NCLEX-RN Pharmacology Immune
System Practice Questions
20 NGN-Style MCQs with Detailed
Rationales
Immunosuppressants, Biologics,
Corticosteroids & Transplant
Medications
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 28-year-old woman with severe rheumatoid arthritis has been
prescribed adalimumab after an inadequate response to
methotrexate. Her medical history includes treated latent
tuberculosis (TB) 5 years ago. Current vital signs are stable. A
tuberculin skin test is positive, and an interferon-gamma release
,assay (IGRA) is pending. The client asks when she can begin the
medication.
Question Stem
Which action should the nurse take first?
A. Administer the first dose of adalimumab as prescribed.
B. Verify TB screening results and notify the provider before
initiating therapy.
C. Teach the client to avoid receiving live vaccines during
treatment.
D. Encourage increased fluid intake before each injection.
Correct Answer
B. Verify TB screening results and notify the provider before
initiating therapy.
Detailed Rationale
Tumor necrosis factor (TNF)-alpha inhibitors such as
adalimumab suppress inflammatory pathways but significantly
increase the risk of reactivation of latent tuberculosis and
other serious opportunistic infections. Before initiating therapy,
the nurse must ensure appropriate TB screening has been
completed and communicate any positive findings to the
healthcare provider. Clients with evidence of latent TB typically
require treatment before or concurrent with biologic therapy
,according to provider recommendations. Preventing a
potentially life-threatening infection takes priority over
medication administration.
Option A is incorrect because administering the medication
before completing infection screening places the client at
significant risk for disseminated TB.
Option C describes appropriate teaching since live vaccines
should generally be avoided during biologic therapy. However,
patient education is not the priority until treatment safety has
been established.
Option D is incorrect because hydration is not a primary nursing
intervention associated with adalimumab administration and
does not address the immediate safety concern.
Nurses should assess for fever, persistent cough, night sweats,
unexplained weight loss, or recent exposure to infectious
diseases before each dose. Ongoing monitoring for infection is
essential throughout treatment.
Learning Objectives
After completing this question, the learner should be able to:
• Identify required infection screening before initiating TNF-
alpha inhibitors.
• Prioritize nursing actions before administering biologic
agents.
, • Recognize the relationship between immunosuppressive
therapy and latent TB reactivation.
Medication Safety Focus
Contraindication and Infection Screening
Question 2
Clinical Scenario
A 45-year-old man received his first dose of rituximab for non-
Hodgkin lymphoma. Fifteen minutes after the infusion begins,
he develops chills, flushing, shortness of breath, and a blood
pressure of 86/52 mm Hg.
Question Stem
What is the nurse's priority action?
A. Slow the infusion rate and continue monitoring.
B. Stop the infusion immediately and initiate emergency
interventions.
C. Administer acetaminophen and continue the infusion.
D. Reassure the client that these findings are expected.
Correct Answer
B. Stop the infusion immediately and initiate emergency
interventions.
System Practice Questions
20 NGN-Style MCQs with Detailed
Rationales
Immunosuppressants, Biologics,
Corticosteroids & Transplant
Medications
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 28-year-old woman with severe rheumatoid arthritis has been
prescribed adalimumab after an inadequate response to
methotrexate. Her medical history includes treated latent
tuberculosis (TB) 5 years ago. Current vital signs are stable. A
tuberculin skin test is positive, and an interferon-gamma release
,assay (IGRA) is pending. The client asks when she can begin the
medication.
Question Stem
Which action should the nurse take first?
A. Administer the first dose of adalimumab as prescribed.
B. Verify TB screening results and notify the provider before
initiating therapy.
C. Teach the client to avoid receiving live vaccines during
treatment.
D. Encourage increased fluid intake before each injection.
Correct Answer
B. Verify TB screening results and notify the provider before
initiating therapy.
Detailed Rationale
Tumor necrosis factor (TNF)-alpha inhibitors such as
adalimumab suppress inflammatory pathways but significantly
increase the risk of reactivation of latent tuberculosis and
other serious opportunistic infections. Before initiating therapy,
the nurse must ensure appropriate TB screening has been
completed and communicate any positive findings to the
healthcare provider. Clients with evidence of latent TB typically
require treatment before or concurrent with biologic therapy
,according to provider recommendations. Preventing a
potentially life-threatening infection takes priority over
medication administration.
Option A is incorrect because administering the medication
before completing infection screening places the client at
significant risk for disseminated TB.
Option C describes appropriate teaching since live vaccines
should generally be avoided during biologic therapy. However,
patient education is not the priority until treatment safety has
been established.
Option D is incorrect because hydration is not a primary nursing
intervention associated with adalimumab administration and
does not address the immediate safety concern.
Nurses should assess for fever, persistent cough, night sweats,
unexplained weight loss, or recent exposure to infectious
diseases before each dose. Ongoing monitoring for infection is
essential throughout treatment.
Learning Objectives
After completing this question, the learner should be able to:
• Identify required infection screening before initiating TNF-
alpha inhibitors.
• Prioritize nursing actions before administering biologic
agents.
, • Recognize the relationship between immunosuppressive
therapy and latent TB reactivation.
Medication Safety Focus
Contraindication and Infection Screening
Question 2
Clinical Scenario
A 45-year-old man received his first dose of rituximab for non-
Hodgkin lymphoma. Fifteen minutes after the infusion begins,
he develops chills, flushing, shortness of breath, and a blood
pressure of 86/52 mm Hg.
Question Stem
What is the nurse's priority action?
A. Slow the infusion rate and continue monitoring.
B. Stop the infusion immediately and initiate emergency
interventions.
C. Administer acetaminophen and continue the infusion.
D. Reassure the client that these findings are expected.
Correct Answer
B. Stop the infusion immediately and initiate emergency
interventions.
