ATI RN PhARmAcology ReTAke exAm (2023) – NgN QuesTIoNs ANd
cAse sceNARIos (ATI) (guARANTee PAss)
SECTION 1: CARDIOVASCULAR & ANTICOAGULANT PHARMACOLOGY (Questions 1–10)
Question 1
A nurse is preparing to administer digoxin to a client with heart failure. Which of the following
findings should prompt the nurse to hold the medication and notify the healthcare provider?
A) Heart rate 62 beats per minute
B) Serum potassium level of 3.2 mEq/L
C) Blood pressure 118/76 mm Hg
D) Respiratory rate of 18 breaths per minute
coRRecT ANsweR: B
Rationale: Digoxin toxicity is potentiated by hypokalemia (potassium < 3.5 mEq/L). Low potassium
increases the risk of digoxin-induced dysrhythmias. The nurse should hold the medication and notify the
provider. A heart rate of 62 (A) is within acceptable range; digoxin is typically held for heart rates < 60.
Blood pressure of 118/76 (C) and respiratory rate of 18 (D) are normal.
Question 2
A client is receiving IV heparin. Which of the following laboratory values indicates the therapy is
therapeutic?
A) aPTT of 60 seconds (control 30 seconds)
B) INR of 2.5
C) Platelet count of 80,000/mm³
D) Hemoglobin of 10 g/dL
coRRecT ANsweR: A
Rationale: Heparin therapy is monitored using the activated Partial Thromboplastin Time (aPTT) ,
with a therapeutic range of 1.5–2.5 times the control value. With a control of 30 seconds, a therapeutic
aPTT would be 45–75 seconds; 60 seconds falls within this range. INR (B) is used for warfarin
monitoring. A platelet count of 80,000 (C) indicates possible heparin-induced thrombocytopenia (HIT).
Hemoglobin of 10 g/dL (D) indicates anemia.
Question 3
A client on warfarin therapy has an INR of 4.5. Which of the following is the priority nursing
action?
A) Administer vitamin K as prescribed
B) Increase the warfarin dose
,C) Continue the current warfarin dose
D) Administer protamine sulfate
coRRecT ANsweR: A
Rationale: An INR of 4.5 is above the therapeutic range (2.0–3.0 for atrial fibrillation) and indicates
increased bleeding risk. Vitamin K is the antidote for warfarin and may be administered to reverse
anticoagulation. Increasing the dose (B) would worsen the problem. Protamine sulfate (D) is the antidote
for heparin, not warfarin.
Question 4
A client receiving IV heparin has a platelet count of 80,000/mm³. Which of the following is the
nurse's priority action?
A) Continue the heparin infusion
B) Decrease the heparin infusion rate
C) Discontinue the heparin infusion immediately
D) Administer protamine sulfate
coRRecT ANsweR: C
Rationale: A platelet count of 80,000/mm³ indicates heparin-induced thrombocytopenia (HIT) , a
serious adverse reaction. Heparin must be discontinued immediately to prevent further platelet
destruction and thrombotic complications. Protamine sulfate (D) is the antidote for bleeding from heparin,
not for HIT.
Question 5
A nurse is providing teaching to a client prescribed sublingual nitroglycerin. Which of the
following statements by the client indicates understanding? (Select all that apply.)
A) "I will take the medication at the first sign of chest pain."
B) "I will swallow the tablet with a full glass of water."
C) "I will place the tablet under my tongue and allow it to dissolve."
D) "I will call 911 if my chest pain is not relieved after one tablet."
E) "I may take up to three tablets 5 minutes apart."
coRRecT ANsweR: A, C, D, E
Rationale: Sublingual nitroglycerin should be taken at the first sign of chest pain (A). It must be
placed under the tongue and allowed to dissolve (C)—not swallowed (B). If pain persists after one
tablet, the patient should call 911 (D) and may take up to three tablets 5 minutes apart (E).
Question 6
A client with heart failure is prescribed furosemide. Which of the following is the priority nursing
assessment?
A) Serum potassium
B) Serum sodium
, C) Serum calcium
D) Serum magnesium
coRRecT ANsweR: A
Rationale: Furosemide is a loop diuretic that causes potassium loss (hypokalemia), which can lead to
cardiac arrhythmias. Serum potassium should be monitored closely. Sodium (B), calcium (C), and
magnesium (D) are also affected but potassium is the priority.
Question 7
A client is prescribed clopidogrel after a stent placement. Which of the following is the
mechanism of action?
A) Inhibits thrombin
B) Blocks ADP receptors on platelets
C) Activates antithrombin III
D) Inhibits vitamin K-dependent clotting factors
coRRecT ANsweR: B
Rationale: Clopidogrel is a P2Y12 ADP receptor antagonist that inhibits platelet aggregation, reducing
the risk of stent thrombosis. It is typically used in combination with aspirin for patients after stent
placement.
Question 8
A client is prescribed amiodarone for a cardiac arrhythmia. Which of the following adverse effects
requires monitoring?
A) Hypothyroidism
B) Pulmonary fibrosis
C) Corneal microdeposits
D) All of the above
coRRecT ANsweR: D
Rationale: Amiodarone has significant adverse effects including hypothyroidism or
hyperthyroidism (due to iodine content), pulmonary fibrosis (interstitial lung disease), and corneal
microdeposits. Regular monitoring of thyroid, liver, and pulmonary function is required.
