NCLEX Immunology & Autoimmune questions
The PrepScore bank has 64 Immunology & Autoimmune questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Generate solutions and Analyze cues, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
HIV/AIDS antiretroviral + opportunistic infections, SLE flare + sun avoidance, multiple sclerosis exacerbation, myasthenia gravis crisis + cholinergic crisis, Guillain-Barré ascending paralysis, scleroderma + Raynaud, post-transplant immunosuppression, immune deficiency/sepsis, vaccine schedule, immunology multi-patient priority.
Three worked questions
Q1. A 28-year-old female presents with new fatigue + malar (butterfly) rash + symmetric small-joint arthralgia + photosensitivity. The clinic nurse reviews diagnostic priorities for suspected SLE. Which lab combination is MOST useful for diagnosis?
- A. CBC alone (cytopenias suggest disease activity but are NOT diagnostic)
- B. ANA + anti-dsDNA (ANA is sensitive >95% screen; anti-dsDNA is specific >95% and correlates with disease activity; together they meet immunologic ACR/EULAR criteria)
- C. LFTs (NOT diagnostic for SLE)
- D. TSH (NOT related to SLE classification)
Show answer and rationale
Answer: ANA + anti-dsDNA (ANA is sensitive >95% screen; anti-dsDNA is specific >95% and correlates with disease activity; together they meet immunologic ACR/EULAR criteria)
SLE diagnostic combo: ANA (sensitive screen) + anti-dsDNA (specific + correlates with activity). CBC supports activity but is not diagnostic; LFTs/TSH unrelated.
Q2. A 30-year-old female with stable SLE asks about lifestyle modifications. The clinic nurse provides evidence-based education. Which modifications are APPROPRIATE? Select all that apply.
- A. Strict sun protection (broad-spectrum SPF 50+, hats, long sleeves) — UV triggers cutaneous + systemic flares
- B. Smoking cessation — smoking worsens SLE activity, hydroxychloroquine response, cardiovascular risk
- C. Regular low-impact exercise — improves fatigue, mood, cardiovascular health (graded per tolerance)
- D. Stress management (CBT, mindfulness, sleep hygiene) — psychosocial stress can trigger flares
- E. Routine vaccinations per immunocompromised guidance (non-live vaccines OK; live vaccines AVOIDED on biologics/high-dose immunosuppression)
- F. Sun-bathing for vitamin D (UNSAFE — triggers SLE flares; supplement vitamin D instead)
Show answer and rationale
Answer: Strict sun protection (broad-spectrum SPF 50+, hats, long sleeves) — UV triggers cutaneous + systemic flaresSmoking cessation — smoking worsens SLE activity, hydroxychloroquine response, cardiovascular riskRegular low-impact exercise — improves fatigue, mood, cardiovascular health (graded per tolerance)Stress management (CBT, mindfulness, sleep hygiene) — psychosocial stress can trigger flaresRoutine vaccinations per immunocompromised guidance (non-live vaccines OK; live vaccines AVOIDED on biologics/high-dose immunosuppression)
SLE lifestyle: sun protection + smoking cessation + exercise + stress management + non-live vaccinations. AVOID sun-bathing (triggers flares).
Q3. A 60-year-old male on prednisone 20 mg PO daily × 6 months for autoimmune disease. The clinic nurse assesses for chronic steroid side effects. Which effects are EXPECTED? Select all that apply.
