VATI RN Pharmacology Comprehensive Study Guide,
Practice Questions & Verified Exam Prep Bundle for ATI
Virtual-ATI RN Pharmacology Assessment | NCLEX-RN
Medication Review, Drug Classifications, Dosage
Calculations, Pharmacokinetics, Nursing Interventions &
Rationales
Question 1: A nurse is preparing to administer enoxaparin to a client. Which of the following
actions should the nurse take?
A. Massage the injection site after administration
B. Administer the medication into the deltoid muscle
C. Expel the air bubble from the prefilled syringe before injection
D. Inject the medication into the abdomen at least 2 inches from the umbilicus
CORRECT ANSWER: D. Inject the medication into the abdomen at least 2 inches from the
umbilicus
Rationale: Enoxaparin, a low-molecular-weight heparin, should be administered
subcutaneously into the abdomen, at least 2 inches away from the umbilicus, to ensure proper
absorption and reduce the risk of bruising. The air bubble should not be expelled as it helps
deliver the full dose. Massaging the site can increase bruising and bleeding risk. The deltoid is
not a recommended site for enoxaparin injection.
Question 2: A nurse is reviewing the medication list of a client who has a new prescription for
warfarin. Which of the following medications should the nurse identify as increasing the risk
of bleeding when taken with warfarin?
A. Acetaminophen
B. Ibuprofen
C. Loratadine
D. Diphenhydramine
CORRECT ANSWER: B. Ibuprofen
Rationale: Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), inhibits platelet function
and can potentiate the anticoagulant effect of warfarin, significantly increasing the risk of
bleeding. Acetaminophen is generally safer for pain relief in clients taking warfarin, though high
doses may still affect INR. Loratadine and diphenhydramine are antihistamines with no
significant interaction with warfarin.
Question 3: A nurse is administering insulin glargine to a client with diabetes mellitus. Which
of the following statements by the client indicates an understanding of the medication?
A. "I should shake the vial well before drawing up the insulin."
B. "I can mix this insulin with my regular insulin in the same syringe."
C. "I should expect this insulin to peak about 2 hours after injection."
D. "I need to take this insulin at the same time every day."
CORRECT ANSWER: D. "I need to take this insulin at the same time every day."
Rationale: Insulin glargine is a long-acting basal insulin with a duration of up to 24 hours and no
pronounced peak. It should be administered at the same time daily to maintain consistent
blood glucose control. It should not be shaken (to avoid altering absorption), should not be
,mixed with other insulins (as it may alter pH and precipitation), and does not have a peak effect
like short-acting insulins.
Question 4: A nurse is caring for a client who is receiving morphine via patient-controlled
analgesia (PCA). Which of the following assessment findings should the nurse recognize as an
adverse effect of the medication?
A. Urinary retention
B. Hypertension
C. Diarrhea
D. Tachypnea
CORRECT ANSWER: A. Urinary retention
Rationale: Morphine, an opioid agonist, commonly causes urinary retention due to increased
bladder sphincter tone and decreased sensation of bladder fullness. Other adverse effects
include respiratory depression (not tachypnea), hypotension (not hypertension), and
constipation (not diarrhea). Nurses should monitor for these effects and intervene
appropriately.
Question 5: A nurse is preparing to administer digoxin to a client. Which of the following
findings should the nurse report to the provider before administering the medication?
A. Apical pulse rate of 58/min
B. Blood pressure of 130/80 mm Hg
C. Serum potassium level of 4.0 mEq/L
D. Respiratory rate of 16/min
CORRECT ANSWER: A. Apical pulse rate of 58/min
Rationale: Digoxin can cause bradycardia and heart block. The nurse should withhold digoxin
and notify the provider if the apical pulse is less than 60/min in an adult. Blood pressure of
130/80 mm Hg, serum potassium of 4.0 mEq/L (within normal range), and respiratory rate of
16/min are not contraindications to digoxin administration. Hypokalemia increases digoxin
toxicity risk, but this potassium level is normal.
