NCLEX-RN Pharmacology Immune System
MCQs: 20 Next-Gen NGN & ATI Style Questions
with Expert Rationales & Medication Safety
Focus
Question 1
Clinical Scenario
A 68-year-old male client with a history of hypertension and
type 2 diabetes is admitted with suspected acute kidney injury.
The client's serum creatinine is 2.8 mg/dL, and estimated
glomerular filtration rate (eGFR) is 25 mL/min/1.73m². The
provider orders intravenous immunoglobulin (IVIG) 0.4
g/kg/day for three days for an autoimmune condition. The
client's current medications include lisinopril 20 mg daily,
metformin 1000 mg BID, and atorvastatin 40 mg daily.
Question Stem
,Which nursing action is the priority before initiating the IVIG
infusion?
Options
A. Administer prescribed diphenhydramine and acetaminophen
as premedication
B. Verify that the client has received the pneumococcal and
influenza vaccines
C. Assess the client's baseline serum creatinine and obtain a
urine output measurement
D. Hold the morning dose of lisinopril and consult the provider
regarding the dose
Correct Answer
D. Hold the morning dose of lisinopril and consult the provider
regarding the dose
Detailed Rationale
The correct answer is D because ACE inhibitors like lisinopril can
potentiate the risk of acute kidney injury when administered
concurrently with IVIG. IVIG contains sucrose or other stabilizers
that can cause osmotic nephrosis, particularly in clients with
preexisting renal impairment. This client already has significant
renal compromise (eGFR 25 mL/min), and the addition of IVIG
,creates a high-risk situation for further renal deterioration. The
nurse should hold the lisinopril and consult the provider to
determine if the medication should be withheld during IVIG
therapy or if the dose needs adjustment.
Option A is incorrect because although premedication with
antihistamines and antipyretics is routine before IVIG to prevent
infusion-related reactions, it is not the priority action in this
scenario. While important, the safety concern related to renal
function supersedes routine premedication. Option B is
incorrect because verifying vaccination status, while a
component of comprehensive care for immunocompromised
clients, is not urgent before the first IVIG infusion. Option C is
incorrect because while monitoring renal function is essential,
the nurse should already have baseline values from the
admission assessment; the priority is intervening to prevent
further injury by holding the ACE inhibitor.
Pharmacology Principles: IVIG is a blood product derived from
pooled human plasma. It can cause acute renal failure,
especially in clients with preexisting renal disease, diabetes,
volume depletion, or those taking nephrotoxic medications.
ACE inhibitors reduce glomerular filtration pressure through
efferent arteriolar vasodilation, which can exacerbate the
hyperviscosity and osmotic effects of IVIG.
, Nursing Considerations: Monitor urine output closely, assess
for signs of fluid overload (dyspnea, crackles, edema), and
maintain adequate hydration before and during IVIG
administration. Infuse IVIG at the prescribed rate; do not
exceed the recommended infusion rate to minimize adverse
reactions. Obtain baseline serum creatinine and monitor daily
during therapy. Premedicate with antihistamines, antipyretics,
and possibly corticosteroids to reduce infusion reactions.
Patient Teaching: Explain the purpose of IVIG therapy, potential
adverse effects including headache, chills, and fluid overload
symptoms. Instruct the client to report any signs of allergic
reaction, difficulty breathing, chest pain, or decreased urine
output.
Monitoring Parameters: Baseline and daily serum creatinine,
BUN, urine output, vital signs during infusion, assessment for
signs of hemolysis or thromboembolic events.
Learning Objective
After completing this question, the learner should be able to:
• Identify medication interactions that increase the risk of
acute kidney injury with IVIG administration.
• Prioritize nursing actions to prevent medication-induced
nephrotoxicity.
MCQs: 20 Next-Gen NGN & ATI Style Questions
with Expert Rationales & Medication Safety
Focus
Question 1
Clinical Scenario
A 68-year-old male client with a history of hypertension and
type 2 diabetes is admitted with suspected acute kidney injury.
The client's serum creatinine is 2.8 mg/dL, and estimated
glomerular filtration rate (eGFR) is 25 mL/min/1.73m². The
provider orders intravenous immunoglobulin (IVIG) 0.4
g/kg/day for three days for an autoimmune condition. The
client's current medications include lisinopril 20 mg daily,
metformin 1000 mg BID, and atorvastatin 40 mg daily.
Question Stem
,Which nursing action is the priority before initiating the IVIG
infusion?
Options
A. Administer prescribed diphenhydramine and acetaminophen
as premedication
B. Verify that the client has received the pneumococcal and
influenza vaccines
C. Assess the client's baseline serum creatinine and obtain a
urine output measurement
D. Hold the morning dose of lisinopril and consult the provider
regarding the dose
Correct Answer
D. Hold the morning dose of lisinopril and consult the provider
regarding the dose
Detailed Rationale
The correct answer is D because ACE inhibitors like lisinopril can
potentiate the risk of acute kidney injury when administered
concurrently with IVIG. IVIG contains sucrose or other stabilizers
that can cause osmotic nephrosis, particularly in clients with
preexisting renal impairment. This client already has significant
renal compromise (eGFR 25 mL/min), and the addition of IVIG
,creates a high-risk situation for further renal deterioration. The
nurse should hold the lisinopril and consult the provider to
determine if the medication should be withheld during IVIG
therapy or if the dose needs adjustment.
Option A is incorrect because although premedication with
antihistamines and antipyretics is routine before IVIG to prevent
infusion-related reactions, it is not the priority action in this
scenario. While important, the safety concern related to renal
function supersedes routine premedication. Option B is
incorrect because verifying vaccination status, while a
component of comprehensive care for immunocompromised
clients, is not urgent before the first IVIG infusion. Option C is
incorrect because while monitoring renal function is essential,
the nurse should already have baseline values from the
admission assessment; the priority is intervening to prevent
further injury by holding the ACE inhibitor.
Pharmacology Principles: IVIG is a blood product derived from
pooled human plasma. It can cause acute renal failure,
especially in clients with preexisting renal disease, diabetes,
volume depletion, or those taking nephrotoxic medications.
ACE inhibitors reduce glomerular filtration pressure through
efferent arteriolar vasodilation, which can exacerbate the
hyperviscosity and osmotic effects of IVIG.
, Nursing Considerations: Monitor urine output closely, assess
for signs of fluid overload (dyspnea, crackles, edema), and
maintain adequate hydration before and during IVIG
administration. Infuse IVIG at the prescribed rate; do not
exceed the recommended infusion rate to minimize adverse
reactions. Obtain baseline serum creatinine and monitor daily
during therapy. Premedicate with antihistamines, antipyretics,
and possibly corticosteroids to reduce infusion reactions.
Patient Teaching: Explain the purpose of IVIG therapy, potential
adverse effects including headache, chills, and fluid overload
symptoms. Instruct the client to report any signs of allergic
reaction, difficulty breathing, chest pain, or decreased urine
output.
Monitoring Parameters: Baseline and daily serum creatinine,
BUN, urine output, vital signs during infusion, assessment for
signs of hemolysis or thromboembolic events.
Learning Objective
After completing this question, the learner should be able to:
• Identify medication interactions that increase the risk of
acute kidney injury with IVIG administration.
• Prioritize nursing actions to prevent medication-induced
nephrotoxicity.