Question 9
The antidote for warfarin is:
A) Protamine sulfate
B) Vitamin K
C) Fresh frozen plasma
D) Both B and C
coRRecT ANsweR: D
cAse sceNARIos (ATI) (guARANTee PAss)
SECTION 1: CARDIOVASCULAR & ANTICOAGULANT PHARMACOLOGY (Questions 1–10)
Question 1
A nurse is preparing to administer digoxin to a client with heart failure. Which of the following
findings should prompt the nurse to hold the medication and notify the healthcare provider?
A) Heart rate 62 beats per minute
B) Serum potassium level of 3.2 mEq/L
C) Blood pressure 118/76 mm Hg
D) Respiratory rate of 18 breaths per minute
coRRecT ANsweR: B
Rationale: Digoxin toxicity is potentiated by hypokalemia (potassium < 3.5 mEq/L). Low potassium
increases the risk of digoxin-induced dysrhythmias. The nurse should hold the medication and notify the
provider. A heart rate of 62 (A) is within acceptable range; digoxin is typically held for heart rates < 60.
Blood pressure of 118/76 (C) and respiratory rate of 18 (D) are normal.
Question 2
A client is receiving IV heparin. Which of the following laboratory values indicates the therapy is
therapeutic?
A) aPTT of 60 seconds (control 30 seconds)
B) INR of 2.5
C) Platelet count of 80,000/mm³
D) Hemoglobin of 10 g/dL
coRRecT ANsweR: A
Rationale: Heparin therapy is monitored using the activated Partial Thromboplastin Time (aPTT) ,
with a therapeutic range of 1.5–2.5 times the control value. With a control of 30 seconds, a therapeutic
aPTT would be 45–75 seconds; 60 seconds falls within this range. INR (B) is used for warfarin
monitoring. A platelet count of 80,000 (C) indicates possible heparin-induced thrombocytopenia (HIT).
Hemoglobin of 10 g/dL (D) indicates anemia.
Question 3
A client on warfarin therapy has an INR of 4.5. Which of the following is the priority nursing
action?
A) Administer vitamin K as prescribed
B) Increase the warfarin dose
,C) Continue the current warfarin dose
D) Administer protamine sulfate
coRRecT ANsweR: A
Rationale: An INR of 4.5 is above the therapeutic range (2.0–3.0 for atrial fibrillation) and indicates
increased bleeding risk. Vitamin K is the antidote for warfarin and may be administered to reverse
anticoagulation. Increasing the dose (B) would worsen the problem. Protamine sulfate (D) is the antidote
for heparin, not warfarin.
Question 4
A client receiving IV heparin has a platelet count of 80,000/mm³. Which of the following is the
nurse's priority action?
A) Continue the heparin infusion
B) Decrease the heparin infusion rate
C) Discontinue the heparin infusion immediately
D) Administer protamine sulfate
coRRecT ANsweR: C
Rationale: A platelet count of 80,000/mm³ indicates heparin-induced thrombocytopenia (HIT) , a
serious adverse reaction. Heparin must be discontinued immediately to prevent further platelet
destruction and thrombotic complications. Protamine sulfate (D) is the antidote for bleeding from heparin,
not for HIT.
Question 5
A nurse is providing teaching to a client prescribed sublingual nitroglycerin. Which of the
following statements by the client indicates understanding? (Select all that apply.)
A) "I will take the medication at the first sign of chest pain."
B) "I will swallow the tablet with a full glass of water."
C) "I will place the tablet under my tongue and allow it to dissolve."
D) "I will call 911 if my chest pain is not relieved after one tablet."
E) "I may take up to three tablets 5 minutes apart."
coRRecT ANsweR: A, C, D, E
Rationale: Sublingual nitroglycerin should be taken at the first sign of chest pain (A). It must be
placed under the tongue and allowed to dissolve (C)—not swallowed (B). If pain persists after one
tablet, the patient should call 911 (D) and may take up to three tablets 5 minutes apart (E).
Question 6
A client with heart failure is prescribed furosemide. Which of the following is the priority nursing
assessment?
A) Serum potassium
B) Serum sodium
, C) Serum calcium
D) Serum magnesium
coRRecT ANsweR: A
Rationale: Furosemide is a loop diuretic that causes potassium loss (hypokalemia), which can lead to
cardiac arrhythmias. Serum potassium should be monitored closely. Sodium (B), calcium (C), and
magnesium (D) are also affected but potassium is the priority.
Question 7
A client is prescribed clopidogrel after a stent placement. Which of the following is the
mechanism of action?
A) Inhibits thrombin
B) Blocks ADP receptors on platelets
C) Activates antithrombin III
D) Inhibits vitamin K-dependent clotting factors
coRRecT ANsweR: B
Rationale: Clopidogrel is a P2Y12 ADP receptor antagonist that inhibits platelet aggregation, reducing
the risk of stent thrombosis. It is typically used in combination with aspirin for patients after stent
placement.
Question 8
A client is prescribed amiodarone for a cardiac arrhythmia. Which of the following adverse effects
requires monitoring?
A) Hypothyroidism
B) Pulmonary fibrosis
C) Corneal microdeposits
D) All of the above
coRRecT ANsweR: D
Rationale: Amiodarone has significant adverse effects including hypothyroidism or
hyperthyroidism (due to iodine content), pulmonary fibrosis (interstitial lung disease), and corneal
microdeposits. Regular monitoring of thyroid, liver, and pulmonary function is required.
Question 9
The antidote for warfarin is:
A) Protamine sulfate
B) Vitamin K
C) Fresh frozen plasma
D) Both B and C
coRRecT ANsweR: D
