ATI PN PHARMACOLOGY 2026 PROCTORED EXAM
Comprehensive Practice Exam & Next Generation NCLEX (NGN) Case
Studies with Detailed Rationales
Part 1: Core Pharmacology & Clinical Judgement (Standard
Questions)
Question 1: A practical nurse (PN) is reinforcing teaching with a client who has a new prescription
for digoxin 0.125 mg PO daily. Which of the following client statements indicates an understanding of
the teaching?
A. "I will take my pulse every morning before taking the medication, and call my provider if it
is below 60/min." (Correct Answer)
B. "If I miss a dose, I should take two doses at the next scheduled time to catch up."
C. "I will take this medication with an antacid if I experience any stomach upset."
D. "I can increase my intake of black licorice to help boost my energy while on this drug."
Rationale: The client should check their apical pulse prior to administration and withhold digoxin if
the pulse is less than 60/min in adults (or less than 70/min in children) and notify the provider.
Doubling doses increases toxicity risk. Antacids decrease digoxin absorption when taken together.
Black licorice promotes potassium loss, increasing the risk of digoxin toxicity.
Question 2: A PN is collecting data from a client who is receiving intravenous gentamicin sulfate
therapy. Which of the following findings should the PN identify as an adverse effect of this
medication?
A. "I have been having pain and stiffness in my shoulders and knees."
B. "My urine output has increased significantly over the past 24 hours."
C. "I notice a high-pitched ringing sound in both of my ears."
D. "I have developed a fine hand tremor when I try to write."
Rationale: Gentamicin is an aminoglycoside antibiotic known for its significant ototoxicity and
nephrotoxicity. Tinnitus (ringing in the ears), dizziness, and hearing loss are hallmark signs of
ototoxicity and should be reported immediately. Joint pain is associated with fluoroquinolones.
Decreased, not increased, urine output is a sign of nephrotoxicity.
Question 3: A PN is preparing to administer regular insulin and NPH insulin to a client with type 1
diabetes mellitus. Which of the following actions should the nurse take when mixing these insulins in
a single syringe?
A. Inject air into the NPH insulin vial first, then inject air into the regular insulin vial.
, B. Aspirate the NPH insulin into the syringe first before drawing up the regular insulin.
C. Roll the regular insulin vial vigorously between the palms before drawing it up.
D. Store the mixed insulin syringe at room temperature for up to 7 days if not used immediately.
Rationale: When mixing regular (clear) and NPH (cloudy) insulin, the nurse must inject air into the
NPH vial first (without touching the liquid), inject air into the regular vial, withdraw the regular (clear)
insulin first, and then withdraw the NPH (cloudy) insulin second ("clear to cloudy"). This prevents
contaminating the regular insulin with NPH. Regular insulin should not be rolled vigorously (NPH is
gently rolled; regular is not). Mixed syringes are typically administered immediately.
Question 4: A PN is caring for a client who is taking warfarin for chronic atrial fibrillation. Which of
the following laboratory values should the PN review to evaluate the therapeutic effectiveness of this
medication?
A. Platelet count
B. Activated partial thromboplastin time (aPTT)
C. International Normalized Ratio (INR) (Correct Answer)
D. Bleeding time
Rationale: Warfarin is monitored using the PT/INR, with a therapeutic target range typically between
2.0 and 3.0 for atrial fibrillation. aPTT is used to monitor unfractionated heparin. Platelets monitor for
thrombocytopenia (e.g., heparin-induced thrombocytopenia).
Question 5: A PN is reinforcing teaching with a client who has a new prescription for levothyroxine
for hypothyroidism. Which of the following statements by the client indicates an understanding of the
teaching?
A. "I should take this medication in the evening right before I go to sleep."
B. "I can expect my symptoms of fatigue and cold intolerance to resolve within 24 hours."
C. "I will take this medication on an empty stomach with a full glass of water." (Correct
Answer)
D. "If I experience rapid weight loss and palpitations, this is a normal adjusting phase."
Rationale: Levothyroxine should be taken on an empty stomach (typically 30 to 60 minutes before
breakfast) with water to ensure optimal absorption. It should be taken in the morning to prevent
insomnia. Full therapeutic effects may take several weeks. Rapid weight loss and palpitations indicate
hyperthyroidism from excessive dosing and must be reported.
Question 6: A PN is administering furosemide 40 mg IV push to a client with acute heart failure.
Which of the following findings should the PN monitor as a priority during and immediately after the
infusion?