Question 6: A nurse is teaching a client about the use of sublingual nitroglycerin for angina.
Which of the following instructions should the nurse include?
A. "Take one tablet every 10 minutes for up to three doses if pain persists."
B. "Store the tablets in a clear plastic container at room temperature."
C. "Swallow the tablet with a full glass of water for faster absorption."
D. "Expect a tingling sensation under the tongue, which indicates the medication is working."
CORRECT ANSWER: D. "Expect a tingling sensation under the tongue, which indicates the
medication is working."
Rationale: Sublingual nitroglycerin often causes a tingling or burning sensation under the
tongue, which is a normal finding and may indicate proper dissolution and absorption. The
correct dosing is one tablet every 5 minutes for up to three doses; if pain persists after three
doses, the client should seek emergency care. Nitroglycerin is light-sensitive and should be
stored in its original dark glass bottle. It must dissolve sublingually; swallowing reduces
effectiveness.
,Question 7: A nurse is administering a scheduled dose of lisinopril to a client. Which of the
following adverse effects should the nurse monitor for?
A. Dry cough
B. Hyperkalemia
C. Peripheral edema
D. Both A and B
CORRECT ANSWER: D. Both A and B
Rationale: Lisinopril, an ACE inhibitor, commonly causes a persistent dry cough due to increased
bradykinin levels. It can also cause hyperkalemia by reducing aldosterone secretion. Peripheral
edema is more commonly associated with calcium channel blockers, not ACE inhibitors. Nurses
should monitor for cough, electrolyte imbalances, and signs of angioedema.
Question 8: A nurse is caring for a client who is receiving vancomycin IV. Which of the
following laboratory values should the nurse monitor to assess for toxicity?
A. Serum creatinine
B. Liver function tests
C. Complete blood count
D. Blood glucose
CORRECT ANSWER: A. Serum creatinine
Rationale: Vancomycin is nephrotoxic and ototoxic. Monitoring serum creatinine and
calculating creatinine clearance helps assess renal function and adjust dosing to prevent
toxicity. Trough levels should also be monitored to ensure therapeutic range (10-20 mcg/mL).
Liver function tests, CBC, and blood glucose are not primary monitoring parameters for
vancomycin toxicity.
Question 9: A nurse is preparing to administer furosemide IV to a client with heart failure.
Which of the following actions should the nurse take?
A. Administer the medication over 1 to 2 minutes
B. Assess the client's lung sounds before and after administration
C. Encourage the client to increase dietary potassium intake
D. Monitor the client for hypertension after administration
CORRECT ANSWER: B. Assess the client's lung sounds before and after administration
Rationale: Furosemide, a loop diuretic, reduces fluid volume and pulmonary congestion in heart
failure. Assessing lung sounds before and after administration helps evaluate therapeutic
effectiveness. IV furosemide should be administered slowly (over at least 2 minutes) to reduce
ototoxicity risk. Furosemide causes potassium loss, so clients may need potassium
supplementation, not increased dietary intake without provider order. Hypotension, not
hypertension, is a potential adverse effect.
Question 10: A nurse is teaching a client about the use of albuterol inhaler. Which of the
following statements by the client indicates a need for further teaching?
A. "I should shake the inhaler well before each use."
B. "I will wait 1 minute between puffs if I need two."
C. "I should rinse my mouth with water after using the inhaler."
D. "I can use this inhaler whenever I feel short of breath, even multiple times an hour."
, CORRECT ANSWER: D. "I can use this inhaler whenever I feel short of breath, even multiple
times an hour."
Rationale: Albuterol is a short-acting beta-agonist (SABA) used for acute bronchospasm.
Overuse (more than every 4-6 hours or exceeding prescribed frequency) can indicate poor
asthma control and increase risk of adverse effects like tachycardia and tremors. Clients should
be instructed to seek medical attention if needing frequent doses. Shaking the inhaler, waiting
between puffs, and rinsing the mouth (to prevent oral thrush with corticosteroid inhalers,
though less critical for albuterol alone) are correct techniques.
