NCLEX-RN Pharmacology Immune
System Exam Questions & Answers
20 Original NCLEX Next Gen Practice
Questions with Detailed Rationales
ATI Pharmacology Made Easy Review
|Nursing Exam Prep PDF
Question 1
Clinical Scenario
A 34-year-old woman with rheumatoid arthritis has been
receiving methotrexate 15 mg orally once weekly for the past 3
months. She presents to the outpatient clinic for follow-up. She
reports increased fatigue, mouth sores, and mild nausea.
Laboratory results are as follows:
• WBC: 2,900/mm³
• Platelets: 118,000/mm³
• Hemoglobin: 11.2 g/dL
, • AST: 62 U/L
• ALT: 68 U/L
The nurse reviews her medication list and notes she also takes
folic acid daily.
Question Stem
Which nursing action is the priority?
A. Encourage the client to continue the medication because
mild adverse effects are expected.
B. Notify the provider and withhold the next dose of
methotrexate.
C. Recommend taking methotrexate with milk to reduce
gastrointestinal upset.
D. Instruct the client to increase dietary protein intake.
Correct Answer
B. Notify the provider and withhold the next dose of
methotrexate.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits folate metabolism, reducing immune-
mediated inflammation. Although effective, it can cause serious
bone marrow suppression and hepatotoxicity. This client's
,leukopenia, thrombocytopenia, elevated liver enzymes, and oral
ulcers are consistent with methotrexate toxicity. The priority
nursing action is to withhold the medication and notify the
provider immediately. Continuing therapy could increase the
risk of severe infection, bleeding, or progressive liver injury.
Additional evaluation and possible dose adjustment or
discontinuation are warranted.
Option A is incorrect because these laboratory abnormalities
are not expected therapeutic effects and require prompt
intervention.
Option C is incorrect because taking methotrexate with food
may lessen nausea, but it does not address the client's
potentially life-threatening toxicity.
Option D is incorrect because improving nutrition will not
reverse bone marrow suppression or hepatic injury.
Patient teaching should include taking methotrexate exactly
once weekly, avoiding alcohol, reporting fever, unusual bruising,
or persistent mouth sores promptly, and obtaining routine CBC
and liver function tests.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of methotrexate toxicity.
, • Prioritize nursing interventions for abnormal laboratory
findings.
• Identify essential laboratory monitoring during
methotrexate therapy.
• Educate patients regarding serious adverse effects.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
A 52-year-old man received a kidney transplant 4 weeks ago.
His prescribed medications include tacrolimus, mycophenolate
mofetil, prednisone, trimethoprim-sulfamethoxazole, and
valganciclovir. During discharge teaching, the nurse assesses the
client's understanding of medication management.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I will avoid grapefruit juice while taking tacrolimus."
B. "I'll take my tacrolimus at the same times every day."
C. "If I feel well, I can skip doses occasionally."
D. "My provider will monitor my tacrolimus blood levels."
System Exam Questions & Answers
20 Original NCLEX Next Gen Practice
Questions with Detailed Rationales
ATI Pharmacology Made Easy Review
|Nursing Exam Prep PDF
Question 1
Clinical Scenario
A 34-year-old woman with rheumatoid arthritis has been
receiving methotrexate 15 mg orally once weekly for the past 3
months. She presents to the outpatient clinic for follow-up. She
reports increased fatigue, mouth sores, and mild nausea.
Laboratory results are as follows:
• WBC: 2,900/mm³
• Platelets: 118,000/mm³
• Hemoglobin: 11.2 g/dL
, • AST: 62 U/L
• ALT: 68 U/L
The nurse reviews her medication list and notes she also takes
folic acid daily.
Question Stem
Which nursing action is the priority?
A. Encourage the client to continue the medication because
mild adverse effects are expected.
B. Notify the provider and withhold the next dose of
methotrexate.
C. Recommend taking methotrexate with milk to reduce
gastrointestinal upset.
D. Instruct the client to increase dietary protein intake.
Correct Answer
B. Notify the provider and withhold the next dose of
methotrexate.
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that inhibits folate metabolism, reducing immune-
mediated inflammation. Although effective, it can cause serious
bone marrow suppression and hepatotoxicity. This client's
,leukopenia, thrombocytopenia, elevated liver enzymes, and oral
ulcers are consistent with methotrexate toxicity. The priority
nursing action is to withhold the medication and notify the
provider immediately. Continuing therapy could increase the
risk of severe infection, bleeding, or progressive liver injury.
Additional evaluation and possible dose adjustment or
discontinuation are warranted.
Option A is incorrect because these laboratory abnormalities
are not expected therapeutic effects and require prompt
intervention.
Option C is incorrect because taking methotrexate with food
may lessen nausea, but it does not address the client's
potentially life-threatening toxicity.
Option D is incorrect because improving nutrition will not
reverse bone marrow suppression or hepatic injury.
Patient teaching should include taking methotrexate exactly
once weekly, avoiding alcohol, reporting fever, unusual bruising,
or persistent mouth sores promptly, and obtaining routine CBC
and liver function tests.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of methotrexate toxicity.
, • Prioritize nursing interventions for abnormal laboratory
findings.
• Identify essential laboratory monitoring during
methotrexate therapy.
• Educate patients regarding serious adverse effects.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
A 52-year-old man received a kidney transplant 4 weeks ago.
His prescribed medications include tacrolimus, mycophenolate
mofetil, prednisone, trimethoprim-sulfamethoxazole, and
valganciclovir. During discharge teaching, the nurse assesses the
client's understanding of medication management.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I will avoid grapefruit juice while taking tacrolimus."
B. "I'll take my tacrolimus at the same times every day."
C. "If I feel well, I can skip doses occasionally."
D. "My provider will monitor my tacrolimus blood levels."