A. Serum potassium level (Correct Answer)
B. Blood glucose level
Comprehensive Practice Exam & Next Generation NCLEX (NGN) Case
Studies with Detailed Rationales
Part 1: Core Pharmacology & Clinical Judgement (Standard
Questions)
Question 1: A practical nurse (PN) is reinforcing teaching with a client who has a new prescription
for digoxin 0.125 mg PO daily. Which of the following client statements indicates an understanding of
the teaching?
A. "I will take my pulse every morning before taking the medication, and call my provider if it
is below 60/min." (Correct Answer)
B. "If I miss a dose, I should take two doses at the next scheduled time to catch up."
C. "I will take this medication with an antacid if I experience any stomach upset."
D. "I can increase my intake of black licorice to help boost my energy while on this drug."
Rationale: The client should check their apical pulse prior to administration and withhold digoxin if
the pulse is less than 60/min in adults (or less than 70/min in children) and notify the provider.
Doubling doses increases toxicity risk. Antacids decrease digoxin absorption when taken together.
Black licorice promotes potassium loss, increasing the risk of digoxin toxicity.
Question 2: A PN is collecting data from a client who is receiving intravenous gentamicin sulfate
therapy. Which of the following findings should the PN identify as an adverse effect of this
medication?
A. "I have been having pain and stiffness in my shoulders and knees."
B. "My urine output has increased significantly over the past 24 hours."
C. "I notice a high-pitched ringing sound in both of my ears."
D. "I have developed a fine hand tremor when I try to write."
Rationale: Gentamicin is an aminoglycoside antibiotic known for its significant ototoxicity and
nephrotoxicity. Tinnitus (ringing in the ears), dizziness, and hearing loss are hallmark signs of
ototoxicity and should be reported immediately. Joint pain is associated with fluoroquinolones.
Decreased, not increased, urine output is a sign of nephrotoxicity.
Question 3: A PN is preparing to administer regular insulin and NPH insulin to a client with type 1
diabetes mellitus. Which of the following actions should the nurse take when mixing these insulins in
a single syringe?
A. Inject air into the NPH insulin vial first, then inject air into the regular insulin vial.
, B. Aspirate the NPH insulin into the syringe first before drawing up the regular insulin.
C. Roll the regular insulin vial vigorously between the palms before drawing it up.
D. Store the mixed insulin syringe at room temperature for up to 7 days if not used immediately.
Rationale: When mixing regular (clear) and NPH (cloudy) insulin, the nurse must inject air into the
NPH vial first (without touching the liquid), inject air into the regular vial, withdraw the regular (clear)
insulin first, and then withdraw the NPH (cloudy) insulin second ("clear to cloudy"). This prevents
contaminating the regular insulin with NPH. Regular insulin should not be rolled vigorously (NPH is
gently rolled; regular is not). Mixed syringes are typically administered immediately.
Question 4: A PN is caring for a client who is taking warfarin for chronic atrial fibrillation. Which of
the following laboratory values should the PN review to evaluate the therapeutic effectiveness of this
medication?
A. Platelet count
B. Activated partial thromboplastin time (aPTT)
C. International Normalized Ratio (INR) (Correct Answer)
D. Bleeding time
Rationale: Warfarin is monitored using the PT/INR, with a therapeutic target range typically between
2.0 and 3.0 for atrial fibrillation. aPTT is used to monitor unfractionated heparin. Platelets monitor for
thrombocytopenia (e.g., heparin-induced thrombocytopenia).
Question 5: A PN is reinforcing teaching with a client who has a new prescription for levothyroxine
for hypothyroidism. Which of the following statements by the client indicates an understanding of the
teaching?
A. "I should take this medication in the evening right before I go to sleep."
B. "I can expect my symptoms of fatigue and cold intolerance to resolve within 24 hours."
C. "I will take this medication on an empty stomach with a full glass of water." (Correct
Answer)
D. "If I experience rapid weight loss and palpitations, this is a normal adjusting phase."
Rationale: Levothyroxine should be taken on an empty stomach (typically 30 to 60 minutes before
breakfast) with water to ensure optimal absorption. It should be taken in the morning to prevent
insomnia. Full therapeutic effects may take several weeks. Rapid weight loss and palpitations indicate
hyperthyroidism from excessive dosing and must be reported.
Question 6: A PN is administering furosemide 40 mg IV push to a client with acute heart failure.
Which of the following findings should the PN monitor as a priority during and immediately after the
infusion?
A. Serum potassium level (Correct Answer)
B. Blood glucose level