Question 11: A nurse is administering metoprolol to a client. Which of the following findings
should the nurse recognize as a contraindication to administering the medication?
A. Heart rate of 88/min
B. Blood pressure of 148/92 mm Hg
C. History of asthma
D. Serum sodium level of 140 mEq/L
CORRECT ANSWER: C. History of asthma
Rationale: Metoprolol is a selective beta-1 blocker, but at higher doses it can block beta-2
receptors in the lungs, causing bronchoconstriction. It is generally contraindicated in clients
with asthma or severe COPD. A heart rate of 88/min and blood pressure of 148/92 mm Hg are
not contraindications; metoprolol is used to treat hypertension and tachycardia. Serum sodium
level is unrelated.
Question 12: A nurse is caring for a client who is receiving heparin IV infusion. Which of the
following laboratory tests should the nurse monitor to evaluate therapeutic effect?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
CORRECT ANSWER: C. Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, which should be maintained at 1.5 to 2.5
times the control value. PT and INR monitor warfarin therapy. Platelet count is monitored to
detect heparin-induced thrombocytopenia (HIT), a serious adverse effect, but does not
measure therapeutic anticoagulation.
Question 13: A nurse is preparing to administer potassium chloride IV to a client with
hypokalemia. Which of the following actions is essential for safe administration?
A. Administer as an IV push over 1 minute
B. Dilute the medication in at least 100 mL of compatible fluid
C. Infuse at a rate not exceeding 20 mEq/hr via peripheral line
D. Mix with other IV medications to reduce infusion volume
CORRECT ANSWER: C. Infuse at a rate not exceeding 20 mEq/hr via peripheral line
Rationale: IV potassium chloride must be diluted and infused slowly to prevent life-threatening
cardiac arrhythmias. The maximum infusion rate via peripheral line is typically 10 mEq/hr; up to
20 mEq/hr may be allowed via central line with cardiac monitoring. IV push administration is
Practice Questions & Verified Exam Prep Bundle for ATI
Virtual-ATI RN Pharmacology Assessment | NCLEX-RN
Medication Review, Drug Classifications, Dosage
Calculations, Pharmacokinetics, Nursing Interventions &
Rationales
Question 1: A nurse is preparing to administer enoxaparin to a client. Which of the following
actions should the nurse take?
A. Massage the injection site after administration
B. Administer the medication into the deltoid muscle
C. Expel the air bubble from the prefilled syringe before injection
D. Inject the medication into the abdomen at least 2 inches from the umbilicus
CORRECT ANSWER: D. Inject the medication into the abdomen at least 2 inches from the
umbilicus
Rationale: Enoxaparin, a low-molecular-weight heparin, should be administered
subcutaneously into the abdomen, at least 2 inches away from the umbilicus, to ensure proper
absorption and reduce the risk of bruising. The air bubble should not be expelled as it helps
deliver the full dose. Massaging the site can increase bruising and bleeding risk. The deltoid is
not a recommended site for enoxaparin injection.
Question 2: A nurse is reviewing the medication list of a client who has a new prescription for
warfarin. Which of the following medications should the nurse identify as increasing the risk
of bleeding when taken with warfarin?
A. Acetaminophen
B. Ibuprofen
C. Loratadine
D. Diphenhydramine
CORRECT ANSWER: B. Ibuprofen
Rationale: Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), inhibits platelet function
and can potentiate the anticoagulant effect of warfarin, significantly increasing the risk of
bleeding. Acetaminophen is generally safer for pain relief in clients taking warfarin, though high
doses may still affect INR. Loratadine and diphenhydramine are antihistamines with no
significant interaction with warfarin.
Question 3: A nurse is administering insulin glargine to a client with diabetes mellitus. Which
of the following statements by the client indicates an understanding of the medication?
