NCLEX-RN Immune System
Pharmacology Exam Questions &
Answers
20 Original Practice MCQs with
Detailed Rationales
Nursing Pharmacology Study Guide
|NGN & ATI Style
Question 1
Clinical Scenario
A 48-year-old woman with rheumatoid arthritis has been
receiving methotrexate 15 mg orally once weekly for 4 months.
She reports improved joint pain but now complains of mouth
sores, increasing fatigue, and mild nausea. Her laboratory
results are as follows:
• WBC: 2,900/mm³
• Hemoglobin: 10.4 g/dL
• Platelets: 118,000/mm³
, • ALT: 72 U/L
• AST: 68 U/L
The provider is notified.
Question Stem
Which nursing action is the priority?
A. Administer the scheduled methotrexate dose.
B. Hold the methotrexate and notify the provider of the
laboratory findings.
C. Encourage the client to increase dietary protein intake.
D. Administer an antiemetic before giving methotrexate.
Correct Answer
Correct Answer: B. Hold the methotrexate and notify the
provider of the laboratory findings.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits folate metabolism, suppressing immune
activity. Although effective for autoimmune diseases, it can
cause bone marrow suppression, hepatotoxicity, and
mucositis. This client demonstrates several concerning findings,
including leukopenia, thrombocytopenia, anemia, elevated liver
enzymes, and oral ulcers, all of which suggest significant
,medication toxicity. Continuing the medication could place the
client at increased risk for severe infection, bleeding, and
progressive liver injury. The priority is to withhold the
medication and promptly communicate these findings to the
provider for further evaluation and possible dosage adjustment
or discontinuation.
Option A is unsafe because administering another dose may
worsen toxicity. Option C does not address the immediate
safety concern; nutritional support may be beneficial later but is
not the priority. Option D may reduce nausea but ignores
evidence of potentially life-threatening adverse effects. Nurses
caring for clients receiving methotrexate should routinely
monitor complete blood counts and liver function tests,
educate clients to report signs of infection, bruising, persistent
fatigue, or oral ulcers promptly, and reinforce that methotrexate
is generally administered once weekly, not daily, to reduce
toxicity.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize laboratory evidence of methotrexate toxicity.
• Prioritize nursing interventions when serious adverse
effects occur.
• Identify monitoring parameters for DMARD therapy.
, • Reinforce safe methotrexate administration practices.
Medication Safety Focus
Monitoring for bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 35-year-old client is beginning treatment with prednisone for
a severe autoimmune flare. During discharge teaching, the
nurse reviews medication instructions.
Question Stem
Which client statement indicates correct understanding of
prednisone therapy?
A. "I can stop taking the medication once I feel better."
B. "I'll take the medication with food and avoid stopping it
suddenly."
C. "If I develop a fever, I'll simply take acetaminophen."
D. "I should receive all live vaccines while taking prednisone."
Correct Answer
Correct Answer: B. "I'll take the medication with food and
avoid stopping it suddenly."
Pharmacology Exam Questions &
Answers
20 Original Practice MCQs with
Detailed Rationales
Nursing Pharmacology Study Guide
|NGN & ATI Style
Question 1
Clinical Scenario
A 48-year-old woman with rheumatoid arthritis has been
receiving methotrexate 15 mg orally once weekly for 4 months.
She reports improved joint pain but now complains of mouth
sores, increasing fatigue, and mild nausea. Her laboratory
results are as follows:
• WBC: 2,900/mm³
• Hemoglobin: 10.4 g/dL
• Platelets: 118,000/mm³
, • ALT: 72 U/L
• AST: 68 U/L
The provider is notified.
Question Stem
Which nursing action is the priority?
A. Administer the scheduled methotrexate dose.
B. Hold the methotrexate and notify the provider of the
laboratory findings.
C. Encourage the client to increase dietary protein intake.
D. Administer an antiemetic before giving methotrexate.
Correct Answer
Correct Answer: B. Hold the methotrexate and notify the
provider of the laboratory findings.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits folate metabolism, suppressing immune
activity. Although effective for autoimmune diseases, it can
cause bone marrow suppression, hepatotoxicity, and
mucositis. This client demonstrates several concerning findings,
including leukopenia, thrombocytopenia, anemia, elevated liver
enzymes, and oral ulcers, all of which suggest significant
,medication toxicity. Continuing the medication could place the
client at increased risk for severe infection, bleeding, and
progressive liver injury. The priority is to withhold the
medication and promptly communicate these findings to the
provider for further evaluation and possible dosage adjustment
or discontinuation.
Option A is unsafe because administering another dose may
worsen toxicity. Option C does not address the immediate
safety concern; nutritional support may be beneficial later but is
not the priority. Option D may reduce nausea but ignores
evidence of potentially life-threatening adverse effects. Nurses
caring for clients receiving methotrexate should routinely
monitor complete blood counts and liver function tests,
educate clients to report signs of infection, bruising, persistent
fatigue, or oral ulcers promptly, and reinforce that methotrexate
is generally administered once weekly, not daily, to reduce
toxicity.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize laboratory evidence of methotrexate toxicity.
• Prioritize nursing interventions when serious adverse
effects occur.
• Identify monitoring parameters for DMARD therapy.
, • Reinforce safe methotrexate administration practices.
Medication Safety Focus
Monitoring for bone marrow suppression and hepatotoxicity
Question 2
Clinical Scenario
A 35-year-old client is beginning treatment with prednisone for
a severe autoimmune flare. During discharge teaching, the
nurse reviews medication instructions.
Question Stem
Which client statement indicates correct understanding of
prednisone therapy?
A. "I can stop taking the medication once I feel better."
B. "I'll take the medication with food and avoid stopping it
suddenly."
C. "If I develop a fever, I'll simply take acetaminophen."
D. "I should receive all live vaccines while taking prednisone."
Correct Answer
Correct Answer: B. "I'll take the medication with food and
avoid stopping it suddenly."
