NCLEX-RN Pharmacology Immune
System Exam Questions
20 Original NGN Practice MCQs with
Rationales
ATI Pharmacology Made Easy Style
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 28-year-old woman with rheumatoid arthritis has been
prescribed methotrexate 15 mg orally once weekly. She tells
the nurse that she plans to become pregnant within the next
few months. Her current laboratory results include AST 28 U/L,
ALT 30 U/L, serum creatinine 0.8 mg/dL, and a negative
hepatitis screen. She reports taking a daily multivitamin and
occasionally drinking wine on weekends.
Question Stem
Which nursing action is the highest priority before the client
begins methotrexate therapy?
,A. Encourage the client to increase dietary protein intake.
B. Instruct the client to discontinue folic acid supplementation.
C. Reinforce the need for reliable contraception and pregnancy
avoidance.
D. Recommend taking the medication with dairy products to
reduce gastrointestinal upset.
Correct Answer
Correct Answer: C. Reinforce the need for reliable
contraception and pregnancy avoidance.
Detailed Rationale
Methotrexate is an immunosuppressant and disease-modifying
antirheumatic drug (DMARD) that inhibits folate metabolism,
reducing immune-mediated inflammation. It is highly
teratogenic and can cause fetal death and severe congenital
abnormalities. Ensuring that women of reproductive potential
understand the importance of effective contraception before,
during, and for an appropriate period after therapy is a priority
nursing responsibility. Pregnancy should be excluded before
initiating therapy, and patients should notify their provider
immediately if pregnancy occurs.
Option A is incorrect because although adequate nutrition
supports overall health, increasing protein intake does not
address the greatest safety concern before therapy.
,Option B is incorrect because folic acid supplementation is
commonly prescribed with low-dose methotrexate to reduce
adverse effects such as stomatitis and bone marrow
suppression without significantly reducing therapeutic benefit.
Option D is incorrect because methotrexate may be taken with
food if gastrointestinal discomfort occurs, but taking it
specifically with dairy products is not a priority intervention.
The nurse should also educate the client to avoid excessive
alcohol consumption because concurrent alcohol use increases
the risk of hepatotoxicity. Routine monitoring of complete
blood count (CBC), liver enzymes, and renal function is essential
throughout treatment.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the reproductive risks associated with
methotrexate therapy.
• Prioritize nursing education before initiating
immunosuppressive treatment.
• Identify laboratory monitoring required during
methotrexate therapy.
• Recognize interventions that reduce medication-related
complications.
, Medication Safety Focus
Black Box Warning / Patient Education
Question 2
Clinical Scenario
A 63-year-old man received a kidney transplant 3 weeks ago
and is prescribed tacrolimus twice daily. During a follow-up
visit, he tells the nurse, "I've started drinking fresh grapefruit
juice every morning because it's healthy."
Question Stem
Which response by the nurse is most appropriate?
A. "Continue drinking grapefruit juice because it improves
kidney function."
B. "Limit grapefruit juice to one serving each week."
C. "Avoid grapefruit juice because it can dangerously increase
tacrolimus levels."
D. "Drink grapefruit juice only when taking the evening dose."
Correct Answer
Correct Answer: C. Avoid grapefruit juice because it can
dangerously increase tacrolimus levels.
Detailed Rationale
System Exam Questions
20 Original NGN Practice MCQs with
Rationales
ATI Pharmacology Made Easy Style
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 28-year-old woman with rheumatoid arthritis has been
prescribed methotrexate 15 mg orally once weekly. She tells
the nurse that she plans to become pregnant within the next
few months. Her current laboratory results include AST 28 U/L,
ALT 30 U/L, serum creatinine 0.8 mg/dL, and a negative
hepatitis screen. She reports taking a daily multivitamin and
occasionally drinking wine on weekends.
Question Stem
Which nursing action is the highest priority before the client
begins methotrexate therapy?
,A. Encourage the client to increase dietary protein intake.
B. Instruct the client to discontinue folic acid supplementation.
C. Reinforce the need for reliable contraception and pregnancy
avoidance.
D. Recommend taking the medication with dairy products to
reduce gastrointestinal upset.
Correct Answer
Correct Answer: C. Reinforce the need for reliable
contraception and pregnancy avoidance.
Detailed Rationale
Methotrexate is an immunosuppressant and disease-modifying
antirheumatic drug (DMARD) that inhibits folate metabolism,
reducing immune-mediated inflammation. It is highly
teratogenic and can cause fetal death and severe congenital
abnormalities. Ensuring that women of reproductive potential
understand the importance of effective contraception before,
during, and for an appropriate period after therapy is a priority
nursing responsibility. Pregnancy should be excluded before
initiating therapy, and patients should notify their provider
immediately if pregnancy occurs.
Option A is incorrect because although adequate nutrition
supports overall health, increasing protein intake does not
address the greatest safety concern before therapy.
,Option B is incorrect because folic acid supplementation is
commonly prescribed with low-dose methotrexate to reduce
adverse effects such as stomatitis and bone marrow
suppression without significantly reducing therapeutic benefit.
Option D is incorrect because methotrexate may be taken with
food if gastrointestinal discomfort occurs, but taking it
specifically with dairy products is not a priority intervention.
The nurse should also educate the client to avoid excessive
alcohol consumption because concurrent alcohol use increases
the risk of hepatotoxicity. Routine monitoring of complete
blood count (CBC), liver enzymes, and renal function is essential
throughout treatment.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the reproductive risks associated with
methotrexate therapy.
• Prioritize nursing education before initiating
immunosuppressive treatment.
• Identify laboratory monitoring required during
methotrexate therapy.
• Recognize interventions that reduce medication-related
complications.
, Medication Safety Focus
Black Box Warning / Patient Education
Question 2
Clinical Scenario
A 63-year-old man received a kidney transplant 3 weeks ago
and is prescribed tacrolimus twice daily. During a follow-up
visit, he tells the nurse, "I've started drinking fresh grapefruit
juice every morning because it's healthy."
Question Stem
Which response by the nurse is most appropriate?
A. "Continue drinking grapefruit juice because it improves
kidney function."
B. "Limit grapefruit juice to one serving each week."
C. "Avoid grapefruit juice because it can dangerously increase
tacrolimus levels."
D. "Drink grapefruit juice only when taking the evening dose."
Correct Answer
Correct Answer: C. Avoid grapefruit juice because it can
dangerously increase tacrolimus levels.
Detailed Rationale
