2026 ATI Pharmacology Proctored ACTUAL EXAM 242
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) |ALREADY GRADED A.
A provider prescribes phenobarbital for a client who has a seizure disorder. The
medication has a long half-life of 4 days. How many times per day should the
nurse expect to administer this medication?
A. One
B. Two
C. Three
D. Four
CORRECT ANS: A
Expert Rationale
Medications with long half-lives remain at therapeutic levels between doses for
extended periods. Phenobarbital has a half-life of approximately 4 days (96
hours), which means it takes 4 days for the plasma concentration to decrease
by 50%. Because of this long half-life, phenobarbital can be administered once
daily (Option A) while maintaining therapeutic levels. Option B is incorrect;
twice-daily dosing is not necessary for a medication with a half-life of 4 days.
Option C and D are incorrect; three or four times daily dosing would be
appropriate for medications with short half-lives, not for phenobarbital. The
nurse should understand that medications with long half-lives require less
frequent dosing to maintain therapeutic levels and reduce the risk of toxicity.
DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: NCLEX: Pharmacological and Parenteral Therapies
,A staff educator is reviewing medication dosages and factors that influence
medication metabolism with a group of nurses at an in-service presentation.
Which of the following factors should the educator include as a reason to
administer lower medication dosages? (Select all that apply.)
A. Increased renal secretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medication the same pathway metabolizes
CORRECT ANS: C, E
Expert Rationale
Factors that decrease medication metabolism require lower dosages to prevent
toxicity. Option C is correct; liver failure decreases metabolism, leading to
increased medication concentration and requiring a lower dosage. Option E is
correct; when two medications are metabolized by the same pathway, they
compete for metabolism, potentially increasing the concentration of one or
both medications, necessitating dosage reduction. Option A is incorrect;
increased renal secretion would increase medication elimination, requiring
higher (not lower) doses. Option B is incorrect; increased medication-
metabolizing enzymes would decrease medication concentration, requiring
higher doses. Option D is incorrect; peripheral vascular disease does not
directly affect medication metabolism or require dosage adjustment.
DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: NCLEX: Pharmacological and Parenteral Therapies
A nurse is preparing to administer eye drops to a client. Which of the following
actions should the nurse take? (Select all that apply.)
A. Have the client lie on her side.
B. Ask the client to look up at the ceiling.
,C. Tell the client to blink when the drops enter her eye.
D. Drop the medication into the center of the client's conjunctival sac.
E. Instruct the client to close her eye gently after instillation.
CORRECT ANS: B, D, E
Expert Rationale
Proper eye drop administration ensures effective medication delivery and
minimizes systemic absorption. Option B is correct; the client should look
upward to prevent the drops from falling onto the cornea, which can cause
discomfort and reduce absorption. Option D is correct; the medication should
be dropped into the center of the conjunctival sac (the lower eyelid pouch) to
promote distribution and prevent corneal damage. Option E is correct; the
client should close her eye gently after instillation to promote distribution of
the medication and prevent it from draining out. Option A is incorrect; the
client should be in a sitting or supine position with the head tilted back, not
lying on her side. Option C is incorrect; blinking can expel the medication; the
client should not blink immediately after instillation.
DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation
MSC: NCLEX: Pharmacological and Parenteral Therapies
A nurse is completing discharge teaching for a client who has a new
prescription for transdermal patches. Which of the following statements should
the nurse identify as an indication that the client understands the instructions?
A. "I will clean the site with an alcohol swab before I apply the patch."
B. "I will rotate the application sites weekly."
C. "I will apply the patch to an area of skin with no hair."
D. "I will place the new patch on the site of the old patch."
CORRECT ANS: C
Expert Rationale
, Transdermal patches deliver medication through the skin, and absorption is
enhanced when applied to hairless areas. The client's statement about applying
the patch to an area with no hair (Option C) indicates understanding of the
instructions. Option A is incorrect; the skin should be clean and dry, but alcohol
can irritate the skin; mild soap and water are preferred. Option B is incorrect;
rotation sites should be changed with each application (every few days), not
weekly, to prevent skin irritation. Option D is incorrect; the new patch should
be applied to a different site, not the same site as the old patch, to prevent skin
irritation.
DIF: Cognitive Level: Evaluate
TOP: Nursing Process: Evaluation
MSC: NCLEX: Pharmacological and Parenteral Therapies
A nurse reviewing a client's medical record notes a new prescription for
verifying the trough level of the client's medication. Which of the following
actions should the nurse take?
A. Obtain a blood specimen immediately prior to administering the next dose
of medication.
B. Verify that the client has been taking the medication for 24 hr before
obtaining a blood specimen.
C. Ask the client to provide a urine specimen after the next dose of medication.
D. Administer the medication, and obtain a blood specimen 30 min later.
CORRECT ANS: A
Expert Rationale
A trough level is the lowest concentration of a medication in the blood, which
occurs just before the next dose is administered. The nurse should obtain a
blood specimen immediately prior to administering the next dose of
medication (Option A). Option B is incorrect; the trough level is drawn based on
the dosing schedule, not after 24 hours of taking the medication. Option C is
incorrect; trough levels are obtained from blood specimens, not urine
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) |ALREADY GRADED A.
