia over time but ignores the
immediate medication-related cause. Folic acid
supplementation helps reduce some adverse effects but does
not prevent significant myelosuppression or hepatotoxicity.
Nurses should educate clients to report fever, unusual bruising,
persistent sore throat, or mouth ulcers promptly and emphasize
that methotrexate is administered once weekly, not daily, to
avoid potentially fatal dosing errors.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of methotrexate toxicity.
• Prioritize nursing interventions for bone marrow
suppression.
• Interpret laboratory findings indicating medication toxicity.
, • Reinforce safe methotrexate administration practices.
Medication Safety Focus
Monitoring – Bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 56-year-old man received a kidney transplant two weeks ago.
He is prescribed tacrolimus, mycophenolate mofetil, and
prednisone. During discharge teaching, he asks which foods
should be avoided while taking tacrolimus.
Question Stem
Which response by the nurse is most appropriate?
A. "You may safely consume grapefruit because it improves
medication absorption."
B. "Avoid grapefruit and grapefruit juice while taking
tacrolimus."
C. "Only avoid dairy products because they reduce tacrolimus
effectiveness."
D. "There are no significant food interactions with tacrolimus."
Correct Answer