A. "I should shake the vial well before drawing up the insulin."
B. "I can mix this insulin with my regular insulin in the same syringe."
C. "I should expect this insulin to peak about 2 hours after injection."
D. "I need to take this insulin at the same time every day."
CORRECT ANSWER: D. "I need to take this insulin at the same time every day."
Rationale: Insulin glargine is a long-acting basal insulin with a duration of up to 24 hours and no
pronounced peak. It should be administered at the same time daily to maintain consistent
blood glucose control. It should not be shaken (to avoid altering absorption), should not be
,mixed with other insulins (as it may alter pH and precipitation), and does not have a peak effect
like short-acting insulins.
Question 4: A nurse is caring for a client who is receiving morphine via patient-controlled
analgesia (PCA). Which of the following assessment findings should the nurse recognize as an
adverse effect of the medication?
A. Urinary retention
B. Hypertension
C. Diarrhea
D. Tachypnea
CORRECT ANSWER: A. Urinary retention
Rationale: Morphine, an opioid agonist, commonly causes urinary retention due to increased
bladder sphincter tone and decreased sensation of bladder fullness. Other adverse effects
include respiratory depression (not tachypnea), hypotension (not hypertension), and
constipation (not diarrhea). Nurses should monitor for these effects and intervene
appropriately.
Question 5: A nurse is preparing to administer digoxin to a client. Which of the following
findings should the nurse report to the provider before administering the medication?
A. Apical pulse rate of 58/min
B. Blood pressure of 130/80 mm Hg
C. Serum potassium level of 4.0 mEq/L
D. Respiratory rate of 16/min
CORRECT ANSWER: A. Apical pulse rate of 58/min
Rationale: Digoxin can cause bradycardia and heart block. The nurse should withhold digoxin
and notify the provider if the apical pulse is less than 60/min in an adult. Blood pressure of
130/80 mm Hg, serum potassium of 4.0 mEq/L (within normal range), and respiratory rate of
16/min are not contraindications to digoxin administration. Hypokalemia increases digoxin
toxicity risk, but this potassium level is normal.
Question 6: A nurse is teaching a client about the use of sublingual nitroglycerin for angina.
Which of the following instructions should the nurse include?
A. "Take one tablet every 10 minutes for up to three doses if pain persists."
B. "Store the tablets in a clear plastic container at room temperature."
C. "Swallow the tablet with a full glass of water for faster absorption."
D. "Expect a tingling sensation under the tongue, which indicates the medication is working."
CORRECT ANSWER: D. "Expect a tingling sensation under the tongue, which indicates the
medication is working."
Rationale: Sublingual nitroglycerin often causes a tingling or burning sensation under the
tongue, which is a normal finding and may indicate proper dissolution and absorption. The
correct dosing is one tablet every 5 minutes for up to three doses; if pain persists after three
doses, the client should seek emergency care. Nitroglycerin is light-sensitive and should be
stored in its original dark glass bottle. It must dissolve sublingually; swallowing reduces
effectiveness.
,Question 7: A nurse is administering a scheduled dose of lisinopril to a client. Which of the
following adverse effects should the nurse monitor for?
A. Dry cough
B. Hyperkalemia
C. Peripheral edema
D. Both A and B
CORRECT ANSWER: D. Both A and B
Rationale: Lisinopril, an ACE inhibitor, commonly causes a persistent dry cough due to increased
bradykinin levels. It can also cause hyperkalemia by reducing aldosterone secretion. Peripheral
edema is more commonly associated with calcium channel blockers, not ACE inhibitors. Nurses
should monitor for cough, electrolyte imbalances, and signs of angioedema.
Question 8: A nurse is caring for a client who is receiving vancomycin IV. Which of the
following laboratory values should the nurse monitor to assess for toxicity?
A. Serum creatinine
B. Liver function tests
C. Complete blood count
D. Blood glucose
CORRECT ANSWER: A. Serum creatinine
Rationale: Vancomycin is nephrotoxic and ototoxic. Monitoring serum creatinine and
calculating creatinine clearance helps assess renal function and adjust dosing to prevent
toxicity. Trough levels should also be monitored to ensure therapeutic range (10-20 mcg/mL).
