ATI Capstone Pharmacology: Comprehensive 100-Question
Examination v2.0 for Advanced Nursing Competency and
NCLEX-RN Success
Instructions: Select the single best answer for each question. Choose the response that most
accurately addresses the clinical scenario or pharmacological principle presented.
Questions 1–100
1. A nurse is preparing to administer intravenous potassium chloride to a client with hypokalemia.
Which action is most appropriate?
A) Administer the potassium via IV push over 2 minutes
B) Infuse the potassium at a rate of 40 mEq/hour through a peripheral IV
C) Administer the potassium as a bolus through a central line
D) Infuse the potassium at a rate of 10 mEq/hour through a peripheral IV
Correct Answer: D
Rationale: IV potassium chloride should be infused at a maximum rate of 10–20 mEq/hour through a
peripheral IV to prevent cardiac toxicity and phlebitis. IV push administration is contraindicated and
can cause fatal cardiac arrest. Higher rates (40 mEq/hour) require central line placement and cardiac
monitoring. The maximum concentration for peripheral administration is 40 mEq/L.
2. A client with chronic obstructive pulmonary disease (COPD) is prescribed theophylline. The nurse
should monitor for which adverse effect indicating toxicity?
A) Bradycardia
B) Seizures
,C) Hypotension
D) Hypoglycemia
Correct Answer: B
Rationale: Theophylline has a narrow therapeutic range (10–20 mcg/mL). Signs of toxicity include
seizures, cardiac dysrhythmias, tachycardia, and severe nausea/vomiting. Theophylline toxicity can be
fatal and requires immediate intervention. Bradycardia, hypotension, and hypoglycemia are not
characteristic of theophylline toxicity.
3. A nurse is providing discharge teaching to a client prescribed warfarin. Which statement by the
client indicates a need for further teaching?
A) "I will avoid eating large amounts of leafy green vegetables"
B) "I will use an electric razor for shaving"
C) "I will take ibuprofen for my occasional headaches"
D) "I will have my blood drawn regularly to check my INR"
Correct Answer: C
Rationale: Ibuprofen is an NSAID that increases the risk of bleeding when taken with warfarin. Clients
should avoid NSAIDs and use acetaminophen for pain management instead. Avoiding large amounts
of vitamin K-rich foods (leafy greens), using an electric razor, and monitoring INR are all appropriate
measures.
4. A nurse is assessing a client who has been taking metoprolol for 6 months. Which finding
indicates the medication is having the desired therapeutic effect?
A) Heart rate of 52 beats/min
B) Blood pressure of 118/72 mmHg
C) Respiratory rate of 20 breaths/min
D) Cardiac output of 4.5 L/min
Correct Answer: B
,Rationale: Metoprolol is a beta-blocker used to treat hypertension. A blood pressure of 118/72 mmHg
is within the normal range, indicating effective blood pressure control. While a heart rate of 52
beats/min may indicate bradycardia (an adverse effect), the primary therapeutic effect is blood
pressure reduction.
5. A nurse is caring for a client receiving IV vancomycin. Which assessment finding requires
immediate nursing intervention?
A) Serum creatinine of 1.2 mg/dL
B) Flushing and pruritus of the face and neck
C) Tinnitus
D) BUN of 18 mg/dL
Correct Answer: B
Rationale: Flushing and pruritus of the face and neck are signs of Red Man Syndrome, a
hypersensitivity reaction to vancomycin. The nurse should stop the infusion immediately and notify the
provider. While elevated creatinine, tinnitus, and elevated BUN are also concerns, they are less urgent
and may indicate nephrotoxicity or ototoxicity developing over time.
6. A nurse is providing teaching to a client with a new prescription for tamsulosin. Which client
statement indicates understanding of the medication's purpose?
A) "This medication will help me urinate more easily"
B) "This medication will lower my blood pressure"
C) "This medication will prevent urinary tract infections"
D) "This medication will shrink my prostate"
Correct Answer: A
Rationale: Tamsulosin (Flomax) is an alpha-1 adrenergic blocker used to treat benign prostatic
hyperplasia (BPH) by relaxing smooth muscle in the bladder neck and prostate, improving urinary flow.
It does not shrink the prostate (that is the action of 5-alpha-reductase inhibitors like finasteride) and
has only mild effects on blood pressure.
, 7. A nurse is preparing to administer phenytoin to a client with a seizure disorder. The client's serum
phenytoin level is 22 mcg/mL. Which action should the nurse take?
A) Administer the medication as prescribed
B) Hold the medication and notify the provider
C) Administer a reduced dose
D) Increase the client's fluid intake
Correct Answer: B
Rationale: The therapeutic range for phenytoin is 10–20 mcg/mL. A level of 22 mcg/mL is above the
therapeutic range and indicates toxicity. Signs of phenytoin toxicity include nystagmus, ataxia,
diplopia, and sedation. The nurse should hold the medication and notify the provider.
8. A nurse is providing teaching to a client prescribed sildenafil for erectile dysfunction. Which
instruction is most important?
A) "Take this medication with a high-fat meal"
B) "Do not take this medication with nitrates"
C) "The medication will work within 15 minutes"
D) "Take this medication daily in the morning"
Correct Answer: B
Rationale: Sildenafil (Viagra) is contraindicated with nitrates due to the risk of severe hypotension and
cardiovascular collapse. The combination causes synergistic vasodilation that can be life-threatening.
Sildenafil should be taken on an empty stomach (high-fat meals delay absorption), takes 30–60
minutes to work, and is taken as needed, not daily.
9. A nurse is assessing a client who has been taking lisinopril for 2 weeks. The client reports a
persistent dry cough. What is the nurse's best response?
