# Review the methotrexate bone marrow suppression trend.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395941&lang=en  
> language: en  
> subject: Medication Administration  
> category: PPT

## Question

Review the methotrexate bone marrow suppression trend.

| Time | Data |
| --- | --- |
| Baseline | Methotrexate started for rheumatoid arthritis; WBC 6,800/mm3 |
| Month 2 | Mouth ulcers, fatigue, WBC 2,400/mm3, platelets 92,000/mm3 |
| Clinic call | Temperature 38.5 C, sore throat, reports taking extra weekly doses by mistake |

Q1. What is the priority concern?

Methotrexate toxicity with infection risk
Expected arthritis flare
Normal medication effect
Resolved immune suppression

Q2. Which action should the nurse take?

Instruct urgent evaluation and notify provider
Tell client to take another dose
Recommend live vaccine today
Delay because fever is mild

## Explanation

Mouth ulcers, cytopenias, fever, sore throat, and dosing error suggest methotrexate toxicity and severe infection risk. Urgent evaluation and provider notification are required.

## In-depth explanation

Clinical Judgment
Trend items ask you to notice what is changing over time and which change creates the highest risk. Link the strongest cue pattern to the safest nursing priority for Methotrexate bone marrow suppression.

Memory Tip
Trend, cue severity, and immediate risk decide priority before routine tasks.

KR vs US
NCLEX NGN items reward clinical judgment using the complete client picture, not one isolated clue.

## Clinical scenario

Clinical Practice Guide
For Methotrexate bone marrow suppression, compare new findings with baseline status, ordered data, and expected complications before choosing the priority response.

Caution
Do not delay urgent stabilization or escalation when airway, breathing, circulation, neurologic status, or safety is worsening.

## Key concepts

- **Methotrexate** — An antimetabolite medication that can suppress bone marrow.
- **Agranulocytosis** — Severe reduction in neutrophils causing high infection risk.
- **Mouth Ulcers** — A toxicity sign that can occur with methotrexate.

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_For study reference only. Always follow current clinical guidelines and your institution’s protocols._