PROCTORED EXAM RETAKE 2023/2026
WITH NGN
180 Verified Questions & 100% Verified Answers
Guaranteed First Attempt Pass!
PROCTORED EXAM STUDY GUIDE | Latest 2025/2026 Update
Exam Questions with Correct Answers and Rationales
Aligned with 2025|2026 ATI Testing Standards
NCSBN Clinical Judgment Measurement Model (NCJMM)
Next Generation NCLEX (NGN) Item Types
Contemporary Pharmacopeia Guidelines
Total Questions: 180 (MCQ with NGN-Ready Items)
Cognitive Levels: 30% Recall | 50% Application | 20% Analysis
Date: April 2026
,ATI RN Pharmacology Proctored Exam Retake 2023/2026 | NGN-Ready | 180 Verified Questions
Abstract
This comprehensive proctored examination review comprises 180 multiple-choice questions designed to
evaluate nursing students' pharmacological knowledge and clinical judgment competencies aligned with the
2025|2026 ATI RN Pharmacology Proctored Exam blueprint and NCSBN Clinical Judgment Measurement
Model (NCJMM). The examination spans seven domains: Pharmacokinetics, Pharmacodynamics and
Medication Safety (25 questions); Autonomic Nervous System, CNS and Psychotropic Medications (25
questions); Cardiovascular, Renal and Respiratory Pharmacotherapy (30 questions); Anti-infectives,
Immunizations and Hematologic Agents (30 questions); Endocrine, GI, Pain Management and Specialty
Medications (30 questions); Pediatric, Geriatric, Pregnancy/Lactation and High-Risk Population Dosing
(20 questions); and NGN Clinical Judgment Items including case studies, bowtie, trend and matrix formats
(20 questions). Approximately 75% of questions employ scenario-based clinical pharmacology vignettes
requiring medication administration reasoning, adverse effect recognition, patient education evaluation, and
priority action determination. Section 7 specifically targets Next Generation NCLEX cognitive skills
including recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking actions,
and evaluating outcomes within pharmacology-focused clinical contexts.
Keywords: ATI Pharmacology, NCLEX NGN, Medication Safety, Pharmacokinetics, High-Alert
Medications, Clinical Judgment, Patient Education, Dose Calculations, Adverse Effects
Examination Blueprint
Sec Domain Q Range Count Focus
1 Pharmacokinetics, Pharmacodynamics & Medication Safety
Q1-Q25 25 30/50/20
2 ANS, CNS & Psychotropic Medications Q26-Q50 25 30/50/20
3 Cardiovascular, Renal & Respiratory Pharmacotherapy Q51-Q80 30 30/50/20
4 Anti-infectives, Immunizations & Hematologic Agents Q81-Q110 30 30/50/20
5 Endocrine, GI, Pain Mgmt & Specialty Medications Q111-Q140 30 30/50/20
6 Pediatric, Geriatric, Pregnancy/Lactation Dosing Q141-Q160 20 30/50/20
7 NGN Clinical Judgment Items Q161-Q180 20 20/40/40
Total 180
Page 2
,ATI RN Pharmacology Proctored Exam Retake 2023/2026 | NGN-Ready | 180 Verified Questions
Section 1: Pharmacokinetics, Pharmacodynamics & Medication Safety Fundamentals
(Q1-Q25)
This section covers ADME principles, half-life and steady-state calculations, therapeutic index, CYP450 drug interactions, the 10
rights of medication administration, high-alert medication protocols, ISMP safety guidelines, adverse drug reactions, anaphylaxis
management, controlled substance regulations, and TJC National Patient Safety Goals.
Q1: A nurse is reviewing the pharmacokinetics of morphine with a nursing student. The student asks why morphine is given intravenously for
acute pain rather than orally. Which of the following is the best response by the nurse?
A. A. Morphine is not absorbed from the gastrointestinal tract
B. B. Morphine undergoes extensive first-pass metabolism, reducing bioavailability [CORRECT]
C. C. Morphine is destroyed by gastric acid and requires IV administration
D. D. Morphine causes severe gastrointestinal side effects when given orally
Correct Answer: B
Rationale: Morphine undergoes significant first-pass metabolism in the liver (via glucuronidation by UGT enzymes), resulting in only about 20-40% oral
bioavailability. First-pass metabolism refers to pre-systemic elimination by the liver before a drug reaches the systemic circulation. IV administration
bypasses this effect, providing 100% bioavailability and more reliable analgesia.
