ATI COMPREHENSIVE PN PHARMACOLOGY
EXAM 2025/2026 – 140 QUESTIONS WITH
NGN & SOLUTIONS (GRADED A+)
1. A nurse is preparing to administer enoxaparin subcutaneously. Which action is
correct?
A. Aspirate before injection
B. Massage the site after injection
C. Inject into the abdominal skinfold
D. Expel the air bubble from the prefilled syringe
Correct answer: C – ✓✓ Inject into the abdominal skinfold.
Rationale: Enoxaparin is a low molecular weight heparin given subcutaneously
into the abdominal skinfold. Aspiration is not recommended because it may cause
bruising. Massaging the site increases bleeding risk. The air bubble in the prefilled
syringe should not be expelled because it ensures full dose delivery and prevents
drug loss.
2. A client is prescribed lithium carbonate. Which serum level indicates toxicity?
A. 0.6 mEq/L
B. 0.8 mEq/L
C. 1.2 mEq/L
D. 1.8 mEq/L
Correct answer: D – ✓✓ *1.8 mEq/L.*
Rationale: *Therapeutic lithium level is 0.6–1.2 mEq/L. Levels above 1.5 mEq/L
are considered toxic. At 1.8 mEq/L, the client is at risk for seizures, coma, and
renal failure. Immediate intervention is required.*
3. A nurse administers IV furosemide to a client with pulmonary edema. Which
finding indicates a therapeutic response?
A. Decreased blood pressure
B. Increased urine output
C. Heart rate 110 bpm
,D. Crackles in lung bases
Correct answer: B – ✓✓ Increased urine output.
Rationale: Furosemide is a loop diuretic that promotes excretion of fluid.
Increased urine output directly indicates the medication is working. Decreased
blood pressure and crackles may improve, but increased urine output is the
primary therapeutic endpoint. Tachycardia and crackles are signs of worsening
pulmonary edema, not a therapeutic response.
4. A client is taking warfarin and has an INR of 1.2. The nurse should anticipate
which order?
A. Increase the warfarin dose
B. Administer vitamin K
C. Hold the next dose of warfarin
D. Give fresh frozen plasma
Correct answer: A – ✓✓ Increase the warfarin dose.
Rationale: INR target for most indications is 2–3. An INR of 1.2 is subtherapeutic,
meaning the client is not adequately anticoagulated. The expected order is to
increase the warfarin dose. Vitamin K or fresh frozen plasma would be used for
supratherapeutic INR or bleeding.
5. NGN – A client with diabetes reports sweating, tachycardia, and confusion. The
nurse checks a blood glucose of 52 mg/dL. Which three actions should the nurse
take? (Select all that apply)
A. Give 15 g of fast-acting carbohydrate
B. Administer insulin lispro subcutaneously
C. Recheck glucose in 15 minutes
D. Give glucagon intramuscularly if unconscious
E. Encourage a high-protein snack
Correct answers: A, C, D – ✓✓ *Give 15 g of fast-acting carbohydrate, recheck
glucose in 15 minutes, and give glucagon intramuscularly if unconscious.*
Rationale: *Hypoglycemia (<70 mg/dL) requires immediate treatment. The rule of
15: give 15 g fast-acting carbohydrate, recheck in 15 minutes, and repeat if
needed. If unconscious, IM glucagon is indicated. Insulin would lower glucose
further; protein does not raise glucose quickly enough.*
,6. A client is prescribed metoprolol for hypertension. Which finding should the
nurse report to the provider immediately?
A. Heart rate 58 bpm
B. Blood pressure 110/70 mmHg
C. Complaints of cold hands and feet
D. Wheezing and shortness of breath
Correct answer: D – ✓✓ Wheezing and shortness of breath.
Rationale: *Metoprolol is a beta-1 selective blocker but can still cause
bronchospasm, especially in clients with asthma or COPD. Wheezing and dyspnea
indicate a serious adverse reaction. HR 58 is acceptable; BP 110/70 is normal; cold
extremities are common but not emergent.*
7. A nurse teaches a client about sublingual nitroglycerin. Which statement
indicates understanding?
A. “I can take one tablet every 10 minutes until pain stops.”
B. “I should store the bottle in the refrigerator.”
C. “I will take one tablet and call 911 if pain is not gone in 5 minutes.”
D. “I can swallow the tablet with a small sip of water.”
Correct answer: C – ✓✓ “I will take one tablet and call 911 if pain is not gone in 5
minutes.”
Rationale: Standard instruction: take one tablet sublingually; if no relief after 5
minutes, call 911. The second dose may be taken while waiting. Refrigeration is
not needed; keep in original dark bottle. Swallowing inactivates the drug.
