ATI RN PHARMACOLOGY PROCTORED EXAM RETAKE 2026/2027 WITH
NGN|NEWEST EXAM PREPARATION WITH COMPLETE QUESTIONS
AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DRUGS (Questions 1–50)
Question 1
A client with heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
A) Heart rate of 72 bpm and blood pressure 120/80
B) Nausea, vomiting, and yellow-green halos around lights
C) Hyperkalemia and tachycardia
D) Weight gain and peripheral edema
Answer: B) Nausea, vomiting, and yellow-green halos around lights
Rationale: Digoxin toxicity causes gastrointestinal symptoms (nausea, vomiting,
anorexia) and visual disturbances (yellow-green halos, blurred vision).
Hypokalemia increases toxicity risk. Bradycardia (not tachycardia) is a
cardiac sign. Weight gain and edema are signs of worsening heart failure,
not digoxin toxicity.
Question 2
A client prescribed warfarin has an INR of 4.5. The nurse should anticipate
which action?
A) Administer vitamin K
B) Increase the warfarin dose
C) Continue the current dose
D) Administer protamine sulfate
Answer: A) Administer vitamin K
Rationale: The therapeutic INR for warfarin is typically 2.0-3.0 (or 2.5-3.5
for mechanical valves). An INR of 4.5 indicates excessive anticoagulation and
increased bleeding risk. Vitamin K is the antidote for warfarin. Protamine
sulfate is the antidote for heparin.
1
,Question 3
A client is prescribed atorvastatin. Which instruction should the nurse
include?
A) "Take this medication with grapefruit juice."
B) "Report any muscle pain or weakness immediately."
C) "Take this medication on an empty stomach."
D) "You may stop taking this medication once your cholesterol is normal."
Answer: B) "Report any muscle pain or weakness immediately."
Rationale: Statins (atorvastatin) can cause myopathy and rhabdomyolysis,
manifested as muscle pain, weakness, or dark urine. Grapefruit juice should
be avoided as it increases statin levels and toxicity risk. Statins are taken
with or without food and should be continued long-term, not stopped when
cholesterol normalizes.
Question 4
A client receiving IV heparin has a partial thromboplastin time (aPTT) of
110 seconds. The nurse should:
A) Continue the heparin infusion as prescribed
B) Decrease the infusion rate
C) Stop the infusion and prepare to administer protamine sulfate
D) Increase the infusion rate
Answer: C) Stop the infusion and prepare to administer protamine sulfate
Rationale: The therapeutic aPTT for heparin is typically 1.5-2.5 times the
normal control value (about 60-80 seconds). An aPTT of 110 seconds is
dangerously elevated and indicates high bleeding risk. The nurse should stop
the heparin infusion and prepare protamine sulfate (the antidote).
Question 5
A client with hypertension is prescribed lisinopril. Which adverse effect is
most characteristic?
2
,A) Dry cough
B) Hypokalemia
C) Tachycardia
D) Weight gain
Answer: A) Dry cough
Rationale: Lisinopril is an ACE inhibitor. The most characteristic adverse
effect is a persistent dry cough due to bradykinin accumulation. ACE
inhibitors cause hyperkalemia (not hypokalemia), hypotension, and
angioedema. Tachycardia and weight gain are not typical.
Question 6
A client is prescribed clopidogrel after a stent placement. The nurse should
monitor for:
A) Bleeding and bruising
B) Hyperglycemia
C) Hypotension
D) Thrombocytosis
Answer: A) Bleeding and bruising
Rationale: Clopidogrel is an antiplatelet agent (P2Y12 inhibitor) that
prevents platelet aggregation. The primary adverse effect is bleeding,
including bruising, gastrointestinal bleeding, and intracranial hemorrhage.
It does not affect glucose, blood pressure, or cause thrombocytosis (it can
cause thrombotic thrombocytopenic purpura, which is thrombocytopenia).
Question 7
A client with heart failure is prescribed furosemide. The nurse should
monitor which laboratory value most closely?
A) Serum potassium
B) Serum calcium
C) Serum sodium
D) Serum magnesium
Answer: A) Serum potassium
3
, Rationale: Furosemide is a loop diuretic that causes significant potassium
wasting, leading to hypokalemia. Hypokalemia increases the risk of cardiac
arrhythmias, especially in clients also taking digoxin. Serum sodium,
calcium, and magnesium should also be monitored, but potassium is the highest
priority.
Question 8
A client is prescribed amlodipine. Which side effect is common?
A) Peripheral edema
B) Cough
C) Hyperkalemia
D) Bradycardia
Answer: A) Peripheral edema
Rationale: Amlodipine is a dihydropyridine calcium channel blocker. The most
common side effect is peripheral edema due to vasodilation. Cough is
associated with ACE inhibitors. Hyperkalemia is not a CCB side effect.
Bradycardia is more common with nondihydropyridines (verapamil, diltiazem).
Question 9
A client is prescribed metoprolol. The nurse should hold the medication and
notify the provider if the client's:
A) Heart rate is 55 bpm
B) Blood pressure is 110/70 mmHg
C) Heart rate is 48 bpm
D) Respiratory rate is 18/min
Answer: C) Heart rate is 48 bpm
Rationale: Metoprolol is a beta-blocker that decreases heart rate and
contractility. A heart rate below 60 bpm (especially <50 bpm) with symptoms
or 48 bpm requires holding the medication and notifying the provider. A heart
rate of 55 bpm may be acceptable if asymptomatic. Blood pressure of 110/70
and respiratory rate of 18 are normal.