Q2: A nurse is caring for a client who is receiving an oral medication that requires an acidic environment for optimal absorption. The client is
also taking omeprazole, a proton pump inhibitor. Which of the following is the most appropriate action by the nurse?
A. A. Administer both medications together to enhance drug synergy
B. B. Administer the oral medication 2 hours before the omeprazole [CORRECT]
C. C. Crush the oral medication and mix it with apple sauce for better absorption
D. D. Hold the oral medication and notify the provider
Correct Answer: B
Rationale: Omeprazole suppresses gastric acid secretion, raising gastric pH and potentially impairing the absorption of drugs that require an acidic
environment (e.g., ketoconazole, iron supplements, some protease inhibitors). Administering the acid-dependent drug at least 2 hours before the PPI allows
some residual acid to remain in the stomach for absorption. Crushing may alter drug release properties.
Q3: A nurse is preparing to administer a new medication to a client with a half-life of 12 hours. The provider orders the drug to be given
every 12 hours. Approximately how long will it take for this medication to reach steady-state concentration?
A. A. 12 hours
B. B. 24 hours
C. C. 2.5 to 3 days [CORRECT]
D. D. 5 to 6 days
Correct Answer: C
Rationale: Steady state is achieved after approximately 4 to 5 half-lives of a drug. For a drug with a 12-hour half-life: 4 x 12 = 48 hours (2 days) to 5 x 12 =
60 hours (2.5 days). Therefore, steady state is reached in approximately 2.5 to 3 days. At steady state, the rate of drug administration equals the rate of
elimination, and plasma concentrations remain relatively stable.
Q4: A nurse is administering warfarin to a client with atrial fibrillation. The nurse understands that warfarin has a narrow therapeutic index.
Which of the following is the most important nursing action related to this characteristic?
A. A. Administer the medication at the same time each day and monitor INR regularly [CORRECT]
B. B. Give the medication with food to reduce gastrointestinal irritation
C. C. Double the dose if the client reports persistent palpitations
D. D. Switch to subcutaneous administration if the client misses a dose
Correct Answer: A
Rationale: A narrow therapeutic index means there is a small margin between the therapeutic dose and the toxic dose. Warfarin requires regular INR
monitoring (therapeutic range 2.0-3.0 for most indications) and consistent administration. Small changes in dose, diet (vitamin K intake), or drug
interactions can lead to serious bleeding (toxicity) or thromboembolic events (subtherapeutic).
Q5: A nurse is caring for a client receiving vancomycin IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection. The provider
orders a trough level. At which of the following times should the nurse obtain the blood specimen?
A. A. 30 minutes after the infusion is complete
B. B. 1 hour before the next scheduled dose [CORRECT]
C. C. 30 minutes before starting the infusion
D. D. 2 hours after the infusion is complete
Correct Answer: B
Rationale: Trough levels for vancomycin should be drawn within 30 minutes before the next scheduled dose. This measures the lowest drug concentration
and ensures it remains above the minimum inhibitory concentration (MIC). The target trough for serious MRSA infections is typically 15-20 mcg/mL. Peak
levels (drawn 1-2 hours post-infusion) are generally not required for vancomycin monitoring.
Q6: A nurse is reviewing the medication list of a client who is taking simvastatin, a CYP3A4 substrate. The provider has prescribed
clarithromycin, a CYP3A4 inhibitor. The nurse should recognize which of the following risks?
A. A. Decreased effectiveness of simvastatin leading to hyperlipidemia
B. B. Increased risk of rhabdomyolysis due to elevated simvastatin levels [CORRECT]
Page 3
, ATI RN Pharmacology Proctored Exam Retake 2023/2026 | NGN-Ready | 180 Verified Questions
C. C. Accelerated elimination of clarithromycin, reducing its efficacy
D. D. No significant interaction, as these drugs use different metabolic pathways
Correct Answer: B
Rationale: Clarithromycin is a strong CYP3A4 inhibitor that reduces the metabolism of simvastatin, a CYP3A4 substrate, leading to significantly elevated
simvastatin blood levels. This increases the risk of statin-induced myopathy and rhabdomyolysis, a potentially life-threatening condition involving skeletal
muscle breakdown and acute kidney injury. The nurse should notify the provider to consider an alternative antibiotic.
