ATI Pharmacology Proctored Exam--
NGN Updated 2026||||questions and
answers with rationales/graded
A+/2026 update/100% correct
/instant download
Student Name: _________________________
Date: _________________________
Total Questions: 80
Time Limit: 2 Hours
Instructions: This examination consists of multiple choice, Select-All-That-Apply
(SATA), and NGN case study questions. Select the best answer(s) for each
question.
Section 1: Cardiovascular & Hematologic Medications (Questions 1-15)
1. A nurse is preparing to administer Digoxin to a client with heart failure.
Which finding requires the nurse to withhold the medication and notify the
provider?
A. Heart rate of 62/min
B. Serum potassium level of 4.2 mEq/L
C. Heart rate of 52/min
D. Blood pressure of 118/76 mmHg
Rationale: Digoxin is withheld if the adult heart rate is below 60/min or if there is
a significant change in rhythm or rate. Bradycardia increases the risk of digoxin
toxicity. Potassium of 4.2 is within normal limits.
2. A client taking Warfarin has an International Normalized Ratio (INR) of
4.5. There is no evidence of bleeding. What is the priority nursing action?
A. Administer Vitamin K orally
B. Hold the next dose of Warfarin
,C. Administer Fresh Frozen Plasma (FFP)
D. Increase the Warfarin dose
Rationale: For an INR of 4.5 without active bleeding, the standard of care is to
hold the Warfarin dose. Vitamin K or FFP is reserved for active bleeding or INRs
above 10.
3. A nurse is administering IV Heparin. Which complication is indicated by a
sudden drop in blood pressure, back pain, and blood in the urine?
A. Heparin-induced thrombocytopenia (HIT)
B. Retroperitoneal bleeding
C. Anaphylactic reaction
D. Pulmonary embolism
Rationale: Back pain accompanied by a drop in BP and hematuria in a client on
anticoagulants is highly suspicious for a retroperitoneal hemorrhage. The nurse
must stop the infusion immediately.
4. A client is started on Amiodarone for atrial fibrillation. Which adverse
effect requires the client to notify the provider immediately?
A. Blue-gray skin discoloration
B. Shortness of breath and dry cough
C. Photosensitivity
D. Tremors
Rationale: Amiodarone can cause pulmonary toxicity (pulmonary fibrosis)
presenting with progressive dyspnea and a non-productive cough. This is a
potentially fatal adverse effect requiring immediate evaluation.
5. The healthcare provider prescribes Clopidogrel (Plavix) for a client. Which
statement indicates the client understands the discharge teaching?
A. "I will take this medication on an empty stomach."
B. "I will use ibuprofen for headaches instead of Tylenol."
C. "I will stop this medication 5 days before my dental surgery."
D. "I will have my blood drawn weekly to check my levels."
Rationale: Clopidogrel increases bleeding risk. It must be stopped 5–7 days before
elective surgery or dental procedures to reduce the risk of hemorrhage.
6. (SATA) A client is prescribed Lisinopril. Which findings indicate an adverse
reaction requiring immediate intervention? (Select all that apply)
, A. Dry cough
B. Angioedema (swelling of lips/tongue)
C. Hyperglycemia
D. Hypotension
E. Hypokalemia
Correct Answers: A, B, D
Rationale: Angioedema is life-threatening and requires immediate epinephrine.
Severe hypotension, especially after the first dose, requires intervention. A
persistent dry cough is a common reason for discontinuation.
7. A client receiving Furosemide (Lasix) reports tinnitus. What is the nurse's
priority action?
A. Administer the dose as scheduled.
B. Check the client's blood pressure.
C. Hold the dose and notify the provider.
D. Reassure the client it is a normal side effect.
Rationale: Tinnitus is an early sign of ototoxicity, a serious and potentially
irreversible adverse effect of loop diuretics like furosemide.
8. A client has a serum potassium level of 3.2 mEq/L and is prescribed
Furosemide 40 mg IV. What is the priority action?
A. Administer the furosemide as ordered.
B. Withhold the furosemide and notify the provider.
C. Encourage the client to eat a banana.
D. Administer the furosemide with a potassium supplement.
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
Administering it to a client who is already hypokalemic (K+ <3.5) would worsen
the deficiency and increase the risk of cardiac dysrhythmias.
9. A client on Metoprolol has a blood pressure of 88/50 mmHg and reports
dizziness. Which action should the nurse take first?
