NCLEX-RN Pharmacology Immune
System Exam Questions & Rationales |
20 Original NCLEX Practice MCQs |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 42-year-old woman with rheumatoid arthritis has been
receiving methotrexate 15 mg orally once weekly for the past 3
months. She reports improved joint stiffness but now complains
of mouth sores and increasing fatigue. Assessment reveals
several oral ulcers. Laboratory results show:
• WBC: 3,100/mm³
• Hemoglobin: 11.2 g/dL
• Platelets: 118,000/mm³
• ALT: 68 U/L
• AST: 64 U/L
The nurse reviews the medication administration record before
the next scheduled dose.
,Question Stem
Which nursing action is the priority?
A. Administer the scheduled methotrexate dose with food.
B. Hold the methotrexate and notify the healthcare provider.
C. Encourage increased dietary protein intake.
D. Instruct the client to increase fluid intake before taking
methotrexate.
Correct Answer
B. Hold the methotrexate and notify the healthcare provider.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. Although effective for rheumatoid
arthritis, it can cause bone marrow suppression,
hepatotoxicity, and mucositis, all of which are evident in this
client. The low white blood cell count, thrombocytopenia,
elevated liver enzymes, and oral ulcers strongly suggest
methotrexate toxicity. The priority nursing action is to withhold
the medication and promptly notify the healthcare provider for
further evaluation and possible dose adjustment or
discontinuation.
,Option A is incorrect because administering another dose could
worsen toxicity. Food may reduce gastrointestinal upset but
does not address serious adverse effects.
Option C is incorrect because nutritional support will not
correct medication-induced bone marrow suppression or liver
injury.
Option D is incorrect because hydration is beneficial for some
medications but does not resolve the client's current toxic
manifestations.
The nurse should also assess for fever or signs of infection,
monitor complete blood counts and liver function tests,
reinforce weekly—not daily—administration, and ensure the
client receives prescribed folic acid supplementation if
indicated.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of methotrexate toxicity.
• Prioritize nursing interventions for abnormal laboratory
findings.
• Identify laboratory values requiring medication
withholding.
• Promote safe monitoring during DMARD therapy.
, Medication Safety Focus
Monitoring for bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 28-year-old woman with systemic lupus erythematosus (SLE)
has been prescribed hydroxychloroquine. During discharge
teaching, she asks what monitoring will be necessary while
taking the medication long term.
Question Stem
Which statement by the nurse is most appropriate?
A. "You should have regular eye examinations during
treatment."
B. "Avoid all foods containing vitamin K."
C. "Take this medication only when joint pain becomes severe."
D. "Stop taking the medication if your urine becomes darker."
Correct Answer
A. "You should have regular eye examinations during
treatment."
Detailed Rationale
System Exam Questions & Rationales |
20 Original NCLEX Practice MCQs |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 42-year-old woman with rheumatoid arthritis has been
receiving methotrexate 15 mg orally once weekly for the past 3
months. She reports improved joint stiffness but now complains
of mouth sores and increasing fatigue. Assessment reveals
several oral ulcers. Laboratory results show:
• WBC: 3,100/mm³
• Hemoglobin: 11.2 g/dL
• Platelets: 118,000/mm³
• ALT: 68 U/L
• AST: 64 U/L
The nurse reviews the medication administration record before
the next scheduled dose.
,Question Stem
Which nursing action is the priority?
A. Administer the scheduled methotrexate dose with food.
B. Hold the methotrexate and notify the healthcare provider.
C. Encourage increased dietary protein intake.
D. Instruct the client to increase fluid intake before taking
methotrexate.
Correct Answer
B. Hold the methotrexate and notify the healthcare provider.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. Although effective for rheumatoid
arthritis, it can cause bone marrow suppression,
hepatotoxicity, and mucositis, all of which are evident in this
client. The low white blood cell count, thrombocytopenia,
elevated liver enzymes, and oral ulcers strongly suggest
methotrexate toxicity. The priority nursing action is to withhold
the medication and promptly notify the healthcare provider for
further evaluation and possible dose adjustment or
discontinuation.
,Option A is incorrect because administering another dose could
worsen toxicity. Food may reduce gastrointestinal upset but
does not address serious adverse effects.
Option C is incorrect because nutritional support will not
correct medication-induced bone marrow suppression or liver
injury.
Option D is incorrect because hydration is beneficial for some
medications but does not resolve the client's current toxic
manifestations.
The nurse should also assess for fever or signs of infection,
monitor complete blood counts and liver function tests,
reinforce weekly—not daily—administration, and ensure the
client receives prescribed folic acid supplementation if
indicated.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of methotrexate toxicity.
• Prioritize nursing interventions for abnormal laboratory
findings.
• Identify laboratory values requiring medication
withholding.
• Promote safe monitoring during DMARD therapy.
, Medication Safety Focus
Monitoring for bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 28-year-old woman with systemic lupus erythematosus (SLE)
has been prescribed hydroxychloroquine. During discharge
teaching, she asks what monitoring will be necessary while
taking the medication long term.
Question Stem
Which statement by the nurse is most appropriate?
A. "You should have regular eye examinations during
treatment."
B. "Avoid all foods containing vitamin K."
C. "Take this medication only when joint pain becomes severe."
D. "Stop taking the medication if your urine becomes darker."
Correct Answer
A. "You should have regular eye examinations during
treatment."
Detailed Rationale
