2026 ATI PHARMACOLOGY PROCTORED 2026-2027 VERSION
WITH ACTUAL QUESTION AND CORRECT DETAILED ANSWERS
WITH RATIONALES .RATED A GRADE
QUESTION
A nurse is about to administer propranolol to a patient. The nurse takes
the patient's apical pulse and documents it as 58 bpm. How should the
nurse continue?
A. Administer the medication as normal
B. Cut the tablet in half and administer half of the normal dose
C. Give the extended-release (XR) form of the medication
D. Withhold administration of the medication and notify the physician
CORRECT ANS: D
Expert Rationale
Propranolol is a non-selective beta-blocker that exerts negative
chronotropic effects, meaning it decreases the heart rate by blocking
beta-1 receptors in the cardiac conduction system. A pulse rate of 58
bpm is below the typical threshold for holding the medication (usually
<60 bpm in adults). Administering propranolol to a patient with
bradycardia can further depress myocardial contractility and
conduction, potentially leading to symptomatic bradycardia, heart
block, or even cardiac arrest. The standard nursing protocol dictates
that the medication should be withheld, and the healthcare provider
should be notified to evaluate the patient's clinical status and
determine if a dose adjustment is necessary. Option A is unsafe and
could lead to adverse cardiovascular events. Option B is not an
appropriate action; altering the dose without a provider's order is
outside the scope of nursing practice. Option C is incorrect because the
extended-release formulation would not mitigate the bradycardic
,effect. Therefore, withholding the medication and notifying the
physician is the correct and safest action.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process:
Implementation MSC: NCLEX: Physiological Integrity – Pharmacological
and Parenteral Therapies
QUESTION
Which of the following should be monitored for patients taking
diuretics? (Select all that apply.)
A. Daily weight
B. Intake and output
C. Amount and location of edema
D. Appetite
E. Lung sounds
CORRECT ANS: A, B, C, E
Expert Rationale
Diuretics are medications that promote the excretion of water and
electrolytes through the kidneys, and they are commonly used to
manage conditions such as hypertension, heart failure, and edema.
Monitoring is essential to evaluate therapeutic effectiveness and detect
adverse effects. Daily weight (Option A) is a sensitive indicator of fluid
status; a rapid increase may indicate fluid retention, while a rapid
decrease may indicate excessive diuresis. Intake and output (Option B)
monitoring provides objective data on fluid balance and renal function.
Assessing the amount and location of edema (Option C) helps evaluate
the effectiveness of the diuretic in reducing fluid overload. Lung sounds
(Option E) should be monitored for crackles or wheezes, which may
indicate pulmonary congestion or fluid overload, or conversely, signs of
dehydration. Option D, appetite, is not a specific or direct monitoring
,parameter for diuretic therapy, although electrolyte imbalances may
affect appetite. Therefore, daily weight, intake and output, edema
assessment, and lung sounds are the appropriate monitoring
parameters.
DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing
Process: Evaluation MSC: NCLEX: Physiological Integrity –
Pharmacological and Parenteral Therapies
QUESTION
Which of the following drugs has a therapeutic effect that increases
cardiac output and slows heart rate?
A. Heparin
B. Alprazolam
C. Digoxin
D. Levothyroxine
CORRECT ANS: C
Expert Rationale
Digoxin is a cardiac glycoside that exerts its therapeutic effects by
inhibiting the sodium-potassium-ATPase pump in myocardial cells,
leading to an increase in intracellular calcium. This results in a positive
inotropic effect (increased force of myocardial contraction), which
enhances cardiac output, and a negative chronotropic effect (decreased
heart rate) by prolonging the refractory period of the atrioventricular
(AV) node. This dual action makes digoxin particularly useful in
managing heart failure and atrial fibrillation. Option A, heparin, is an
anticoagulant that prevents clot formation but does not affect cardiac
output or heart rate. Option B, alprazolam, is a benzodiazepine used for
anxiety and panic disorders, not for cardiac effects. Option D,
levothyroxine, is thyroid hormone replacement used to treat
, hypothyroidism; it can increase heart rate but does not increase cardiac
output in the same therapeutic manner. Therefore, digoxin is the
correct answer.
DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing
Process: Implementation MSC: NCLEX: Physiological Integrity –
Pharmacological and Parenteral Therapies
QUESTION
Which of the following is a potassium-sparing diuretic?
A. Furosemide
B. Spironolactone
C. Hydrochlorothiazide
D. Bumetanide
CORRECT ANS: B
Expert Rationale
Potassium-sparing diuretics are a class of medications that promote
diuresis while minimizing potassium loss in the urine. Spironolactone is
a competitive antagonist of aldosterone, a mineralocorticoid hormone
that promotes sodium reabsorption and potassium excretion in the
distal convoluted tubule and collecting duct. By blocking aldosterone,
spironolactone increases sodium and water excretion while conserving
potassium, hence the term "potassium-sparing." Option A, furosemide,
is a loop diuretic that causes significant potassium loss. Option C,
hydrochlorothiazide, is a thiazide diuretic that also causes potassium
depletion. Option D, bumetanide, is another loop diuretic that similarly
leads to potassium wasting. Therefore, spironolactone is the correct
potassium-sparing diuretic.
DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process:
WITH ACTUAL QUESTION AND CORRECT DETAILED ANSWERS
WITH RATIONALES .RATED A GRADE
QUESTION
A nurse is about to administer propranolol to a patient. The nurse takes
the patient's apical pulse and documents it as 58 bpm. How should the
nurse continue?
A. Administer the medication as normal
B. Cut the tablet in half and administer half of the normal dose
C. Give the extended-release (XR) form of the medication
D. Withhold administration of the medication and notify the physician
CORRECT ANS: D
Expert Rationale
Propranolol is a non-selective beta-blocker that exerts negative
chronotropic effects, meaning it decreases the heart rate by blocking
beta-1 receptors in the cardiac conduction system. A pulse rate of 58
bpm is below the typical threshold for holding the medication (usually
<60 bpm in adults). Administering propranolol to a patient with
bradycardia can further depress myocardial contractility and
conduction, potentially leading to symptomatic bradycardia, heart
block, or even cardiac arrest. The standard nursing protocol dictates
that the medication should be withheld, and the healthcare provider
should be notified to evaluate the patient's clinical status and
determine if a dose adjustment is necessary. Option A is unsafe and
could lead to adverse cardiovascular events. Option B is not an
appropriate action; altering the dose without a provider's order is
outside the scope of nursing practice. Option C is incorrect because the
extended-release formulation would not mitigate the bradycardic
,effect. Therefore, withholding the medication and notifying the
physician is the correct and safest action.
DIF: Cognitive Level: Apply (Application) TOP: Nursing Process:
Implementation MSC: NCLEX: Physiological Integrity – Pharmacological
and Parenteral Therapies
QUESTION
Which of the following should be monitored for patients taking
diuretics? (Select all that apply.)
A. Daily weight
B. Intake and output
C. Amount and location of edema
D. Appetite
E. Lung sounds
CORRECT ANS: A, B, C, E
Expert Rationale
Diuretics are medications that promote the excretion of water and
electrolytes through the kidneys, and they are commonly used to
manage conditions such as hypertension, heart failure, and edema.
Monitoring is essential to evaluate therapeutic effectiveness and detect
adverse effects. Daily weight (Option A) is a sensitive indicator of fluid
status; a rapid increase may indicate fluid retention, while a rapid
decrease may indicate excessive diuresis. Intake and output (Option B)
monitoring provides objective data on fluid balance and renal function.
Assessing the amount and location of edema (Option C) helps evaluate
the effectiveness of the diuretic in reducing fluid overload. Lung sounds
(Option E) should be monitored for crackles or wheezes, which may
indicate pulmonary congestion or fluid overload, or conversely, signs of
dehydration. Option D, appetite, is not a specific or direct monitoring
,parameter for diuretic therapy, although electrolyte imbalances may
affect appetite. Therefore, daily weight, intake and output, edema
assessment, and lung sounds are the appropriate monitoring
parameters.
DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing
Process: Evaluation MSC: NCLEX: Physiological Integrity –
Pharmacological and Parenteral Therapies
QUESTION
Which of the following drugs has a therapeutic effect that increases
cardiac output and slows heart rate?
A. Heparin
B. Alprazolam
C. Digoxin
D. Levothyroxine
CORRECT ANS: C
Expert Rationale
Digoxin is a cardiac glycoside that exerts its therapeutic effects by
inhibiting the sodium-potassium-ATPase pump in myocardial cells,
leading to an increase in intracellular calcium. This results in a positive
inotropic effect (increased force of myocardial contraction), which
enhances cardiac output, and a negative chronotropic effect (decreased
heart rate) by prolonging the refractory period of the atrioventricular
(AV) node. This dual action makes digoxin particularly useful in
managing heart failure and atrial fibrillation. Option A, heparin, is an
anticoagulant that prevents clot formation but does not affect cardiac
output or heart rate. Option B, alprazolam, is a benzodiazepine used for
anxiety and panic disorders, not for cardiac effects. Option D,
levothyroxine, is thyroid hormone replacement used to treat
, hypothyroidism; it can increase heart rate but does not increase cardiac
output in the same therapeutic manner. Therefore, digoxin is the
correct answer.
DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing
Process: Implementation MSC: NCLEX: Physiological Integrity –
Pharmacological and Parenteral Therapies
QUESTION
Which of the following is a potassium-sparing diuretic?
A. Furosemide
B. Spironolactone
C. Hydrochlorothiazide
D. Bumetanide
CORRECT ANS: B
Expert Rationale
Potassium-sparing diuretics are a class of medications that promote
diuresis while minimizing potassium loss in the urine. Spironolactone is
a competitive antagonist of aldosterone, a mineralocorticoid hormone
that promotes sodium reabsorption and potassium excretion in the
distal convoluted tubule and collecting duct. By blocking aldosterone,
spironolactone increases sodium and water excretion while conserving
potassium, hence the term "potassium-sparing." Option A, furosemide,
is a loop diuretic that causes significant potassium loss. Option C,
hydrochlorothiazide, is a thiazide diuretic that also causes potassium
depletion. Option D, bumetanide, is another loop diuretic that similarly
leads to potassium wasting. Therefore, spironolactone is the correct
potassium-sparing diuretic.
DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process:
