ATI PHARMACOLOGY PRACTICE EXAMINATION
2026–2027 — COMPREHENSIVE STUDY GUIDE |
LATEST UPDATE 2026/2027 | ACTUAL EXAM
PRACTICE QUESTIONS AND ANSWERS | EXAM
REVIEW | 100% CORRECT ANSWERS | VERIFIED
SOLUTIONS
This advanced pharmacology practice examination is designed for nursing
students preparing for the ATI Pharmacology assessment, the HESI Pharmacology
exam, and the NCLEX-RN® licensure examination. The 100-question test evaluates
mastery of pharmacologic principles, medication safety, dosage calculations,
therapeutic uses, adverse effects, drug interactions, and nursing considerations
across major drug classifications. Questions are written at the application,
analysis, and evaluation levels to mirror the cognitive complexity of high-stakes
licensing examinations, requiring the test taker to anticipate adverse reactions,
interpret laboratory values, prioritize interventions, and educate patients
effectively. Each item includes a detailed rationale to reinforce learning and clarify
incorrect options. Use this comprehensive review to self-assess your readiness,
strengthen pharmacological knowledge, and build confidence for safe medication
administration in clinical practice. This 2026–2027 edition reflects current
evidence-based guidelines, FDA warnings, and national patient safety standards.
Table of Contents
I. Pharmacokinetics, Pharmacodynamics, and Medication Safety
II. Autonomic Nervous System Medications
III. Cardiovascular and Renal Medications
IV. Anticoagulants, Antiplatelets, and Thrombolytics
V. Respiratory, Gastrointestinal, and Endocrine Medications
VI. Anti-Infectives: Antibiotics, Antivirals, and Antifungals
VII. Antineoplastic and Immunosuppressant Medications
VIII. Central Nervous System and Psychotropic Medications
IX. Pain Management and Anesthetic Agents
,X. Herbal, Over-the-Counter, and Complementary Therapies
XI. Dosage Calculations and Intravenous Therapy
1. A nurse is preparing to administer digoxin to a client with heart failure. The
client’s serum digoxin level is 2.4 ng/mL (therapeutic range 0.5–2.0 ng/mL).
Which assessment finding is most consistent with digoxin toxicity?
A) Hypertension and tachycardia
B) Visual disturbances such as yellow halos and anorexia
C) Hyperactive bowel sounds and diarrhea with hyperkalemia
D) Flushing and throbbing headache
Correct Answer: B
Digoxin toxicity commonly presents with gastrointestinal symptoms (anorexia,
nausea), visual changes (yellow or green halos, blurred vision), and cardiac
dysrhythmias. Hypokalemia, not hyperkalemia, potentiates digoxin toxicity.
Hypertension and tachycardia (A) are not typical. Flushing and headache (D)
suggest nitroglycerin or calcium channel blocker effects.
2. A client is prescribed warfarin for atrial fibrillation. The nurse should
instruct the client to avoid which over-the-counter medication due to
increased bleeding risk?
A) Acetaminophen
B) Ibuprofen
C) Calcium carbonate
D) Diphenhydramine
Correct Answer: B
Ibuprofen is an NSAID that inhibits platelet aggregation and increases the risk of
bleeding when taken with warfarin. Acetaminophen (A) is safer in moderation but
may affect INR at high doses. Calcium carbonate (C) and diphenhydramine (D) do
not significantly increase bleeding risk.
, 3. A client is receiving a continuous infusion of unfractionated heparin. The
aPTT is 90 seconds (control 30 seconds). The client has no signs of bleeding.
Which action should the nurse take?
A) Stop the infusion and administer protamine sulfate
B) Continue the infusion at the current rate
C) Reduce the infusion rate according to the titration nomogram and
recheck aPTT in 6 hours
D) Administer vitamin K orally
Correct Answer: C
The aPTT is supratherapeutic (3 times control). Without bleeding, the appropriate
action is to reduce the rate per protocol and recheck. Protamine (A) is for severe
bleeding or overdose. Vitamin K (D) reverses warfarin, not heparin. Continuing (B)
increases bleeding risk.
4. A nurse is teaching a client with type 2 diabetes who is prescribed
metformin. Which statement by the client indicates a need for further
teaching?
