NCLEX-RN Immune System Pharmacology: 20
NGN Practice MCQs & Rationales (ATI Prep)
Question 1
Clinical Scenario
A 42-year-old female client with severe rheumatoid arthritis is
receiving her first dose of intravenous infliximab at an
outpatient infusion clinic. Fifteen minutes into the infusion, the
client reports chest tightness, dizziness, and sudden facial
flushing. Her vital signs are: BP 84/52 mm Hg, HR 122/min, RR
26/min, and $SpO_2$ 91% on room air.
Question Stem
Which priority action should the nurse take first?
A. Slow the infusion rate by 50% and recheck vital signs in 15
minutes.
B. Stop the infliximab infusion immediately and disconnect the
tubing from the intravenous catheter.
,C. Administer prescribed intramuscular epinephrine and call for
emergency assistance.
D. Place the client in High-Fowler's position and administer 2
L/min oxygen via nasal cannula.
Correct Answer: B. Stop the infliximab infusion immediately
and disconnect the tubing from the intravenous catheter.
Detailed Rationale
The client is exhibiting classical signs of an acute
hypersensitivity/anaphylactic infusion reaction to infliximab, a
tumor necrosis factor (TNF) inhibitor monoclonal antibody. The
primary nursing action during any suspected acute infusion
reaction is to immediately stop the infusion to prevent further
exposure to the offending antigen. Disconnecting the tubing
ensures that no additional medication remains in the line to be
flushed into the vein accidentally.
While oxygen administration (Option D) and intramuscular
epinephrine (Option C) are standard emergency interventions
for anaphylaxis, stopping the trigger must precede or happen
simultaneously with calling for immediate assistance and
initiating emergency drug protocols. Continuing or simply
slowing the infusion rate (Option A) in the presence of severe
hypotension, respiratory distress, and tachycardia is unsafe and
can lead to complete cardiovascular collapse.
,Learning Objective
After completing this question, the learner should be able to:
• Recognize the clinical manifestations of an acute infusion
reaction during monoclonal antibody therapy.
• Prioritize emergency nursing actions when a client
experiences an anaphylactic reaction.
• Distinguish between mild infusion reactions and life-
threatening hypersensitivity responses.
Medication Safety Focus: High-alert medication / Emergency
Intervention
Question 2
Clinical Scenario
A 35-year-old male client who underwent a renal
transplantation 6 months ago is taking tacrolimus daily to
prevent organ rejection. During a routine clinic follow-up visit,
the nurse reviews his laboratory results: Serum Tacrolimus
Trough Level: 18 ng/mL (Target range: 5–15 ng/mL), Serum
Creatinine: 2.3 mg/dL (Baseline: 1.0 mg/dL), BUN: 34 mg/dL,
Fasting Blood Glucose: 142 mg/dL.
Question Stem
Based on these findings, which action should the nurse
anticipate taking?
, A. Increase the daily tacrolimus dose to maintain solid organ
immunosuppression.
B. Hold the dose and notify the healthcare provider regarding
acute nephrotoxicity.
C. Administer an immediate intravenous bolus of 0.9% normal
saline to treat hyperglycemia.
D. Instruct the client to take the tacrolimus dose with grapefruit
juice to lower serum blood levels.
Correct Answer: B. Hold the dose and notify the healthcare
provider regarding acute nephrotoxicity.
Detailed Rationale
Tacrolimus is a calcineurin inhibitor immunosuppressant with a
narrow therapeutic index. Its major dose-limiting toxicity is
nephrotoxicity, which manifests as elevated serum creatinine
and blood urea nitrogen (BUN) levels accompanied by elevated
therapeutic trough levels (>15 ng/mL). The nurse must
recognize that an elevated trough level combined with doubling
serum creatinine points directly toward tacrolimus-induced
renal injury. The immediate action is to withhold the dose and
contact the healthcare provider for a dose reduction.
Increasing the dose (Option A) would exacerbate kidney
damage and potentially lead to irreversible renal failure.