A. Administer the scheduled Metoprolol.
B. Notify the Rapid Response Team.
C. Withhold the medication and re-check BP.
D. Place the client in Trendelenburg position.
NGN Updated 2026||||questions and
answers with rationales/graded
A+/2026 update/100% correct
/instant download
Student Name: _________________________
Date: _________________________
Total Questions: 80
Time Limit: 2 Hours
Instructions: This examination consists of multiple choice, Select-All-That-Apply
(SATA), and NGN case study questions. Select the best answer(s) for each
question.
Section 1: Cardiovascular & Hematologic Medications (Questions 1-15)
1. A nurse is preparing to administer Digoxin to a client with heart failure.
Which finding requires the nurse to withhold the medication and notify the
provider?
A. Heart rate of 62/min
B. Serum potassium level of 4.2 mEq/L
C. Heart rate of 52/min
D. Blood pressure of 118/76 mmHg
Rationale: Digoxin is withheld if the adult heart rate is below 60/min or if there is
a significant change in rhythm or rate. Bradycardia increases the risk of digoxin
toxicity. Potassium of 4.2 is within normal limits.
2. A client taking Warfarin has an International Normalized Ratio (INR) of
4.5. There is no evidence of bleeding. What is the priority nursing action?
A. Administer Vitamin K orally
B. Hold the next dose of Warfarin
,C. Administer Fresh Frozen Plasma (FFP)
D. Increase the Warfarin dose
Rationale: For an INR of 4.5 without active bleeding, the standard of care is to
hold the Warfarin dose. Vitamin K or FFP is reserved for active bleeding or INRs
above 10.
3. A nurse is administering IV Heparin. Which complication is indicated by a
sudden drop in blood pressure, back pain, and blood in the urine?
A. Heparin-induced thrombocytopenia (HIT)
B. Retroperitoneal bleeding
C. Anaphylactic reaction
D. Pulmonary embolism
Rationale: Back pain accompanied by a drop in BP and hematuria in a client on
anticoagulants is highly suspicious for a retroperitoneal hemorrhage. The nurse
must stop the infusion immediately.
4. A client is started on Amiodarone for atrial fibrillation. Which adverse
effect requires the client to notify the provider immediately?
A. Blue-gray skin discoloration
B. Shortness of breath and dry cough
C. Photosensitivity
D. Tremors
Rationale: Amiodarone can cause pulmonary toxicity (pulmonary fibrosis)
presenting with progressive dyspnea and a non-productive cough. This is a
potentially fatal adverse effect requiring immediate evaluation.
5. The healthcare provider prescribes Clopidogrel (Plavix) for a client. Which
statement indicates the client understands the discharge teaching?
A. "I will take this medication on an empty stomach."
B. "I will use ibuprofen for headaches instead of Tylenol."
C. "I will stop this medication 5 days before my dental surgery."
D. "I will have my blood drawn weekly to check my levels."
Rationale: Clopidogrel increases bleeding risk. It must be stopped 5–7 days before
elective surgery or dental procedures to reduce the risk of hemorrhage.
6. (SATA) A client is prescribed Lisinopril. Which findings indicate an adverse
reaction requiring immediate intervention? (Select all that apply)
, A. Dry cough
B. Angioedema (swelling of lips/tongue)
C. Hyperglycemia
D. Hypotension
E. Hypokalemia
Correct Answers: A, B, D
Rationale: Angioedema is life-threatening and requires immediate epinephrine.
Severe hypotension, especially after the first dose, requires intervention. A
persistent dry cough is a common reason for discontinuation.
7. A client receiving Furosemide (Lasix) reports tinnitus. What is the nurse's
priority action?
A. Administer the dose as scheduled.
B. Check the client's blood pressure.
C. Hold the dose and notify the provider.
D. Reassure the client it is a normal side effect.
Rationale: Tinnitus is an early sign of ototoxicity, a serious and potentially
irreversible adverse effect of loop diuretics like furosemide.
8. A client has a serum potassium level of 3.2 mEq/L and is prescribed
Furosemide 40 mg IV. What is the priority action?
A. Administer the furosemide as ordered.
B. Withhold the furosemide and notify the provider.
C. Encourage the client to eat a banana.
D. Administer the furosemide with a potassium supplement.
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
Administering it to a client who is already hypokalemic (K+ <3.5) would worsen
the deficiency and increase the risk of cardiac dysrhythmias.
9. A client on Metoprolol has a blood pressure of 88/50 mmHg and reports
dizziness. Which action should the nurse take first?
A. Administer the scheduled Metoprolol.
B. Notify the Rapid Response Team.
C. Withhold the medication and re-check BP.
D. Place the client in Trendelenburg position.
