Infection or Not
A client taking prednisone daily for several months reports a sore throat and temperature of 100.9°F. What is the priority interpretation?
Answer: Possible infection related to immunosuppression.
Why: Chronic corticosteroids suppress immune response, so fever and sore throat should never be minimized.
A patient asks why prednisone cannot be stopped abruptly after months of use. What is the best answer?
Answer: Abrupt withdrawal can cause adrenal insufficiency.
Why: Long-term steroid use suppresses adrenal function, so tapering is required.
A patient on tacrolimus after kidney transplant asks whether they can receive a live vaccine. What is the best response?
Answer: Live vaccines are generally avoided because of immunosuppression.
Why: These patients are at risk for vaccine-related infection.
A client with an acute gout flare asks whether today’s dose of allopurinol will relieve the pain by tonight. What is the best response?
Answer: No. Allopurinol lowers uric acid long term but does not provide rapid pain relief for an acute flare.
Why: Students must separate acute treatment from chronic prevention.
A client on prednisone has blood glucose of 248 mg/dL before lunch. What is the nurse’s best interpretation?
Answer: Hyperglycemia is a likely corticosteroid adverse effect.
Why: Steroids raise glucose and require monitoring.
A client taking adalimumab reports fatigue, cough, and night sweats. What complication should the nurse suspect first?
Answer: Possible tuberculosis reactivation.
Why: TNF inhibitors increase the risk for serious infection, especially reactivation of latent TB.
A nurse prepares to give ibuprofen to an older adult with black stools and epigastric pain. What should the nurse do?
Answer: Hold the medication and notify the provider.
Why: These findings suggest GI bleeding, a major NSAID complication.
A nursing student says, “Because a client’s vaccines are behind, the whole series must be restarted.” Is that correct?
Answer: No. Most delayed vaccine series are resumed, not restarted.
Why: This is a common NCLEX immunization principle.
A client with osteoarthritis has chronic knee pain and asks why acetaminophen might not reduce swelling as well as an NSAID. What is the best answer?
Answer: Acetaminophen relieves pain but has minimal anti-inflammatory effect.
Why: NSAIDs reduce prostaglandin-mediated inflammation.
A nurse is caring for a patient receiving cyclosporine. Which assessment is priority: bowel sounds, creatinine, visual acuity, or pedal pulses?
Answer: Creatinine.
Why: Calcineurin inhibitors are strongly associated with nephrotoxicity.
A patient taking methotrexate has oral ulcers, low WBC count, and new weakness. What is the most likely cause?
Answer: Methotrexate toxicity with bone marrow suppression.
Why: Mouth sores plus leukopenia is a high-yield toxicity pattern.
A patient takes allopurinol and reports a new rash. What is the best nursing action?
Answer: Hold the medication and notify the provider immediately.
Why: Rash may signal a serious hypersensitivity reaction.
A client asks the difference between active immunity and passive immunity. Which example best demonstrates passive immunity?
Answer: Receiving immune globulin after exposure.
Why: Passive immunity means preformed antibodies are given to the patient.
A patient with gout and chronic kidney disease receives a prescription for an NSAID. What is the nurse’s best concern?
Answer: NSAIDs may worsen renal function.
Why: NSAIDs can reduce renal perfusion and are high risk in CKD.
A client on a biologic DMARD is scheduled for therapy today but reports fever and productive cough. What is the priority nursing action?
Answer: Hold the medication and notify the provider.
Why: Biologics should not be given in the setting of possible active infection.
A client with rheumatoid arthritis takes prednisone, methotrexate, and a biologic DMARD. Which new symptom should the nurse report first: ankle swelling, insomnia, temperature 101.3°F, or mild nausea?
Answer: Temperature 101.3°F.
Why: In an immunosuppressed patient, fever is the priority because it may indicate severe infection.
A client prescribed colchicine for acute gout now reports severe diarrhea and muscle pain. What does the nurse suspect?
Answer: Colchicine toxicity.
Why: Major toxicity clues include GI distress and neuromuscular symptoms.
A client on biologic therapy wants the nurse to choose which is safer: intranasal influenza vaccine or injectable influenza vaccine. What is the best answer?
Answer: Injectable influenza vaccine.
Why: The nasal form is live attenuated; the injectable form is inactivated.
A client with gout is started on colchicine for a flare and allopurinol for long-term control. Which teaching point is most important?
Answer: Colchicine treats the inflammation now; allopurinol helps prevent future flares.
Why: ATI often tests whether students confuse symptom control with prevention.
A patient with rheumatoid arthritis asks why DMARDs are prescribed if NSAIDs already help with pain. What is the best response?
Answer: DMARDs help slow disease progression and joint damage, while NSAIDs mainly relieve symptoms.
Why: This is a major testable distinction.
A transplant patient on tacrolimus has creatinine 2.1 mg/dL, tremors, and BP 168/92. What is the priority concern?
Answer: Tacrolimus toxicity causing nephrotoxicity.
Why: Tacrolimus commonly causes kidney injury, hypertension, and neurotoxicity.
A patient receiving methotrexate says, “I take it every day so it works better.” What is the nurse’s priority response?
Answer: Clarify that methotrexate for inflammatory disorders is typically taken weekly and notify the provider of incorrect use.
Why: Daily dosing can cause severe toxicity and is a classic safety trap.
A pregnant patient asks why vaccine screening includes questions about immunosuppression and pregnancy. What is the best explanation?
Answer: Some vaccines, especially live vaccines, may be contraindicated in pregnancy or significant immunosuppression.
Why: Vaccine safety depends on patient condition, not just age.
An older adult takes naproxen daily for osteoarthritis and now has fatigue, Hgb 9.4 g/dL, and dark stools. Which complication best explains these findings?
Answer: Chronic GI blood loss from NSAID use.
Why: This is a classic medication-safety recognition question.
A nurse is reviewing several patients. Which patient should be seen first?
A. Patient on prednisone with glucose 210 mg/dL
B. Patient on allopurinol with mild nausea
C. Patient on tacrolimus with rising creatinine
D. Patient on cetirizine with dry mouth
Answer: C. Patient on tacrolimus with rising creatinine.
Why: This suggests serious nephrotoxicity and possible organ threat.