4
NGN|NEWEST EXAM PREPARATION WITH COMPLETE QUESTIONS
AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DRUGS (Questions 1–50)
Question 1
A client with heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
A) Heart rate of 72 bpm and blood pressure 120/80
B) Nausea, vomiting, and yellow-green halos around lights
C) Hyperkalemia and tachycardia
D) Weight gain and peripheral edema
Answer: B) Nausea, vomiting, and yellow-green halos around lights
Rationale: Digoxin toxicity causes gastrointestinal symptoms (nausea, vomiting,
anorexia) and visual disturbances (yellow-green halos, blurred vision).
Hypokalemia increases toxicity risk. Bradycardia (not tachycardia) is a
cardiac sign. Weight gain and edema are signs of worsening heart failure,
not digoxin toxicity.
Question 2
A client prescribed warfarin has an INR of 4.5. The nurse should anticipate
which action?
A) Administer vitamin K
B) Increase the warfarin dose
C) Continue the current dose
D) Administer protamine sulfate
Answer: A) Administer vitamin K
Rationale: The therapeutic INR for warfarin is typically 2.0-3.0 (or 2.5-3.5
for mechanical valves). An INR of 4.5 indicates excessive anticoagulation and
increased bleeding risk. Vitamin K is the antidote for warfarin. Protamine
sulfate is the antidote for heparin.
1
,Question 3
A client is prescribed atorvastatin. Which instruction should the nurse
include?
A) "Take this medication with grapefruit juice."
B) "Report any muscle pain or weakness immediately."
C) "Take this medication on an empty stomach."
D) "You may stop taking this medication once your cholesterol is normal."
Answer: B) "Report any muscle pain or weakness immediately."
Rationale: Statins (atorvastatin) can cause myopathy and rhabdomyolysis,
manifested as muscle pain, weakness, or dark urine. Grapefruit juice should
be avoided as it increases statin levels and toxicity risk. Statins are taken
with or without food and should be continued long-term, not stopped when
cholesterol normalizes.
Question 4
A client receiving IV heparin has a partial thromboplastin time (aPTT) of
110 seconds. The nurse should:
A) Continue the heparin infusion as prescribed
B) Decrease the infusion rate
C) Stop the infusion and prepare to administer protamine sulfate
D) Increase the infusion rate
Answer: C) Stop the infusion and prepare to administer protamine sulfate
Rationale: The therapeutic aPTT for heparin is typically 1.5-2.5 times the
normal control value (about 60-80 seconds). An aPTT of 110 seconds is
dangerously elevated and indicates high bleeding risk. The nurse should stop
the heparin infusion and prepare protamine sulfate (the antidote).
Question 5
A client with hypertension is prescribed lisinopril. Which adverse effect is
most characteristic?
2
,A) Dry cough
B) Hypokalemia
C) Tachycardia
D) Weight gain
Answer: A) Dry cough
Rationale: Lisinopril is an ACE inhibitor. The most characteristic adverse
effect is a persistent dry cough due to bradykinin accumulation. ACE
inhibitors cause hyperkalemia (not hypokalemia), hypotension, and
angioedema. Tachycardia and weight gain are not typical.
Question 6
A client is prescribed clopidogrel after a stent placement. The nurse should
monitor for:
A) Bleeding and bruising
B) Hyperglycemia
C) Hypotension
D) Thrombocytosis
Answer: A) Bleeding and bruising
Rationale: Clopidogrel is an antiplatelet agent (P2Y12 inhibitor) that
prevents platelet aggregation. The primary adverse effect is bleeding,
including bruising, gastrointestinal bleeding, and intracranial hemorrhage.
It does not affect glucose, blood pressure, or cause thrombocytosis (it can
cause thrombotic thrombocytopenic purpura, which is thrombocytopenia).
Question 7
A client with heart failure is prescribed furosemide. The nurse should
monitor which laboratory value most closely?
A) Serum potassium
B) Serum calcium
C) Serum sodium
D) Serum magnesium
Answer: A) Serum potassium
3
, Rationale: Furosemide is a loop diuretic that causes significant potassium
wasting, leading to hypokalemia. Hypokalemia increases the risk of cardiac
arrhythmias, especially in clients also taking digoxin. Serum sodium,
calcium, and magnesium should also be monitored, but potassium is the highest
priority.
Question 8
A client is prescribed amlodipine. Which side effect is common?
A) Peripheral edema
B) Cough
C) Hyperkalemia
D) Bradycardia
Answer: A) Peripheral edema
Rationale: Amlodipine is a dihydropyridine calcium channel blocker. The most
common side effect is peripheral edema due to vasodilation. Cough is
associated with ACE inhibitors. Hyperkalemia is not a CCB side effect.
Bradycardia is more common with nondihydropyridines (verapamil, diltiazem).
Question 9
A client is prescribed metoprolol. The nurse should hold the medication and
notify the provider if the client's:
A) Heart rate is 55 bpm
B) Blood pressure is 110/70 mmHg
C) Heart rate is 48 bpm
D) Respiratory rate is 18/min
Answer: C) Heart rate is 48 bpm
Rationale: Metoprolol is a beta-blocker that decreases heart rate and
contractility. A heart rate below 60 bpm (especially <50 bpm) with symptoms
or 48 bpm requires holding the medication and notifying the provider. A heart
rate of 55 bpm may be acceptable if asymptomatic. Blood pressure of 110/70
and respiratory rate of 18 are normal.
4