8. A client on haloperidol develops a temperature of 104°F, muscle rigidity, and
altered mental status. The nurse suspects:
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Extrapyramidal symptoms
D. Tardive dyskinesia
Correct answer: B – ✓✓ Neuroleptic malignant syndrome.
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to
antipsychotics like haloperidol. Classic signs: fever, severe muscle rigidity,
autonomic instability, and altered mental status. Serotonin syndrome involves
hyperreflexia and clonus. Extrapyramidal symptoms include dystonia and
akathisia. Tardive dyskinesia is involuntary movements after long-term use.
, 9. A client receives a prescription for digoxin. Which lab value should the nurse
check before administering the first dose?
A. Serum calcium
B. Serum magnesium
C. Serum potassium
D. Serum sodium
Correct answer: C – ✓✓ Serum potassium.
Rationale: Hypokalemia increases the risk of digoxin toxicity. Potassium levels
must be assessed before each dose. Hypomagnesemia also increases risk, but
potassium is the primary concern. Calcium and sodium are less directly related to
digoxin safety.
10. A nurse administers morphine sulfate 4 mg IV to a client with postoperative
pain. Fifteen minutes later, the client’s respiratory rate is 8 breaths/min. Which
medication should the nurse prepare to administer?
A. Flumazenil
B. Naloxone
C. Naltrexone
D. Acetylcysteine
Correct answer: B – ✓✓ Naloxone.
Rationale: Naloxone is an opioid antagonist that reverses respiratory depression
caused by morphine. Flumazenil reverses benzodiazepines. Naltrexone is used for
alcohol/opioid dependence maintenance. Acetylcysteine is for acetaminophen
overdose.
11. A client with type 2 diabetes is starting metformin. Which instruction is most
important?
A. “Take this medication on an empty stomach.”
B. “Expect your urine to turn orange.”
C. “Report muscle pain or fatigue to your provider.”
D. “You may stop taking it if your blood sugar is normal.”
Correct answer: C – ✓✓ “Report muscle pain or fatigue to your provider.”
Rationale: Metformin can cause lactic acidosis, a rare but life-threatening
complication. Early symptoms include unexplained muscle pain, malaise, and
fatigue. The medication should be taken with meals to reduce GI upset. Orange
urine is not expected. Never stop without provider guidance.
EXAM 2025/2026 – 140 QUESTIONS WITH
NGN & SOLUTIONS (GRADED A+)
1. A nurse is preparing to administer enoxaparin subcutaneously. Which action is
correct?
A. Aspirate before injection
B. Massage the site after injection
C. Inject into the abdominal skinfold
D. Expel the air bubble from the prefilled syringe
Correct answer: C – ✓✓ Inject into the abdominal skinfold.
Rationale: Enoxaparin is a low molecular weight heparin given subcutaneously
into the abdominal skinfold. Aspiration is not recommended because it may cause
bruising. Massaging the site increases bleeding risk. The air bubble in the prefilled
syringe should not be expelled because it ensures full dose delivery and prevents
drug loss.
2. A client is prescribed lithium carbonate. Which serum level indicates toxicity?
A. 0.6 mEq/L
B. 0.8 mEq/L
C. 1.2 mEq/L
D. 1.8 mEq/L
Correct answer: D – ✓✓ *1.8 mEq/L.*
Rationale: *Therapeutic lithium level is 0.6–1.2 mEq/L. Levels above 1.5 mEq/L
are considered toxic. At 1.8 mEq/L, the client is at risk for seizures, coma, and
renal failure. Immediate intervention is required.*
3. A nurse administers IV furosemide to a client with pulmonary edema. Which
finding indicates a therapeutic response?
A. Decreased blood pressure
B. Increased urine output
C. Heart rate 110 bpm
,D. Crackles in lung bases
Correct answer: B – ✓✓ Increased urine output.
Rationale: Furosemide is a loop diuretic that promotes excretion of fluid.
Increased urine output directly indicates the medication is working. Decreased
blood pressure and crackles may improve, but increased urine output is the
primary therapeutic endpoint. Tachycardia and crackles are signs of worsening
pulmonary edema, not a therapeutic response.
4. A client is taking warfarin and has an INR of 1.2. The nurse should anticipate
which order?
A. Increase the warfarin dose
B. Administer vitamin K
C. Hold the next dose of warfarin
D. Give fresh frozen plasma
Correct answer: A – ✓✓ Increase the warfarin dose.
Rationale: INR target for most indications is 2–3. An INR of 1.2 is subtherapeutic,
meaning the client is not adequately anticoagulated. The expected order is to
increase the warfarin dose. Vitamin K or fresh frozen plasma would be used for
supratherapeutic INR or bleeding.
