NCLEX-RN Pharmacology Immune
System Practice Exam
20 Original NGN-Style MCQs with
Detailed Rationales
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 32-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. During a follow-up
clinic visit, she reports mild nausea after taking the medication.
Her medical history includes seasonal allergies and well-
controlled hypertension. Laboratory results reveal AST 24 U/L,
ALT 28 U/L, WBC 6,800/mm³, platelet count 245,000/mm³, and
serum creatinine 0.9 mg/dL. The nurse provides medication
education before the client begins therapy.
Question Stem
Which statement by the client indicates correct understanding
of methotrexate therapy?
,A. "I will take this medication every morning to keep my
symptoms controlled."
B. "I should avoid alcohol while taking this medication."
C. "I can receive live vaccines whenever recommended."
D. "If I become pregnant, I should continue taking the
medication unless I feel ill."
Correct Answer
Correct Answer: B. "I should avoid alcohol while taking this
medication."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits folate metabolism, suppressing immune
cell proliferation and reducing inflammation. Because
methotrexate may cause hepatotoxicity, avoiding alcohol is
essential to minimize the risk of liver injury. Routine monitoring
of liver function tests, complete blood counts, and renal
function is required throughout therapy.
Option A is incorrect because methotrexate for autoimmune
disorders is typically administered once weekly, not daily. Daily
administration instead of weekly has resulted in serious toxicity
and fatal medication errors.
,Option C is incorrect because immunosuppressive therapy
increases susceptibility to infection, and live vaccines should
generally be avoided unless specifically approved by the
healthcare provider.
Option D is incorrect because methotrexate is highly
teratogenic and contraindicated during pregnancy. Patients
should use effective contraception during therapy and for the
recommended period after discontinuation.
Nursing care includes reinforcing weekly dosing, encouraging
laboratory monitoring, assessing for signs of infection or
unusual bleeding, and teaching patients to report persistent
fever, mouth sores, jaundice, or dark urine promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Identify essential patient teaching for methotrexate
therapy.
• Recognize medication safety concerns related to dosing
frequency.
• Explain why alcohol avoidance is recommended during
treatment.
• Identify laboratory parameters requiring routine
monitoring.
, Medication Safety Focus
Medication administration (weekly dosing) and hepatotoxicity
monitoring
Question 2
Clinical Scenario
A 68-year-old man with Crohn disease has been receiving
infliximab infusions every 8 weeks. Before today's infusion, he
reports fatigue, a persistent cough lasting three weeks, and an
unintended 4-kg weight loss. His temperature is 37.9°C
(100.2°F). The nurse reviews his history before initiating
treatment.
Question Stem
Which nursing action is the priority?
A. Administer acetaminophen before beginning the infusion.
B. Begin the infusion at a slower rate.
C. Hold the infusion and notify the healthcare provider.
D. Encourage increased oral fluid intake before treatment.
Correct Answer
Correct Answer: C. Hold the infusion and notify the healthcare
provider.
System Practice Exam
20 Original NGN-Style MCQs with
Detailed Rationales
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 32-year-old woman with rheumatoid arthritis is prescribed
methotrexate 15 mg orally once weekly. During a follow-up
clinic visit, she reports mild nausea after taking the medication.
Her medical history includes seasonal allergies and well-
controlled hypertension. Laboratory results reveal AST 24 U/L,
ALT 28 U/L, WBC 6,800/mm³, platelet count 245,000/mm³, and
serum creatinine 0.9 mg/dL. The nurse provides medication
education before the client begins therapy.
Question Stem
Which statement by the client indicates correct understanding
of methotrexate therapy?
,A. "I will take this medication every morning to keep my
symptoms controlled."
B. "I should avoid alcohol while taking this medication."
C. "I can receive live vaccines whenever recommended."
D. "If I become pregnant, I should continue taking the
medication unless I feel ill."
Correct Answer
Correct Answer: B. "I should avoid alcohol while taking this
medication."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits folate metabolism, suppressing immune
cell proliferation and reducing inflammation. Because
methotrexate may cause hepatotoxicity, avoiding alcohol is
essential to minimize the risk of liver injury. Routine monitoring
of liver function tests, complete blood counts, and renal
function is required throughout therapy.
Option A is incorrect because methotrexate for autoimmune
disorders is typically administered once weekly, not daily. Daily
administration instead of weekly has resulted in serious toxicity
and fatal medication errors.
,Option C is incorrect because immunosuppressive therapy
increases susceptibility to infection, and live vaccines should
generally be avoided unless specifically approved by the
healthcare provider.
Option D is incorrect because methotrexate is highly
teratogenic and contraindicated during pregnancy. Patients
should use effective contraception during therapy and for the
recommended period after discontinuation.
Nursing care includes reinforcing weekly dosing, encouraging
laboratory monitoring, assessing for signs of infection or
unusual bleeding, and teaching patients to report persistent
fever, mouth sores, jaundice, or dark urine promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Identify essential patient teaching for methotrexate
therapy.
• Recognize medication safety concerns related to dosing
frequency.
• Explain why alcohol avoidance is recommended during
treatment.
• Identify laboratory parameters requiring routine
monitoring.
, Medication Safety Focus
Medication administration (weekly dosing) and hepatotoxicity
monitoring
Question 2
Clinical Scenario
A 68-year-old man with Crohn disease has been receiving
infliximab infusions every 8 weeks. Before today's infusion, he
reports fatigue, a persistent cough lasting three weeks, and an
unintended 4-kg weight loss. His temperature is 37.9°C
(100.2°F). The nurse reviews his history before initiating
treatment.
Question Stem
Which nursing action is the priority?
A. Administer acetaminophen before beginning the infusion.
B. Begin the infusion at a slower rate.
C. Hold the infusion and notify the healthcare provider.
D. Encourage increased oral fluid intake before treatment.
Correct Answer
Correct Answer: C. Hold the infusion and notify the healthcare
provider.
