NCLEX-RN Immune System
Pharmacology Exam Practice Questions
| 20 Original NCLEX-Style MCQs with
Detailed Rationales |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 42-year-old woman with newly diagnosed rheumatoid
arthritis is prescribed methotrexate 15 mg orally once weekly.
During a follow-up visit, she reports mild fatigue and occasional
nausea. Her laboratory results reveal: AST 28 U/L, ALT 30 U/L,
WBC 6,800/mm³, platelet count 235,000/mm³, serum
creatinine 0.8 mg/dL, and negative pregnancy test. The nurse
provides medication education before the patient begins
therapy.
Question Stem
Which statement by the patient indicates correct
understanding of methotrexate therapy?
,A. "I should take this medication every morning after
breakfast."
B. "If I develop mouth sores or a fever, I should notify my
healthcare provider."
C. "I can safely receive all live vaccines while taking this
medication."
D. "Once my joint pain improves, I can stop taking the
medication."
Correct Answer
Correct Answer: B. "If I develop mouth sores or a fever, I
should notify my healthcare provider."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. Bone marrow suppression is a
serious adverse effect that may present as fever, sore throat,
mouth ulcers, or unusual bruising. Prompt reporting of these
findings allows early intervention and reduces the risk of severe
infection or bleeding. Regular monitoring of complete blood
count, liver enzymes, and renal function is essential throughout
therapy.
Option A is incorrect because methotrexate for autoimmune
diseases is administered once weekly, not daily. Daily
,administration is a well-recognized medication error that can
result in life-threatening toxicity.
Option C is incorrect because live vaccines should generally be
avoided during immunosuppressive therapy due to the risk of
vaccine-associated infection.
Option D is incorrect because methotrexate requires several
weeks to achieve its full therapeutic effect, and abrupt
discontinuation may worsen disease activity. Patients should
continue therapy as prescribed unless instructed otherwise by
the provider.
Patient education should also include avoiding excessive alcohol
intake, using effective contraception, taking folic acid if
prescribed, and attending scheduled laboratory appointments.
Learning Objectives
After completing this question, the learner should be able to:
• Identify important patient teaching for methotrexate
therapy.
• Recognize signs of bone marrow suppression.
• Explain appropriate laboratory monitoring for DMARD
therapy.
• Promote medication safety through correct dosing
schedules.
, Medication Safety Focus: Medication administration
Question 2
Clinical Scenario
A 58-year-old man received a kidney transplant six weeks ago.
His medications include tacrolimus, prednisone, and
mycophenolate mofetil. During assessment he reports tremors
and headache. Vital signs are stable. Laboratory results show
serum creatinine 1.5 mg/dL (baseline 1.0 mg/dL) and a
tacrolimus trough level above the prescribed therapeutic range.
Question Stem
Which nursing action is the priority?
A. Administer the next tacrolimus dose as scheduled.
B. Notify the healthcare provider about the elevated trough
level.
C. Encourage increased dietary potassium intake.
D. Hold the prednisone until laboratory values normalize.
Correct Answer
Correct Answer: B. Notify the healthcare provider about the
elevated trough level.
Detailed Rationale
Pharmacology Exam Practice Questions
| 20 Original NCLEX-Style MCQs with
Detailed Rationales |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 42-year-old woman with newly diagnosed rheumatoid
arthritis is prescribed methotrexate 15 mg orally once weekly.
During a follow-up visit, she reports mild fatigue and occasional
nausea. Her laboratory results reveal: AST 28 U/L, ALT 30 U/L,
WBC 6,800/mm³, platelet count 235,000/mm³, serum
creatinine 0.8 mg/dL, and negative pregnancy test. The nurse
provides medication education before the patient begins
therapy.
Question Stem
Which statement by the patient indicates correct
understanding of methotrexate therapy?
,A. "I should take this medication every morning after
breakfast."
B. "If I develop mouth sores or a fever, I should notify my
healthcare provider."
C. "I can safely receive all live vaccines while taking this
medication."
D. "Once my joint pain improves, I can stop taking the
medication."
Correct Answer
Correct Answer: B. "If I develop mouth sores or a fever, I
should notify my healthcare provider."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune cell proliferation by
inhibiting folate metabolism. Bone marrow suppression is a
serious adverse effect that may present as fever, sore throat,
mouth ulcers, or unusual bruising. Prompt reporting of these
findings allows early intervention and reduces the risk of severe
infection or bleeding. Regular monitoring of complete blood
count, liver enzymes, and renal function is essential throughout
therapy.
Option A is incorrect because methotrexate for autoimmune
diseases is administered once weekly, not daily. Daily
,administration is a well-recognized medication error that can
result in life-threatening toxicity.
Option C is incorrect because live vaccines should generally be
avoided during immunosuppressive therapy due to the risk of
vaccine-associated infection.
Option D is incorrect because methotrexate requires several
weeks to achieve its full therapeutic effect, and abrupt
discontinuation may worsen disease activity. Patients should
continue therapy as prescribed unless instructed otherwise by
the provider.
Patient education should also include avoiding excessive alcohol
intake, using effective contraception, taking folic acid if
prescribed, and attending scheduled laboratory appointments.
Learning Objectives
After completing this question, the learner should be able to:
• Identify important patient teaching for methotrexate
therapy.
• Recognize signs of bone marrow suppression.
• Explain appropriate laboratory monitoring for DMARD
therapy.
• Promote medication safety through correct dosing
schedules.
, Medication Safety Focus: Medication administration
Question 2
Clinical Scenario
A 58-year-old man received a kidney transplant six weeks ago.
His medications include tacrolimus, prednisone, and
mycophenolate mofetil. During assessment he reports tremors
and headache. Vital signs are stable. Laboratory results show
serum creatinine 1.5 mg/dL (baseline 1.0 mg/dL) and a
tacrolimus trough level above the prescribed therapeutic range.
Question Stem
Which nursing action is the priority?
A. Administer the next tacrolimus dose as scheduled.
B. Notify the healthcare provider about the elevated trough
level.
C. Encourage increased dietary potassium intake.
D. Hold the prednisone until laboratory values normalize.
Correct Answer
Correct Answer: B. Notify the healthcare provider about the
elevated trough level.
Detailed Rationale