- A. Hyperglycemia / new-onset diabetes (gluconeogenic effect; monitor glucose)
- B. Osteoporosis (anti-osteoblastic + pro-osteoclastic; bone health: DEXA, Ca, vit D, bisphosphonate if indicated)
- C. Weight gain + central adiposity + moon facies (Cushingoid)
- D. Infection susceptibility (impaired neutrophil/T-cell function; vaccinate per guidance)
- E. Hypertension + adrenal suppression (cortisol axis suppression; AVOID abrupt taper)
- F. Improved bone density (OPPOSITE — chronic steroids cause bone loss)
Show answer and rationale
Answer: Hyperglycemia / new-onset diabetes (gluconeogenic effect; monitor glucose)Osteoporosis (anti-osteoblastic + pro-osteoclastic; bone health: DEXA, Ca, vit D, bisphosphonate if indicated)Weight gain + central adiposity + moon facies (Cushingoid)Infection susceptibility (impaired neutrophil/T-cell function; vaccinate per guidance)Hypertension + adrenal suppression (cortisol axis suppression; AVOID abrupt taper)
Chronic steroid side effects: hyperglycemia + osteoporosis + Cushingoid + infection susceptibility + HTN + adrenal suppression. Opposite of bone density improvement.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
ART adherence > 95% prevents resistance + viral rebound. OI prophylaxis by CD4: < 200 → PJP (Bactrim DS daily); < 100 → toxoplasmosis (Bactrim); < 50 → MAC (azithromycin weekly). U=U: undetectable = untransmittable. Avoid live vaccines if CD4 < 200; inactivated safe. Never stop ART unilaterally — switch regimen if needed.
SLE triggers: SUN/UV exposure (#1), infection, stress, pregnancy, drugs (procainamide, hydralazine, sulfas). Hydroxychloroquine foundational (annual eye exam for retinal toxicity); never stop. Lupus nephritis (RBC casts + proteinuria + ↑Cr) = high-dose steroids + cyclophosphamide/MMF + biopsy. Steroid taper gradual (adrenal crisis if abrupt). Sun protection SPF 30+ + clothing + avoid tanning + hat.
Multiple sclerosis: ascending demyelinating disease (RRMS most common); dissemination in time + space on MRI. Symptoms: optic neuritis, Lhermitte sign, weakness, spasticity, fatigue, bladder/bowel/sexual dysfunction. Acute relapse: IV methylprednisolone 1 g × 3-5 days (speeds recovery, doesn't change long-term). Continue DMT. AVOID HEAT (Uhthoff phenomenon worsens symptoms). Symptomatic: PT, baclofen, amantadine/modafinil for fatigue.
Myasthenia gravis: AChR antibodies; weakness worsens with USE, improves with REST. Myasthenic crisis (under-treated/infection): weakness, respiratory failure, NO SLUDGE → MORE anticholinesterase + IVIG/plasmapheresis. Cholinergic crisis (overdose): SLUDGE (salivation, lacrimation, urination, defecation, GI cramps, emesis) + bradycardia + miosis → HOLD pyridostigmine + atropine. Monitor FVC + NIF. AVOID aminoglycosides + magnesium + beta-blockers + neuromuscular blockers.
Guillain-Barré: post-infectious ASCENDING symmetric weakness + areflexia (often after Campylobacter GI or respiratory infection). LP: albuminocytologic dissociation (HIGH protein + NORMAL WBC). Treatment: IVIG 2 g/kg over 5 days OR plasmapheresis — STEROIDS DO NOT HELP. Monitor FVC + NIF q4h; intubate at FVC < 15-20 mL/kg or NIF > -20. Autonomic instability common. Recovery over months.
Limited cutaneous systemic sclerosis = CREST (Calcinosis + Raynaud + Esophageal dysmotility + Sclerodactyly + Telangiectasias). Raynaud: keep warm + gloves + no smoking + CCB (nifedipine); AVOID beta-blockers (worsen Raynaud). Esophageal: small frequent meals + upright + PPI + HOB elevated. Skin: emollients + ulcers monitoring. Annual screen: pulmonary HTN (echo) + ILD (CT/PFT). Scleroderma renal crisis (new HTN + AKI) → ACEi STAT (life-saving exception).
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Immunology & Autoimmune questions does the bank have?
64 multiple-choice items, plus 10 unfolding cases in the Immunology & Autoimmune pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Generate solutions and Analyze cues, though every step appears.
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