A) "The cough indicates an allergic reaction and requires immediate evaluation"
B) "This is a common side effect that may resolve or require medication change"
Examination v2.0 for Advanced Nursing Competency and
NCLEX-RN Success
Instructions: Select the single best answer for each question. Choose the response that most
accurately addresses the clinical scenario or pharmacological principle presented.
Questions 1–100
1. A nurse is preparing to administer intravenous potassium chloride to a client with hypokalemia.
Which action is most appropriate?
A) Administer the potassium via IV push over 2 minutes
B) Infuse the potassium at a rate of 40 mEq/hour through a peripheral IV
C) Administer the potassium as a bolus through a central line
D) Infuse the potassium at a rate of 10 mEq/hour through a peripheral IV
Correct Answer: D
Rationale: IV potassium chloride should be infused at a maximum rate of 10–20 mEq/hour through a
peripheral IV to prevent cardiac toxicity and phlebitis. IV push administration is contraindicated and
can cause fatal cardiac arrest. Higher rates (40 mEq/hour) require central line placement and cardiac
monitoring. The maximum concentration for peripheral administration is 40 mEq/L.
2. A client with chronic obstructive pulmonary disease (COPD) is prescribed theophylline. The nurse
should monitor for which adverse effect indicating toxicity?
A) Bradycardia
B) Seizures
,C) Hypotension
D) Hypoglycemia
Correct Answer: B
Rationale: Theophylline has a narrow therapeutic range (10–20 mcg/mL). Signs of toxicity include
seizures, cardiac dysrhythmias, tachycardia, and severe nausea/vomiting. Theophylline toxicity can be
fatal and requires immediate intervention. Bradycardia, hypotension, and hypoglycemia are not
characteristic of theophylline toxicity.
3. A nurse is providing discharge teaching to a client prescribed warfarin. Which statement by the
client indicates a need for further teaching?
A) "I will avoid eating large amounts of leafy green vegetables"
B) "I will use an electric razor for shaving"
C) "I will take ibuprofen for my occasional headaches"
D) "I will have my blood drawn regularly to check my INR"
Correct Answer: C
Rationale: Ibuprofen is an NSAID that increases the risk of bleeding when taken with warfarin. Clients
should avoid NSAIDs and use acetaminophen for pain management instead. Avoiding large amounts
of vitamin K-rich foods (leafy greens), using an electric razor, and monitoring INR are all appropriate
measures.
4. A nurse is assessing a client who has been taking metoprolol for 6 months. Which finding
indicates the medication is having the desired therapeutic effect?
A) Heart rate of 52 beats/min
B) Blood pressure of 118/72 mmHg
C) Respiratory rate of 20 breaths/min
D) Cardiac output of 4.5 L/min
Correct Answer: B
,Rationale: Metoprolol is a beta-blocker used to treat hypertension. A blood pressure of 118/72 mmHg
is within the normal range, indicating effective blood pressure control. While a heart rate of 52
beats/min may indicate bradycardia (an adverse effect), the primary therapeutic effect is blood
pressure reduction.
5. A nurse is caring for a client receiving IV vancomycin. Which assessment finding requires
immediate nursing intervention?
A) Serum creatinine of 1.2 mg/dL
B) Flushing and pruritus of the face and neck
C) Tinnitus
D) BUN of 18 mg/dL
Correct Answer: B
Rationale: Flushing and pruritus of the face and neck are signs of Red Man Syndrome, a
hypersensitivity reaction to vancomycin. The nurse should stop the infusion immediately and notify the
provider. While elevated creatinine, tinnitus, and elevated BUN are also concerns, they are less urgent
and may indicate nephrotoxicity or ototoxicity developing over time.
6. A nurse is providing teaching to a client with a new prescription for tamsulosin. Which client
statement indicates understanding of the medication's purpose?
A) "This medication will help me urinate more easily"
B) "This medication will lower my blood pressure"
C) "This medication will prevent urinary tract infections"
D) "This medication will shrink my prostate"
Correct Answer: A
Rationale: Tamsulosin (Flomax) is an alpha-1 adrenergic blocker used to treat benign prostatic
hyperplasia (BPH) by relaxing smooth muscle in the bladder neck and prostate, improving urinary flow.
It does not shrink the prostate (that is the action of 5-alpha-reductase inhibitors like finasteride) and
has only mild effects on blood pressure.
, 7. A nurse is preparing to administer phenytoin to a client with a seizure disorder. The client's serum
phenytoin level is 22 mcg/mL. Which action should the nurse take?
A) Administer the medication as prescribed
B) Hold the medication and notify the provider
C) Administer a reduced dose
D) Increase the client's fluid intake
Correct Answer: B
Rationale: The therapeutic range for phenytoin is 10–20 mcg/mL. A level of 22 mcg/mL is above the
therapeutic range and indicates toxicity. Signs of phenytoin toxicity include nystagmus, ataxia,
diplopia, and sedation. The nurse should hold the medication and notify the provider.
8. A nurse is providing teaching to a client prescribed sildenafil for erectile dysfunction. Which
instruction is most important?
A) "Take this medication with a high-fat meal"
B) "Do not take this medication with nitrates"
C) "The medication will work within 15 minutes"
D) "Take this medication daily in the morning"
Correct Answer: B
Rationale: Sildenafil (Viagra) is contraindicated with nitrates due to the risk of severe hypotension and
cardiovascular collapse. The combination causes synergistic vasodilation that can be life-threatening.
Sildenafil should be taken on an empty stomach (high-fat meals delay absorption), takes 30–60
minutes to work, and is taken as needed, not daily.
9. A nurse is assessing a client who has been taking lisinopril for 2 weeks. The client reports a
persistent dry cough. What is the nurse's best response?
A) "The cough indicates an allergic reaction and requires immediate evaluation"
B) "This is a common side effect that may resolve or require medication change"
