NCLEX-RN Pharmacology Immune
System Exam 2026
20 NGN-Style Practice Questions with
Detailed Rationales
|Immunosuppressants, Biologics,
Corticosteroids & DMARDs
Question 1
Clinical Scenario
A 52-year-old man received a kidney transplant 10 days ago. His
current medications include tacrolimus, mycophenolate mofetil,
prednisone, trimethoprim-sulfamethoxazole, and valganciclovir.
During morning rounds, the nurse notes that the client's blood
pressure is 146/88 mm Hg, temperature is 37.1°C (98.8°F),
serum creatinine is slightly elevated from baseline, and the
client reports a mild hand tremor. The client asks whether the
tremor means the medication is not working.
Question Stem
Which nursing response is most appropriate?
,A. "Stop taking tacrolimus until the tremor resolves."
B. "A mild tremor can occur with tacrolimus, but it should be
reported and monitored."
C. "The tremor means your body is rejecting the transplanted
kidney."
D. "Increase your fluid intake and skip today's tacrolimus dose."
Correct Answer
Correct Answer: B. "A mild tremor can occur with tacrolimus,
but it should be reported and monitored."
Detailed Rationale
Tacrolimus is a calcineurin inhibitor commonly used to prevent
organ transplant rejection by suppressing T-lymphocyte
activation. Mild tremor is a well-recognized dose-related
adverse effect and should be documented and monitored
because worsening neurologic symptoms may indicate elevated
drug levels or toxicity. The nurse should reinforce medication
adherence and notify the provider if symptoms worsen or
therapeutic drug levels require adjustment.
Option A is unsafe because abruptly discontinuing tacrolimus
significantly increases the risk of acute transplant rejection.
Immunosuppressive medications should never be stopped
without provider direction.
,Option C is incorrect because a tremor alone is not evidence of
rejection. Rejection is more commonly associated with
declining organ function, fever, reduced urine output, graft
tenderness, or increasing serum creatinine.
Option D is inappropriate because skipping doses can
precipitate rejection. Although hydration is important, it does
not replace appropriate drug monitoring. Tacrolimus requires
regular assessment of trough concentrations, renal function,
blood pressure, blood glucose, and neurologic status. Nurses
should also educate patients to avoid grapefruit products,
which can increase tacrolimus concentrations and toxicity.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize common adverse effects of tacrolimus.
• Reinforce adherence to immunosuppressive therapy after
transplantation.
• Identify appropriate nursing monitoring for calcineurin
inhibitors.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
, A 44-year-old woman with severe rheumatoid arthritis is
prescribed adalimumab. Before administering the first dose, the
nurse reviews the medical record. The client reports feeling well
today and denies current symptoms.
Question Stem
Which assessment finding requires the nurse to notify the
provider before administering the medication?
A. History of seasonal allergic rhinitis
B. Positive tuberculosis screening without documented
treatment
C. Mild osteoarthritis of the knees
D. Family history of type 2 diabetes
Correct Answer
Correct Answer: B. Positive tuberculosis screening without
documented treatment
Detailed Rationale
Adalimumab is a tumor necrosis factor (TNF)-alpha inhibitor
that suppresses inflammatory cytokines. Because TNF plays an
essential role in containing latent tuberculosis, treatment with
TNF inhibitors can reactivate latent TB. Clients should undergo
TB screening before therapy, and those with untreated latent TB
System Exam 2026
20 NGN-Style Practice Questions with
Detailed Rationales
|Immunosuppressants, Biologics,
Corticosteroids & DMARDs
Question 1
Clinical Scenario
A 52-year-old man received a kidney transplant 10 days ago. His
current medications include tacrolimus, mycophenolate mofetil,
prednisone, trimethoprim-sulfamethoxazole, and valganciclovir.
During morning rounds, the nurse notes that the client's blood
pressure is 146/88 mm Hg, temperature is 37.1°C (98.8°F),
serum creatinine is slightly elevated from baseline, and the
client reports a mild hand tremor. The client asks whether the
tremor means the medication is not working.
Question Stem
Which nursing response is most appropriate?
,A. "Stop taking tacrolimus until the tremor resolves."
B. "A mild tremor can occur with tacrolimus, but it should be
reported and monitored."
C. "The tremor means your body is rejecting the transplanted
kidney."
D. "Increase your fluid intake and skip today's tacrolimus dose."
Correct Answer
Correct Answer: B. "A mild tremor can occur with tacrolimus,
but it should be reported and monitored."
Detailed Rationale
Tacrolimus is a calcineurin inhibitor commonly used to prevent
organ transplant rejection by suppressing T-lymphocyte
activation. Mild tremor is a well-recognized dose-related
adverse effect and should be documented and monitored
because worsening neurologic symptoms may indicate elevated
drug levels or toxicity. The nurse should reinforce medication
adherence and notify the provider if symptoms worsen or
therapeutic drug levels require adjustment.
Option A is unsafe because abruptly discontinuing tacrolimus
significantly increases the risk of acute transplant rejection.
Immunosuppressive medications should never be stopped
without provider direction.
,Option C is incorrect because a tremor alone is not evidence of
rejection. Rejection is more commonly associated with
declining organ function, fever, reduced urine output, graft
tenderness, or increasing serum creatinine.
Option D is inappropriate because skipping doses can
precipitate rejection. Although hydration is important, it does
not replace appropriate drug monitoring. Tacrolimus requires
regular assessment of trough concentrations, renal function,
blood pressure, blood glucose, and neurologic status. Nurses
should also educate patients to avoid grapefruit products,
which can increase tacrolimus concentrations and toxicity.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize common adverse effects of tacrolimus.
• Reinforce adherence to immunosuppressive therapy after
transplantation.
• Identify appropriate nursing monitoring for calcineurin
inhibitors.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
, A 44-year-old woman with severe rheumatoid arthritis is
prescribed adalimumab. Before administering the first dose, the
nurse reviews the medical record. The client reports feeling well
today and denies current symptoms.
Question Stem
Which assessment finding requires the nurse to notify the
provider before administering the medication?
A. History of seasonal allergic rhinitis
B. Positive tuberculosis screening without documented
treatment
C. Mild osteoarthritis of the knees
D. Family history of type 2 diabetes
Correct Answer
Correct Answer: B. Positive tuberculosis screening without
documented treatment
Detailed Rationale
Adalimumab is a tumor necrosis factor (TNF)-alpha inhibitor
that suppresses inflammatory cytokines. Because TNF plays an
essential role in containing latent tuberculosis, treatment with
TNF inhibitors can reactivate latent TB. Clients should undergo
TB screening before therapy, and those with untreated latent TB
