NCLEX-RN Pharmacology Immune
System Exam Questions & Answers
20 NGN-Style MCQs with Rationales
ATI Pharmacology Made Easy Review
2026
Question 1
Clinical Scenario
A 24-year-old woman with severe rheumatoid arthritis is
prescribed methotrexate 15 mg orally once weekly. During a
follow-up visit, she tells the nurse that she has been taking the
medication every morning for the past 5 days because she
wanted faster symptom relief. She reports mouth sores, nausea,
and fatigue.
Question Stem
Which nursing action is the priority?
A. Instruct the client to continue the medication as prescribed
B. Notify the provider immediately about possible methotrexate
toxicity
,C. Encourage increased dietary protein intake
D. Administer the next scheduled dose
Correct Answer
Correct Answer: B. Notify the provider immediately about
possible methotrexate toxicity
Detailed Rationale
Methotrexate is commonly prescribed for autoimmune
disorders and is typically administered once weekly, not daily.
Daily administration can rapidly lead to toxicity, including bone
marrow suppression, hepatotoxicity, mucositis, and severe
gastrointestinal effects. The client's symptoms of mouth sores,
nausea, and fatigue suggest potential toxicity requiring
immediate provider notification and laboratory evaluation.
A is incorrect because continuing the medication could worsen
toxicity.
C is incorrect because nutritional interventions do not address
the potentially life-threatening medication error.
D is incorrect because additional dosing may further increase
toxic effects.
Nurses should verify dosing schedules carefully because
methotrexate is associated with significant medication errors
due to confusion between daily and weekly administration.
Monitoring includes CBC, liver function tests, and renal
, function. Patient education should emphasize exact dosing
schedules and avoidance of alcohol.
Learning Objective
After completing this question, the learner should be able to:
• Identify signs of methotrexate toxicity.
• Recognize a high-risk medication administration error.
• Prioritize nursing actions when toxicity is suspected.
• Describe required monitoring for methotrexate therapy.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 38-year-old client with Crohn disease is receiving
adalimumab therapy. Before administering the next dose, the
nurse reviews the chart and notes a temperature of 38.5°C
(101.3°F), productive cough, and a positive chest x-ray
indicating pneumonia.
Question Stem
Which action should the nurse take?
System Exam Questions & Answers
20 NGN-Style MCQs with Rationales
ATI Pharmacology Made Easy Review
2026
Question 1
Clinical Scenario
A 24-year-old woman with severe rheumatoid arthritis is
prescribed methotrexate 15 mg orally once weekly. During a
follow-up visit, she tells the nurse that she has been taking the
medication every morning for the past 5 days because she
wanted faster symptom relief. She reports mouth sores, nausea,
and fatigue.
Question Stem
Which nursing action is the priority?
A. Instruct the client to continue the medication as prescribed
B. Notify the provider immediately about possible methotrexate
toxicity
,C. Encourage increased dietary protein intake
D. Administer the next scheduled dose
Correct Answer
Correct Answer: B. Notify the provider immediately about
possible methotrexate toxicity
Detailed Rationale
Methotrexate is commonly prescribed for autoimmune
disorders and is typically administered once weekly, not daily.
Daily administration can rapidly lead to toxicity, including bone
marrow suppression, hepatotoxicity, mucositis, and severe
gastrointestinal effects. The client's symptoms of mouth sores,
nausea, and fatigue suggest potential toxicity requiring
immediate provider notification and laboratory evaluation.
A is incorrect because continuing the medication could worsen
toxicity.
C is incorrect because nutritional interventions do not address
the potentially life-threatening medication error.
D is incorrect because additional dosing may further increase
toxic effects.
Nurses should verify dosing schedules carefully because
methotrexate is associated with significant medication errors
due to confusion between daily and weekly administration.
Monitoring includes CBC, liver function tests, and renal
, function. Patient education should emphasize exact dosing
schedules and avoidance of alcohol.
Learning Objective
After completing this question, the learner should be able to:
• Identify signs of methotrexate toxicity.
• Recognize a high-risk medication administration error.
• Prioritize nursing actions when toxicity is suspected.
• Describe required monitoring for methotrexate therapy.
Medication Safety Focus
Medication administration
Question 2
Clinical Scenario
A 38-year-old client with Crohn disease is receiving
adalimumab therapy. Before administering the next dose, the
nurse reviews the chart and notes a temperature of 38.5°C
(101.3°F), productive cough, and a positive chest x-ray
indicating pneumonia.
Question Stem
Which action should the nurse take?