Liver function tests, CBC, and blood glucose are not primary monitoring parameters for
vancomycin toxicity.
Question 9: A nurse is preparing to administer furosemide IV to a client with heart failure.
Which of the following actions should the nurse take?
A. Administer the medication over 1 to 2 minutes
B. Assess the client's lung sounds before and after administration
C. Encourage the client to increase dietary potassium intake
D. Monitor the client for hypertension after administration
CORRECT ANSWER: B. Assess the client's lung sounds before and after administration
Rationale: Furosemide, a loop diuretic, reduces fluid volume and pulmonary congestion in heart
failure. Assessing lung sounds before and after administration helps evaluate therapeutic
effectiveness. IV furosemide should be administered slowly (over at least 2 minutes) to reduce
ototoxicity risk. Furosemide causes potassium loss, so clients may need potassium
supplementation, not increased dietary intake without provider order. Hypotension, not
hypertension, is a potential adverse effect.
Question 10: A nurse is teaching a client about the use of albuterol inhaler. Which of the
following statements by the client indicates a need for further teaching?
A. "I should shake the inhaler well before each use."
B. "I will wait 1 minute between puffs if I need two."
C. "I should rinse my mouth with water after using the inhaler."
D. "I can use this inhaler whenever I feel short of breath, even multiple times an hour."
, CORRECT ANSWER: D. "I can use this inhaler whenever I feel short of breath, even multiple
times an hour."
Rationale: Albuterol is a short-acting beta-agonist (SABA) used for acute bronchospasm.
Overuse (more than every 4-6 hours or exceeding prescribed frequency) can indicate poor
asthma control and increase risk of adverse effects like tachycardia and tremors. Clients should
be instructed to seek medical attention if needing frequent doses. Shaking the inhaler, waiting
between puffs, and rinsing the mouth (to prevent oral thrush with corticosteroid inhalers,
though less critical for albuterol alone) are correct techniques.
Question 11: A nurse is administering metoprolol to a client. Which of the following findings
should the nurse recognize as a contraindication to administering the medication?
A. Heart rate of 88/min
B. Blood pressure of 148/92 mm Hg
C. History of asthma
D. Serum sodium level of 140 mEq/L
CORRECT ANSWER: C. History of asthma
Rationale: Metoprolol is a selective beta-1 blocker, but at higher doses it can block beta-2
receptors in the lungs, causing bronchoconstriction. It is generally contraindicated in clients
with asthma or severe COPD. A heart rate of 88/min and blood pressure of 148/92 mm Hg are
not contraindications; metoprolol is used to treat hypertension and tachycardia. Serum sodium
level is unrelated.
Question 12: A nurse is caring for a client who is receiving heparin IV infusion. Which of the
following laboratory tests should the nurse monitor to evaluate therapeutic effect?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
CORRECT ANSWER: C. Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, which should be maintained at 1.5 to 2.5
times the control value. PT and INR monitor warfarin therapy. Platelet count is monitored to
detect heparin-induced thrombocytopenia (HIT), a serious adverse effect, but does not
measure therapeutic anticoagulation.
Question 13: A nurse is preparing to administer potassium chloride IV to a client with
hypokalemia. Which of the following actions is essential for safe administration?
A. Administer as an IV push over 1 minute
B. Dilute the medication in at least 100 mL of compatible fluid
C. Infuse at a rate not exceeding 20 mEq/hr via peripheral line
D. Mix with other IV medications to reduce infusion volume
CORRECT ANSWER: C. Infuse at a rate not exceeding 20 mEq/hr via peripheral line
Rationale: IV potassium chloride must be diluted and infused slowly to prevent life-threatening
cardiac arrhythmias. The maximum infusion rate via peripheral line is typically 10 mEq/hr; up to
20 mEq/hr may be allowed via central line with cardiac monitoring. IV push administration is
