NCLEX-RN Pharmacology Immune
System Test Bank (20 Questions)
Immunosuppressants, Biologics,
Corticosteroids with Rationales
Question 1
Clinical Scenario
A 42-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. During a follow-up
visit, she reports increasing fatigue and mild nausea after each
dose. Her laboratory results are as follows:
• ALT: 58 U/L (elevated)
• AST: 54 U/L (elevated)
• WBC: 5,800/mm³
• Platelets: 220,000/mm³
She asks whether she can take the medication every day instead
of once weekly because she thinks it may "work better."
Question Stem
,Which response by the nurse is most appropriate?
A. "Taking methotrexate every day increases its effectiveness."
B. "Methotrexate should be taken only once each week because
daily dosing can cause serious toxicity."
C. "Skip this week's dose and restart the medication next
month."
D. "Take methotrexate twice weekly if joint pain increases."
Correct Answer
Correct Answer: B. "Methotrexate should be taken only once
each week because daily dosing can cause serious toxicity."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits folate metabolism, reducing immune-
mediated inflammation. For autoimmune diseases such as
rheumatoid arthritis, methotrexate is administered once
weekly, not daily. Medication errors involving daily
administration have caused severe bone marrow suppression,
mucositis, hepatotoxicity, renal impairment, and death. The
patient's mildly elevated liver enzymes warrant continued
monitoring and possible dose adjustment by the prescriber, but
they do not justify changing the prescribed schedule
independently.
,Option A is incorrect because daily dosing dramatically
increases toxicity without improving therapeutic benefit for
rheumatoid arthritis. Option C is incorrect because abruptly
discontinuing therapy without provider guidance may worsen
disease control and is not indicated based solely on mildly
elevated liver enzymes. Option D is incorrect because patients
should never increase methotrexate frequency based on
symptoms without provider direction.
The nurse should reinforce weekly dosing, advise avoidance of
alcohol to reduce hepatic injury risk, encourage routine CBC and
liver function monitoring, and discuss folic acid
supplementation if prescribed to decrease adverse effects such
as stomatitis and gastrointestinal discomfort.
Learning Objective
After completing this question, the learner should be able to:
• Identify the correct dosing schedule for methotrexate in
autoimmune disorders.
• Recognize medication errors associated with methotrexate
administration.
• Explain the importance of routine liver function and CBC
monitoring.
• Educate patients regarding safe methotrexate use.
, Medication Safety Focus: High-alert medication; Medication
administration
Question 2
Clinical Scenario
A 59-year-old man with severe plaque psoriasis recently began
treatment with adalimumab. Before receiving his second dose,
he reports a productive cough, night sweats, and an
unintentional 5-kg weight loss over the past month. His
temperature is 38.2°C (100.8°F).
Question Stem
Which nursing action has the highest priority?
A. Administer the scheduled adalimumab injection.
B. Instruct the patient to increase fluid intake and continue
therapy.
C. Hold the medication and notify the provider for evaluation of
possible tuberculosis.
D. Recommend an over-the-counter cough suppressant.
Correct Answer
Correct Answer: C. Hold the medication and notify the
provider for evaluation of possible tuberculosis.
System Test Bank (20 Questions)
Immunosuppressants, Biologics,
Corticosteroids with Rationales
Question 1
Clinical Scenario
A 42-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. During a follow-up
visit, she reports increasing fatigue and mild nausea after each
dose. Her laboratory results are as follows:
• ALT: 58 U/L (elevated)
• AST: 54 U/L (elevated)
• WBC: 5,800/mm³
• Platelets: 220,000/mm³
She asks whether she can take the medication every day instead
of once weekly because she thinks it may "work better."
Question Stem
,Which response by the nurse is most appropriate?
A. "Taking methotrexate every day increases its effectiveness."
B. "Methotrexate should be taken only once each week because
daily dosing can cause serious toxicity."
C. "Skip this week's dose and restart the medication next
month."
D. "Take methotrexate twice weekly if joint pain increases."
Correct Answer
Correct Answer: B. "Methotrexate should be taken only once
each week because daily dosing can cause serious toxicity."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits folate metabolism, reducing immune-
mediated inflammation. For autoimmune diseases such as
rheumatoid arthritis, methotrexate is administered once
weekly, not daily. Medication errors involving daily
administration have caused severe bone marrow suppression,
mucositis, hepatotoxicity, renal impairment, and death. The
patient's mildly elevated liver enzymes warrant continued
monitoring and possible dose adjustment by the prescriber, but
they do not justify changing the prescribed schedule
independently.
,Option A is incorrect because daily dosing dramatically
increases toxicity without improving therapeutic benefit for
rheumatoid arthritis. Option C is incorrect because abruptly
discontinuing therapy without provider guidance may worsen
disease control and is not indicated based solely on mildly
elevated liver enzymes. Option D is incorrect because patients
should never increase methotrexate frequency based on
symptoms without provider direction.
The nurse should reinforce weekly dosing, advise avoidance of
alcohol to reduce hepatic injury risk, encourage routine CBC and
liver function monitoring, and discuss folic acid
supplementation if prescribed to decrease adverse effects such
as stomatitis and gastrointestinal discomfort.
Learning Objective
After completing this question, the learner should be able to:
• Identify the correct dosing schedule for methotrexate in
autoimmune disorders.
• Recognize medication errors associated with methotrexate
administration.
• Explain the importance of routine liver function and CBC
monitoring.
• Educate patients regarding safe methotrexate use.
, Medication Safety Focus: High-alert medication; Medication
administration
Question 2
Clinical Scenario
A 59-year-old man with severe plaque psoriasis recently began
treatment with adalimumab. Before receiving his second dose,
he reports a productive cough, night sweats, and an
unintentional 5-kg weight loss over the past month. His
temperature is 38.2°C (100.8°F).
Question Stem
Which nursing action has the highest priority?
A. Administer the scheduled adalimumab injection.
B. Instruct the patient to increase fluid intake and continue
therapy.
C. Hold the medication and notify the provider for evaluation of
possible tuberculosis.
D. Recommend an over-the-counter cough suppressant.
Correct Answer
Correct Answer: C. Hold the medication and notify the
provider for evaluation of possible tuberculosis.