5. NGN – A client with diabetes reports sweating, tachycardia, and confusion. The
nurse checks a blood glucose of 52 mg/dL. Which three actions should the nurse
take? (Select all that apply)
A. Give 15 g of fast-acting carbohydrate
B. Administer insulin lispro subcutaneously
C. Recheck glucose in 15 minutes
D. Give glucagon intramuscularly if unconscious
E. Encourage a high-protein snack
Correct answers: A, C, D – ✓✓ *Give 15 g of fast-acting carbohydrate, recheck
glucose in 15 minutes, and give glucagon intramuscularly if unconscious.*
Rationale: *Hypoglycemia (<70 mg/dL) requires immediate treatment. The rule of
15: give 15 g fast-acting carbohydrate, recheck in 15 minutes, and repeat if
needed. If unconscious, IM glucagon is indicated. Insulin would lower glucose
further; protein does not raise glucose quickly enough.*
,6. A client is prescribed metoprolol for hypertension. Which finding should the
nurse report to the provider immediately?
A. Heart rate 58 bpm
B. Blood pressure 110/70 mmHg
C. Complaints of cold hands and feet
D. Wheezing and shortness of breath
Correct answer: D – ✓✓ Wheezing and shortness of breath.
Rationale: *Metoprolol is a beta-1 selective blocker but can still cause
bronchospasm, especially in clients with asthma or COPD. Wheezing and dyspnea
indicate a serious adverse reaction. HR 58 is acceptable; BP 110/70 is normal; cold
extremities are common but not emergent.*
7. A nurse teaches a client about sublingual nitroglycerin. Which statement
indicates understanding?
A. “I can take one tablet every 10 minutes until pain stops.”
B. “I should store the bottle in the refrigerator.”
C. “I will take one tablet and call 911 if pain is not gone in 5 minutes.”
D. “I can swallow the tablet with a small sip of water.”
Correct answer: C – ✓✓ “I will take one tablet and call 911 if pain is not gone in 5
minutes.”
Rationale: Standard instruction: take one tablet sublingually; if no relief after 5
minutes, call 911. The second dose may be taken while waiting. Refrigeration is
not needed; keep in original dark bottle. Swallowing inactivates the drug.
8. A client on haloperidol develops a temperature of 104°F, muscle rigidity, and
altered mental status. The nurse suspects:
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Extrapyramidal symptoms
D. Tardive dyskinesia
Correct answer: B – ✓✓ Neuroleptic malignant syndrome.
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to
antipsychotics like haloperidol. Classic signs: fever, severe muscle rigidity,
autonomic instability, and altered mental status. Serotonin syndrome involves
hyperreflexia and clonus. Extrapyramidal symptoms include dystonia and
akathisia. Tardive dyskinesia is involuntary movements after long-term use.
, 9. A client receives a prescription for digoxin. Which lab value should the nurse
check before administering the first dose?
A. Serum calcium
B. Serum magnesium
C. Serum potassium
D. Serum sodium
Correct answer: C – ✓✓ Serum potassium.
Rationale: Hypokalemia increases the risk of digoxin toxicity. Potassium levels
must be assessed before each dose. Hypomagnesemia also increases risk, but
potassium is the primary concern. Calcium and sodium are less directly related to
digoxin safety.
10. A nurse administers morphine sulfate 4 mg IV to a client with postoperative
pain. Fifteen minutes later, the client’s respiratory rate is 8 breaths/min. Which
medication should the nurse prepare to administer?
A. Flumazenil
B. Naloxone
C. Naltrexone
D. Acetylcysteine
Correct answer: B – ✓✓ Naloxone.
Rationale: Naloxone is an opioid antagonist that reverses respiratory depression
caused by morphine. Flumazenil reverses benzodiazepines. Naltrexone is used for
alcohol/opioid dependence maintenance. Acetylcysteine is for acetaminophen
overdose.
11. A client with type 2 diabetes is starting metformin. Which instruction is most
important?
A. “Take this medication on an empty stomach.”
B. “Expect your urine to turn orange.”
C. “Report muscle pain or fatigue to your provider.”
D. “You may stop taking it if your blood sugar is normal.”
Correct answer: C – ✓✓ “Report muscle pain or fatigue to your provider.”
Rationale: Metformin can cause lactic acidosis, a rare but life-threatening
complication. Early symptoms include unexplained muscle pain, malaise, and
fatigue. The medication should be taken with meals to reduce GI upset. Orange
urine is not expected. Never stop without provider guidance.