Intravenous fluid administration (Option C) does not address
NGN Practice MCQs & Rationales (ATI Prep)
Question 1
Clinical Scenario
A 42-year-old female client with severe rheumatoid arthritis is
receiving her first dose of intravenous infliximab at an
outpatient infusion clinic. Fifteen minutes into the infusion, the
client reports chest tightness, dizziness, and sudden facial
flushing. Her vital signs are: BP 84/52 mm Hg, HR 122/min, RR
26/min, and $SpO_2$ 91% on room air.
Question Stem
Which priority action should the nurse take first?
A. Slow the infusion rate by 50% and recheck vital signs in 15
minutes.
B. Stop the infliximab infusion immediately and disconnect the
tubing from the intravenous catheter.
,C. Administer prescribed intramuscular epinephrine and call for
emergency assistance.
D. Place the client in High-Fowler's position and administer 2
L/min oxygen via nasal cannula.
Correct Answer: B. Stop the infliximab infusion immediately
and disconnect the tubing from the intravenous catheter.
Detailed Rationale
The client is exhibiting classical signs of an acute
hypersensitivity/anaphylactic infusion reaction to infliximab, a
tumor necrosis factor (TNF) inhibitor monoclonal antibody. The
primary nursing action during any suspected acute infusion
reaction is to immediately stop the infusion to prevent further
exposure to the offending antigen. Disconnecting the tubing
ensures that no additional medication remains in the line to be
flushed into the vein accidentally.
While oxygen administration (Option D) and intramuscular
epinephrine (Option C) are standard emergency interventions
for anaphylaxis, stopping the trigger must precede or happen
simultaneously with calling for immediate assistance and
initiating emergency drug protocols. Continuing or simply
slowing the infusion rate (Option A) in the presence of severe
hypotension, respiratory distress, and tachycardia is unsafe and
can lead to complete cardiovascular collapse.
,Learning Objective
After completing this question, the learner should be able to:
• Recognize the clinical manifestations of an acute infusion
reaction during monoclonal antibody therapy.
• Prioritize emergency nursing actions when a client
experiences an anaphylactic reaction.
• Distinguish between mild infusion reactions and life-
threatening hypersensitivity responses.
Medication Safety Focus: High-alert medication / Emergency
Intervention
Question 2
Clinical Scenario
A 35-year-old male client who underwent a renal
transplantation 6 months ago is taking tacrolimus daily to
prevent organ rejection. During a routine clinic follow-up visit,
the nurse reviews his laboratory results: Serum Tacrolimus
Trough Level: 18 ng/mL (Target range: 5–15 ng/mL), Serum
Creatinine: 2.3 mg/dL (Baseline: 1.0 mg/dL), BUN: 34 mg/dL,
Fasting Blood Glucose: 142 mg/dL.
Question Stem
Based on these findings, which action should the nurse
anticipate taking?
, A. Increase the daily tacrolimus dose to maintain solid organ
immunosuppression.
B. Hold the dose and notify the healthcare provider regarding
acute nephrotoxicity.
C. Administer an immediate intravenous bolus of 0.9% normal
saline to treat hyperglycemia.
D. Instruct the client to take the tacrolimus dose with grapefruit
juice to lower serum blood levels.
Correct Answer: B. Hold the dose and notify the healthcare
provider regarding acute nephrotoxicity.
Detailed Rationale
Tacrolimus is a calcineurin inhibitor immunosuppressant with a
narrow therapeutic index. Its major dose-limiting toxicity is
nephrotoxicity, which manifests as elevated serum creatinine
and blood urea nitrogen (BUN) levels accompanied by elevated
therapeutic trough levels (>15 ng/mL). The nurse must
recognize that an elevated trough level combined with doubling
serum creatinine points directly toward tacrolimus-induced
renal injury. The immediate action is to withhold the dose and
contact the healthcare provider for a dose reduction.
Increasing the dose (Option A) would exacerbate kidney
damage and potentially lead to irreversible renal failure.
Intravenous fluid administration (Option C) does not address
