NCLEX-RN Pharmacology Immune System
MCQs |
20 Original ATI-Style Questions with Detailed
Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old female client with rheumatoid arthritis is
prescribed adalimumab (Humira) subcutaneous injections every
other week. The client reports she has been experiencing
frequent upper respiratory infections and has not yet received
her annual influenza vaccine. She asks the nurse if she should
get the flu shot today during her clinic visit.
Question Stem
Which response by the nurse is most appropriate?
,A. "You should receive the flu shot today since you are at
increased risk for complications from influenza."
B. "We should delay the flu shot until you have been on
adalimumab for at least 3 months."
C. "You should receive the flu shot, but only after your next
adalimumab dose is administered."
D. "The flu shot is not recommended while you are taking
adalimumab because it contains live virus."
Correct Answer
A. "You should receive the flu shot today since you are at
increased risk for complications from influenza."
Detailed Rationale
Correct Answer Rationale: Adalimumab is a tumor necrosis
factor (TNF) inhibitor that suppresses the immune system,
increasing susceptibility to infections. The inactivated influenza
vaccine is safe and recommended for clients on TNF inhibitors,
as these clients are at increased risk for complications from
influenza. The vaccine should be administered at least 2 weeks
before starting TNF inhibitor therapy if possible, but if the client
is already on therapy, the vaccine should still be given. The
,nurse should educate the client that live vaccines (e.g., MMR,
varicella, nasal spray influenza) are contraindicated during TNF
inhibitor therapy, but inactivated vaccines are safe.
Incorrect Options Rationale:
• Option B: There is no evidence-based recommendation to
delay influenza vaccination for 3 months after starting
adalimumab. In fact, delaying vaccination unnecessarily
increases the client's risk of influenza infection during a
period of immunosuppression.
• Option C: Timing the flu shot around adalimumab dosing is
not necessary. The vaccine can be administered regardless
of when the last dose was given or when the next dose is
scheduled.
• Option D: This is incorrect because the injectable influenza
vaccine is an inactivated (killed) virus vaccine, not a live
virus vaccine. Only live attenuated vaccines are
contraindicated during TNF inhibitor therapy.
Key Pharmacology and Nursing Considerations: TNF inhibitors
like adalimumab work by binding to and neutralizing TNF-alpha,
reducing inflammation but also impairing the immune response
to infections. Clients should receive all recommended
inactivated vaccines before starting therapy if possible. The
nurse should assess for active infection before administration
and monitor for signs of infection after vaccination. The client
, should be educated to report fever, chills, or other signs of
infection immediately. The CDC recommends annual influenza
vaccination for all individuals 6 months and older, with specific
emphasis on immunocompromised clients.
Learning Objective
After completing this question, the learner should be able to:
• Distinguish between live and inactivated vaccines and
identify which are safe for immunocompromised clients.
• Determine appropriate timing and recommendations for
vaccination in clients receiving immunosuppressive
therapy.
• Provide evidence-based patient education regarding
vaccine safety during TNF inhibitor therapy.
Medication Safety Focus
Vaccination safety in immunocompromised clients
Question 2
Clinical Scenario
MCQs |
20 Original ATI-Style Questions with Detailed
Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old female client with rheumatoid arthritis is
prescribed adalimumab (Humira) subcutaneous injections every
other week. The client reports she has been experiencing
frequent upper respiratory infections and has not yet received
her annual influenza vaccine. She asks the nurse if she should
get the flu shot today during her clinic visit.
Question Stem
Which response by the nurse is most appropriate?
,A. "You should receive the flu shot today since you are at
increased risk for complications from influenza."
B. "We should delay the flu shot until you have been on
adalimumab for at least 3 months."
C. "You should receive the flu shot, but only after your next
adalimumab dose is administered."
D. "The flu shot is not recommended while you are taking
adalimumab because it contains live virus."
Correct Answer
A. "You should receive the flu shot today since you are at
increased risk for complications from influenza."
Detailed Rationale
Correct Answer Rationale: Adalimumab is a tumor necrosis
factor (TNF) inhibitor that suppresses the immune system,
increasing susceptibility to infections. The inactivated influenza
vaccine is safe and recommended for clients on TNF inhibitors,
as these clients are at increased risk for complications from
influenza. The vaccine should be administered at least 2 weeks
before starting TNF inhibitor therapy if possible, but if the client
is already on therapy, the vaccine should still be given. The
,nurse should educate the client that live vaccines (e.g., MMR,
varicella, nasal spray influenza) are contraindicated during TNF
inhibitor therapy, but inactivated vaccines are safe.
Incorrect Options Rationale:
• Option B: There is no evidence-based recommendation to
delay influenza vaccination for 3 months after starting
adalimumab. In fact, delaying vaccination unnecessarily
increases the client's risk of influenza infection during a
period of immunosuppression.
• Option C: Timing the flu shot around adalimumab dosing is
not necessary. The vaccine can be administered regardless
of when the last dose was given or when the next dose is
scheduled.
• Option D: This is incorrect because the injectable influenza
vaccine is an inactivated (killed) virus vaccine, not a live
virus vaccine. Only live attenuated vaccines are
contraindicated during TNF inhibitor therapy.
Key Pharmacology and Nursing Considerations: TNF inhibitors
like adalimumab work by binding to and neutralizing TNF-alpha,
reducing inflammation but also impairing the immune response
to infections. Clients should receive all recommended
inactivated vaccines before starting therapy if possible. The
nurse should assess for active infection before administration
and monitor for signs of infection after vaccination. The client
, should be educated to report fever, chills, or other signs of
infection immediately. The CDC recommends annual influenza
vaccination for all individuals 6 months and older, with specific
emphasis on immunocompromised clients.
Learning Objective
After completing this question, the learner should be able to:
• Distinguish between live and inactivated vaccines and
identify which are safe for immunocompromised clients.
• Determine appropriate timing and recommendations for
vaccination in clients receiving immunosuppressive
therapy.
• Provide evidence-based patient education regarding
vaccine safety during TNF inhibitor therapy.
Medication Safety Focus
Vaccination safety in immunocompromised clients
Question 2
Clinical Scenario