A) “I will take the medication with meals to reduce stomach upset.”
B) “I will stop the medication before any procedure that uses contrast dye.”
C) “I will have my kidney function checked regularly.”
D) “I can drink alcohol in moderation while taking this medication.”
Correct Answer: D
Alcohol can increase the risk of lactic acidosis with metformin and should be
limited or avoided. The other statements are correct: metformin should be held
before contrast procedures (B) and renal function monitored (C).
5. A client with a history of asthma is prescribed propranolol for migraine
prophylaxis. What is the nurse’s priority action?
A) Administer the medication as prescribed
B) Hold the medication and notify the provider due to the risk of
bronchospasm
C) Give the medication with a bronchodilator
D) Reduce the dose by half and administer
, Correct Answer: B
Propranolol is a nonselective beta-blocker that can cause bronchospasm in clients
with asthma and is contraindicated. The nurse should hold the medication and
notify the provider. Administering (A) risks respiratory distress. The nurse cannot
alter the dose (D) or give with a bronchodilator (C) without an order.
6. A nurse is preparing to administer levothyroxine to a client with
hypothyroidism. Which client statement indicates the client understands
how to take the medication?
A) “I will take it with a glass of milk at bedtime.”
B) “I will take it on an empty stomach in the morning.”
C) “I will take it with an antacid to prevent upset stomach.”
D) “I will take it with food to improve absorption.”
Correct Answer: B
Levothyroxine is best absorbed on an empty stomach, preferably in the morning,
30–60 minutes before breakfast. Milk (A), antacids (C), and food (D) interfere with
absorption.
7. A client is prescribed furosemide for heart failure. Which laboratory value
requires immediate notification of the provider before administering the
dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Furosemide is a loop diuretic that causes potassium loss. A potassium of 3.1 mEq/L
is hypokalemic and increases the risk of cardiac dysrhythmias, especially in heart
failure. The provider should be notified before giving the dose. The other values
are within normal limits.
8. A client is receiving vancomycin intravenously for a methicillin-resistant
Staphylococcus aureus infection. The nurse notes the client is flushed, has
2026–2027 — COMPREHENSIVE STUDY GUIDE |
LATEST UPDATE 2026/2027 | ACTUAL EXAM
PRACTICE QUESTIONS AND ANSWERS | EXAM
REVIEW | 100% CORRECT ANSWERS | VERIFIED
SOLUTIONS
This advanced pharmacology practice examination is designed for nursing
students preparing for the ATI Pharmacology assessment, the HESI Pharmacology
exam, and the NCLEX-RN® licensure examination. The 100-question test evaluates
mastery of pharmacologic principles, medication safety, dosage calculations,
therapeutic uses, adverse effects, drug interactions, and nursing considerations
across major drug classifications. Questions are written at the application,
analysis, and evaluation levels to mirror the cognitive complexity of high-stakes
licensing examinations, requiring the test taker to anticipate adverse reactions,
interpret laboratory values, prioritize interventions, and educate patients
effectively. Each item includes a detailed rationale to reinforce learning and clarify
incorrect options. Use this comprehensive review to self-assess your readiness,
strengthen pharmacological knowledge, and build confidence for safe medication
administration in clinical practice. This 2026–2027 edition reflects current
evidence-based guidelines, FDA warnings, and national patient safety standards.
Table of Contents
I. Pharmacokinetics, Pharmacodynamics, and Medication Safety
II. Autonomic Nervous System Medications
III. Cardiovascular and Renal Medications
IV. Anticoagulants, Antiplatelets, and Thrombolytics
V. Respiratory, Gastrointestinal, and Endocrine Medications
VI. Anti-Infectives: Antibiotics, Antivirals, and Antifungals
VII. Antineoplastic and Immunosuppressant Medications
VIII. Central Nervous System and Psychotropic Medications
IX. Pain Management and Anesthetic Agents
,X. Herbal, Over-the-Counter, and Complementary Therapies
XI. Dosage Calculations and Intravenous Therapy
1. A nurse is preparing to administer digoxin to a client with heart failure. The
client’s serum digoxin level is 2.4 ng/mL (therapeutic range 0.5–2.0 ng/mL).
