ATI Pharmacology Made Easy Immune System
Exam Questions | 20 NCLEX-RN Pharmacology
Practice Questions with Rationales |
Immunosuppressants, Biologics,
Corticosteroids & Monoclonal Antibodies
Study Guide
Question 1
Difficulty: Easy
Clinical Scenario
A 28-year-old woman with rheumatoid arthritis has been
prescribed methotrexate 15 mg orally once weekly. During a
follow-up clinic visit, she tells the nurse, "I want to make sure
I'm taking this medication correctly." Her medical history is
otherwise unremarkable. She takes a daily multivitamin and
occasionally drinks wine with dinner. Laboratory results are
within normal limits.
,Question Stem
Which statement by the client indicates the need for additional
teaching?
A. "I should report mouth sores or unusual bruising to my
healthcare provider."
B. "I'll avoid becoming pregnant while taking this medication."
C. "I should take my methotrexate every morning to help it
work better."
D. "My provider may order blood tests to monitor my liver
function."
Correct Answer
C. "I should take my methotrexate every morning to help it
work better."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune activity by inhibiting folate-
dependent cellular replication. For autoimmune diseases such
as rheumatoid arthritis, it is administered once weekly, not
daily. Taking methotrexate every day instead of weekly is a well-
recognized medication error that can result in severe bone
marrow suppression, mucositis, hepatotoxicity, infection, and
,potentially fatal toxicity. The nurse should reinforce the
prescribed weekly schedule and encourage the patient to use
calendars, medication organizers, or reminders to avoid dosing
mistakes.
Option A is correct teaching because mouth ulcers, unexplained
bruising, bleeding, or persistent fever may indicate bone
marrow suppression and require prompt evaluation. Option B is
also correct because methotrexate is teratogenic, and effective
contraception is recommended during treatment. Option D is
appropriate because methotrexate may elevate liver enzymes,
making routine monitoring of liver function tests and complete
blood counts essential.
The priority nursing responsibility is preventing dosing errors
while promoting adherence to monitoring recommendations
and patient education regarding toxicity.
Learning Objectives
After completing this question, the learner should be able to:
• Identify the correct dosing schedule for methotrexate.
• Recognize early signs of methotrexate toxicity.
• Explain essential laboratory monitoring during
methotrexate therapy.
Medication Safety Focus
, Medication administration (weekly dosing prevents serious
toxicity).
Question 2
Difficulty: Moderate
Clinical Scenario
A 63-year-old man received a kidney transplant 3 months ago.
He is prescribed tacrolimus, mycophenolate mofetil, and low-
dose prednisone. During today's clinic visit, he asks about
dietary restrictions because he recently started eating
grapefruit every morning.
Question Stem
Which response by the nurse is most appropriate?
A. "Grapefruit helps improve absorption of tacrolimus."
B. "Continue eating grapefruit if your kidney function remains
normal."
C. "Avoid grapefruit because it can increase tacrolimus levels
and toxicity."
D. "Only avoid grapefruit during the first month after
transplantation."
Correct Answer
Exam Questions | 20 NCLEX-RN Pharmacology
Practice Questions with Rationales |
Immunosuppressants, Biologics,
Corticosteroids & Monoclonal Antibodies
Study Guide
Question 1
Difficulty: Easy
Clinical Scenario
A 28-year-old woman with rheumatoid arthritis has been
prescribed methotrexate 15 mg orally once weekly. During a
follow-up clinic visit, she tells the nurse, "I want to make sure
I'm taking this medication correctly." Her medical history is
otherwise unremarkable. She takes a daily multivitamin and
occasionally drinks wine with dinner. Laboratory results are
within normal limits.
,Question Stem
Which statement by the client indicates the need for additional
teaching?
A. "I should report mouth sores or unusual bruising to my
healthcare provider."
B. "I'll avoid becoming pregnant while taking this medication."
C. "I should take my methotrexate every morning to help it
work better."
D. "My provider may order blood tests to monitor my liver
function."
Correct Answer
C. "I should take my methotrexate every morning to help it
work better."
Detailed Rationale
Methotrexate is a disease-modifying antirheumatic drug
(DMARD) that suppresses immune activity by inhibiting folate-
dependent cellular replication. For autoimmune diseases such
as rheumatoid arthritis, it is administered once weekly, not
daily. Taking methotrexate every day instead of weekly is a well-
recognized medication error that can result in severe bone
marrow suppression, mucositis, hepatotoxicity, infection, and
,potentially fatal toxicity. The nurse should reinforce the
prescribed weekly schedule and encourage the patient to use
calendars, medication organizers, or reminders to avoid dosing
mistakes.
Option A is correct teaching because mouth ulcers, unexplained
bruising, bleeding, or persistent fever may indicate bone
marrow suppression and require prompt evaluation. Option B is
also correct because methotrexate is teratogenic, and effective
contraception is recommended during treatment. Option D is
appropriate because methotrexate may elevate liver enzymes,
making routine monitoring of liver function tests and complete
blood counts essential.
The priority nursing responsibility is preventing dosing errors
while promoting adherence to monitoring recommendations
and patient education regarding toxicity.
Learning Objectives
After completing this question, the learner should be able to:
• Identify the correct dosing schedule for methotrexate.
• Recognize early signs of methotrexate toxicity.
• Explain essential laboratory monitoring during
methotrexate therapy.
Medication Safety Focus
, Medication administration (weekly dosing prevents serious
toxicity).
Question 2
Difficulty: Moderate
Clinical Scenario
A 63-year-old man received a kidney transplant 3 months ago.
He is prescribed tacrolimus, mycophenolate mofetil, and low-
dose prednisone. During today's clinic visit, he asks about
dietary restrictions because he recently started eating
grapefruit every morning.
Question Stem
Which response by the nurse is most appropriate?
A. "Grapefruit helps improve absorption of tacrolimus."
B. "Continue eating grapefruit if your kidney function remains
normal."
C. "Avoid grapefruit because it can increase tacrolimus levels
and toxicity."
D. "Only avoid grapefruit during the first month after
transplantation."
Correct Answer