Q7: A nurse is caring for a client receiving warfarin who is started on sulfamethoxazole-trimethoprim for a urinary tract infection. The nurse
should monitor the client closely for which of the following?
A. A. Decreased INR and increased risk of thrombosis
B. B. Increased INR and increased risk of bleeding [CORRECT]
C. C. No change in INR, as these drugs do not interact
D. D. Decreased effectiveness of the antibiotic
Correct Answer: B
Rationale: Sulfamethoxazole-trimethoprim (SMX-TMP) increases INR and bleeding risk through multiple mechanisms: sulfamethoxazole is a CYP2C9
inhibitor (reducing warfarin metabolism), has a structural similarity to warfarin that may add to anticoagulant effect, and can displace warfarin from
protein-binding sites, increasing free (active) warfarin levels. The nurse should monitor INR closely and assess for signs of bleeding.
Q8: A nurse is preparing to administer medications to a client. Which of the following is one of the 10 rights of medication administration
that should be verified prior to giving the medication?
A. A. Right room number
B. B. Right documentation after administration [CORRECT]
C. C. Right pharmacy
D. D. Right brand name
Correct Answer: B
Rationale: The 10 rights of medication administration are: right patient, right drug, right dose, right route, right time, right documentation, right reason, right
response, right to refuse, and right education/evaluation. Right documentation requires the nurse to document immediately after administering the
medication (not before). Right room number, right pharmacy, and right brand name are not part of the 10 rights.
Q9: A nurse is administering insulin to a client with diabetes mellitus. Which of the following actions is most important to prevent a
medication error with this high-alert medication?
A. A. Have a second nurse independently verify the dose and draw up the insulin [CORRECT]
B. B. Administer the insulin at room temperature only
C. C. Always give insulin intravenously for faster absorption
D. D. Use the same syringe for both regular and NPH insulin without mixing
Correct Answer: A
Rationale: Insulin is classified as a high-alert medication by the Institute for Safe Medication Practices (ISMP). Independent double-check of the dose, drug,
and pump settings by a second nurse is a critical safety strategy. Insulin errors (especially involving units vs. milliliters confusion between U-100 and U-500
formulations) can be fatal. ISMP recommends independent verification before administering insulin doses.
Q10: A nurse receives an order to administer heparin 25,000 units in 500 mL D5W at a rate of 1,000 units/hr to a client with a pulmonary
embolism. Which of the following is the most important safety action before starting the infusion?
A. A. Verify the pump rate with a second nurse and ensure the concentration matches the order [CORRECT]
B. B. Administer the medication through a peripheral IV in the forearm only
C. C. Obtain a complete blood count before each dose change
D. D. Give a loading dose of oral warfarin concurrently
Correct Answer: A
Rationale: Heparin is a high-alert medication (ISMP). Errors involving concentration, rate, and units are common and potentially fatal. Independent
double-check of the dose calculation, concentration, and pump settings by a second qualified nurse is essential. The pump rate should be 20 mL/hr (1,000
units/hr divided by 50 units/mL). Heparin requires aPTT monitoring, not CBC before each change. Overlapping therapy with warfarin requires a minimum
4-5 days.
Q11: A nurse realizes that she administered metoprolol 100 mg instead of the ordered metoprolol 50 mg to a client. Which of the following
actions should the nurse take first?
A. A. Complete an incident report after the shift ends
B. B. Assess the client's blood pressure and heart rate immediately [CORRECT]
C. C. Notify the risk management department
D. D. Document the error in the client's medical record and continue care
Correct Answer: B
Rationale: When a medication error occurs, the first priority is to assess the client for adverse effects. Metoprolol is a beta-blocker, and a double dose can
cause bradycardia, hypotension, and heart block. After assessing the client, the nurse should notify the provider, implement any ordered interventions, and
complete an incident report. The error should also be documented in the client's medical record.
Q12: A nurse is performing medication reconciliation at the time of a client's admission to the hospital. Which of the following is the most
important action for the nurse to take?
A. A. Rely solely on the electronic health record for the medication list
B. B. Ask the client to bring all current medications, supplements, and herbal products to the hospital [CORRECT]
C. C. Discontinue all home medications until the provider reviews them
Page 4