Which assessment finding is most consistent with digoxin toxicity?
A) Hypertension and tachycardia
B) Visual disturbances such as yellow halos and anorexia
C) Hyperactive bowel sounds and diarrhea with hyperkalemia
D) Flushing and throbbing headache
Correct Answer: B
Digoxin toxicity commonly presents with gastrointestinal symptoms (anorexia,
nausea), visual changes (yellow or green halos, blurred vision), and cardiac
dysrhythmias. Hypokalemia, not hyperkalemia, potentiates digoxin toxicity.
Hypertension and tachycardia (A) are not typical. Flushing and headache (D)
suggest nitroglycerin or calcium channel blocker effects.
2. A client is prescribed warfarin for atrial fibrillation. The nurse should
instruct the client to avoid which over-the-counter medication due to
increased bleeding risk?
A) Acetaminophen
B) Ibuprofen
C) Calcium carbonate
D) Diphenhydramine
Correct Answer: B
Ibuprofen is an NSAID that inhibits platelet aggregation and increases the risk of
bleeding when taken with warfarin. Acetaminophen (A) is safer in moderation but
may affect INR at high doses. Calcium carbonate (C) and diphenhydramine (D) do
not significantly increase bleeding risk.
, 3. A client is receiving a continuous infusion of unfractionated heparin. The
aPTT is 90 seconds (control 30 seconds). The client has no signs of bleeding.
Which action should the nurse take?
A) Stop the infusion and administer protamine sulfate
B) Continue the infusion at the current rate
C) Reduce the infusion rate according to the titration nomogram and
recheck aPTT in 6 hours
D) Administer vitamin K orally
Correct Answer: C
The aPTT is supratherapeutic (3 times control). Without bleeding, the appropriate
action is to reduce the rate per protocol and recheck. Protamine (A) is for severe
bleeding or overdose. Vitamin K (D) reverses warfarin, not heparin. Continuing (B)
increases bleeding risk.
4. A nurse is teaching a client with type 2 diabetes who is prescribed
metformin. Which statement by the client indicates a need for further
teaching?
A) “I will take the medication with meals to reduce stomach upset.”
B) “I will stop the medication before any procedure that uses contrast dye.”
C) “I will have my kidney function checked regularly.”
D) “I can drink alcohol in moderation while taking this medication.”
Correct Answer: D
Alcohol can increase the risk of lactic acidosis with metformin and should be
limited or avoided. The other statements are correct: metformin should be held
before contrast procedures (B) and renal function monitored (C).
5. A client with a history of asthma is prescribed propranolol for migraine
prophylaxis. What is the nurse’s priority action?
A) Administer the medication as prescribed
B) Hold the medication and notify the provider due to the risk of
bronchospasm
C) Give the medication with a bronchodilator
D) Reduce the dose by half and administer
, Correct Answer: B
Propranolol is a nonselective beta-blocker that can cause bronchospasm in clients
with asthma and is contraindicated. The nurse should hold the medication and
notify the provider. Administering (A) risks respiratory distress. The nurse cannot
alter the dose (D) or give with a bronchodilator (C) without an order.
6. A nurse is preparing to administer levothyroxine to a client with
hypothyroidism. Which client statement indicates the client understands
how to take the medication?
A) “I will take it with a glass of milk at bedtime.”
B) “I will take it on an empty stomach in the morning.”
C) “I will take it with an antacid to prevent upset stomach.”
D) “I will take it with food to improve absorption.”
Correct Answer: B
Levothyroxine is best absorbed on an empty stomach, preferably in the morning,
30–60 minutes before breakfast. Milk (A), antacids (C), and food (D) interfere with
absorption.
7. A client is prescribed furosemide for heart failure. Which laboratory value
requires immediate notification of the provider before administering the
dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Furosemide is a loop diuretic that causes potassium loss. A potassium of 3.1 mEq/L
is hypokalemic and increases the risk of cardiac dysrhythmias, especially in heart
failure. The provider should be notified before giving the dose. The other values
are within normal limits.
8. A client is receiving vancomycin intravenously for a methicillin-resistant
Staphylococcus aureus infection. The nurse notes the client is flushed, has
