NCLEX-RN Immune System
Pharmacology Exam Questions &
Answers
20 Original NGN Clinical Judgment
MCQs
ATI Pharmacology Made Easy | Nursing
Pharmacology Study Guide
Detailed Rationales
RN, BSN, ADN Review
Question 1
Clinical Scenario
A 42-year-old woman with rheumatoid arthritis has been taking
methotrexate 15 mg orally once weekly for the past 2 months.
She also takes folic acid daily. During a follow-up visit, she
reports increasing fatigue, mouth sores, and decreased
appetite. Laboratory results reveal:
, • WBC: 2,900/mm³
• Hemoglobin: 11.0 g/dL
• Platelets: 105,000/mm³
• ALT: 92 U/L
• AST: 88 U/L
The nurse reviews the medication administration record before
the patient's scheduled weekly 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 the patient to increase dietary protein intake.
D. Administer the methotrexate and repeat laboratory tests
next week.
Correct Answer
B. Hold the methotrexate and notify the healthcare provider.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune function by inhibiting folate
metabolism and DNA synthesis. Although effective in reducing
,inflammation and slowing joint destruction, it carries significant
risks of bone marrow suppression and hepatotoxicity. This
patient demonstrates both complications: leukopenia,
thrombocytopenia, elevated liver enzymes, fatigue, and oral
ulcers. These findings warrant withholding the medication and
immediately notifying the provider for further evaluation.
Continuing therapy could increase the risk of severe infection,
bleeding, or progressive liver injury.
Option A is incorrect because administering methotrexate
despite abnormal laboratory findings may worsen toxicity. Food
may reduce gastrointestinal upset but does not prevent bone
marrow suppression or liver injury.
Option C is incorrect because nutritional support does not
address potentially life-threatening adverse effects.
Option D is unsafe because delaying intervention while
continuing therapy exposes the patient to worsening toxicity.
Nurses should review CBC, platelet count, and liver function
tests before administering methotrexate. Patients should also
avoid alcohol, promptly report fever or sore throat, and
understand that methotrexate is taken once weekly, not daily,
to prevent fatal dosing errors.
Learning Objectives
After completing this question, the learner should be able to:
, • Recognize laboratory evidence of methotrexate toxicity.
• Identify priority nursing actions for immunosuppressive
therapy.
• Monitor patients receiving DMARD therapy safely.
• Educate patients regarding weekly methotrexate dosing.
Medication Safety Focus
Monitoring—Bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 55-year-old man recently received a kidney transplant and is
prescribed tacrolimus, mycophenolate mofetil, and prednisone.
During discharge teaching, the nurse discusses medications and
dietary precautions.
Question Stem
Which patient statement indicates a need for further teaching?
A. "I will take my tacrolimus at the same time every day."
B. "I should avoid grapefruit juice while taking this medication."
C. "If I miss a dose, I'll double the next one."
D. "I'll report fever or signs of infection immediately."
Pharmacology Exam Questions &
Answers
20 Original NGN Clinical Judgment
MCQs
ATI Pharmacology Made Easy | Nursing
Pharmacology Study Guide
Detailed Rationales
RN, BSN, ADN Review
Question 1
Clinical Scenario
A 42-year-old woman with rheumatoid arthritis has been taking
methotrexate 15 mg orally once weekly for the past 2 months.
She also takes folic acid daily. During a follow-up visit, she
reports increasing fatigue, mouth sores, and decreased
appetite. Laboratory results reveal:
, • WBC: 2,900/mm³
• Hemoglobin: 11.0 g/dL
• Platelets: 105,000/mm³
• ALT: 92 U/L
• AST: 88 U/L
The nurse reviews the medication administration record before
the patient's scheduled weekly 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 the patient to increase dietary protein intake.
D. Administer the methotrexate and repeat laboratory tests
next week.
Correct Answer
B. Hold the methotrexate and notify the healthcare provider.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune function by inhibiting folate
metabolism and DNA synthesis. Although effective in reducing
,inflammation and slowing joint destruction, it carries significant
risks of bone marrow suppression and hepatotoxicity. This
patient demonstrates both complications: leukopenia,
thrombocytopenia, elevated liver enzymes, fatigue, and oral
ulcers. These findings warrant withholding the medication and
immediately notifying the provider for further evaluation.
Continuing therapy could increase the risk of severe infection,
bleeding, or progressive liver injury.
Option A is incorrect because administering methotrexate
despite abnormal laboratory findings may worsen toxicity. Food
may reduce gastrointestinal upset but does not prevent bone
marrow suppression or liver injury.
Option C is incorrect because nutritional support does not
address potentially life-threatening adverse effects.
Option D is unsafe because delaying intervention while
continuing therapy exposes the patient to worsening toxicity.
Nurses should review CBC, platelet count, and liver function
tests before administering methotrexate. Patients should also
avoid alcohol, promptly report fever or sore throat, and
understand that methotrexate is taken once weekly, not daily,
to prevent fatal dosing errors.
Learning Objectives
After completing this question, the learner should be able to:
, • Recognize laboratory evidence of methotrexate toxicity.
• Identify priority nursing actions for immunosuppressive
therapy.
• Monitor patients receiving DMARD therapy safely.
• Educate patients regarding weekly methotrexate dosing.
Medication Safety Focus
Monitoring—Bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 55-year-old man recently received a kidney transplant and is
prescribed tacrolimus, mycophenolate mofetil, and prednisone.
During discharge teaching, the nurse discusses medications and
dietary precautions.
Question Stem
Which patient statement indicates a need for further teaching?
A. "I will take my tacrolimus at the same time every day."
B. "I should avoid grapefruit juice while taking this medication."
C. "If I miss a dose, I'll double the next one."
D. "I'll report fever or signs of infection immediately."