A provider prescribes phenobarbital for a client who has a seizure disorder. The
medication has a long half-life of 4 days. How many times per day should the
nurse expect to administer this medication?
A. One
B. Two
C. Three
D. Four
CORRECT ANS: A
Expert Rationale
Medications with long half-lives remain at therapeutic levels between doses for
extended periods. Phenobarbital has a half-life of approximately 4 days (96
hours), which means it takes 4 days for the plasma concentration to decrease
by 50%. Because of this long half-life, phenobarbital can be administered once
daily (Option A) while maintaining therapeutic levels. Option B is incorrect;
twice-daily dosing is not necessary for a medication with a half-life of 4 days.
Option C and D are incorrect; three or four times daily dosing would be
appropriate for medications with short half-lives, not for phenobarbital. The
nurse should understand that medications with long half-lives require less
frequent dosing to maintain therapeutic levels and reduce the risk of toxicity.
DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: NCLEX: Pharmacological and Parenteral Therapies
,A staff educator is reviewing medication dosages and factors that influence
medication metabolism with a group of nurses at an in-service presentation.
Which of the following factors should the educator include as a reason to
administer lower medication dosages? (Select all that apply.)
A. Increased renal secretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medication the same pathway metabolizes
CORRECT ANS: C, E
Expert Rationale
Factors that decrease medication metabolism require lower dosages to prevent
toxicity. Option C is correct; liver failure decreases metabolism, leading to
increased medication concentration and requiring a lower dosage. Option E is
correct; when two medications are metabolized by the same pathway, they
compete for metabolism, potentially increasing the concentration of one or
both medications, necessitating dosage reduction. Option A is incorrect;
increased renal secretion would increase medication elimination, requiring
higher (not lower) doses. Option B is incorrect; increased medication-
metabolizing enzymes would decrease medication concentration, requiring
higher doses. Option D is incorrect; peripheral vascular disease does not
directly affect medication metabolism or require dosage adjustment.
DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: NCLEX: Pharmacological and Parenteral Therapies
A nurse is preparing to administer eye drops to a client. Which of the following
actions should the nurse take? (Select all that apply.)
A. Have the client lie on her side.
B. Ask the client to look up at the ceiling.
,C. Tell the client to blink when the drops enter her eye.
D. Drop the medication into the center of the client's conjunctival sac.
E. Instruct the client to close her eye gently after instillation.
CORRECT ANS: B, D, E
Expert Rationale
Proper eye drop administration ensures effective medication delivery and
minimizes systemic absorption. Option B is correct; the client should look
upward to prevent the drops from falling onto the cornea, which can cause
discomfort and reduce absorption. Option D is correct; the medication should
be dropped into the center of the conjunctival sac (the lower eyelid pouch) to
promote distribution and prevent corneal damage. Option E is correct; the
client should close her eye gently after instillation to promote distribution of
the medication and prevent it from draining out. Option A is incorrect; the
client should be in a sitting or supine position with the head tilted back, not
lying on her side. Option C is incorrect; blinking can expel the medication; the
client should not blink immediately after instillation.
DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation
MSC: NCLEX: Pharmacological and Parenteral Therapies
A nurse is completing discharge teaching for a client who has a new
prescription for transdermal patches. Which of the following statements should
the nurse identify as an indication that the client understands the instructions?
A. "I will clean the site with an alcohol swab before I apply the patch."
B. "I will rotate the application sites weekly."
C. "I will apply the patch to an area of skin with no hair."
D. "I will place the new patch on the site of the old patch."
CORRECT ANS: C
Expert Rationale
, Transdermal patches deliver medication through the skin, and absorption is
enhanced when applied to hairless areas. The client's statement about applying
the patch to an area with no hair (Option C) indicates understanding of the
instructions. Option A is incorrect; the skin should be clean and dry, but alcohol
can irritate the skin; mild soap and water are preferred. Option B is incorrect;
rotation sites should be changed with each application (every few days), not
weekly, to prevent skin irritation. Option D is incorrect; the new patch should
be applied to a different site, not the same site as the old patch, to prevent skin
irritation.
DIF: Cognitive Level: Evaluate
TOP: Nursing Process: Evaluation
MSC: NCLEX: Pharmacological and Parenteral Therapies
A nurse reviewing a client's medical record notes a new prescription for
verifying the trough level of the client's medication. Which of the following
actions should the nurse take?
A. Obtain a blood specimen immediately prior to administering the next dose
of medication.
B. Verify that the client has been taking the medication for 24 hr before
obtaining a blood specimen.
C. Ask the client to provide a urine specimen after the next dose of medication.
D. Administer the medication, and obtain a blood specimen 30 min later.
CORRECT ANS: A
Expert Rationale
A trough level is the lowest concentration of a medication in the blood, which
occurs just before the next dose is administered. The nurse should obtain a
blood specimen immediately prior to administering the next dose of
medication (Option A). Option B is incorrect; the trough level is drawn based on
the dosing schedule, not after 24 hours of taking the medication. Option C is
incorrect; trough levels are obtained from blood specimens, not urine
