1
ATI PN PHARMACOLOGY
2023 Latest — 2025/2026 Proctored Exam
with NGN | 180 Real Exam Questions & 100%
Correct Answers
Most Tested, Most Difficult — Complete with Rationales
Includes: Multiple Choice • NGN Extended Items • Clinical Judgment
Pass Your 2026 ATI PN Pharmacology Proctored Exam
HOW TO USE THIS STUDY GUIDE
This comprehensive 180-question ATI PN Pharmacology study guide mirrors the format and difficulty of
the official 2025/2026 ATI Proctored Pharmacology Exam. The guide includes:
• Traditional multiple-choice questions (Most Tested Topics)
• Next-Generation NCLEX (NGN) style items: Extended Multiple Response, Matrix, Cloze, Bowtie,
Trend, Priority
• Complete rationales for every question explaining the correct and incorrect options
• Organized by pharmacological category for focused study
ATI Level Mapping: Level 1 (Proficiency 1), Level 2 (Proficiency 2 — Target), Level 3 (Proficiency 3 —
Exemplary). Questions in this guide are weighted toward Levels 2–3.
Key Topics Covered: Cardiovascular • Antibiotics • Pain Management • Diabetes • Respiratory •
CNS/Mental Health • Anticoagulants • GI • Endocrine • Neurological • Oncology • Renal • Musculoskeletal •
Women's Health • IV Therapy • Medication Safety • Geriatric • Hematologic • Immune • Pediatric • NGN
Clinical Judgment
— CARDIOVASCULAR MEDICATIONS —
Question 1 ● Cardiovascular
A client is prescribed digoxin 0.125 mg PO daily. Which assessment finding requires the nurse to
HOLD the medication and notify the provider?
A. Heart rate of 62 beats/min
B. Heart rate of 52 beats/min
C. Blood pressure of 110/70 mmHg
D. Serum potassium of 4.0 mEq/L
✔ Correct Answer: Option B
Rationale: Digoxin is held when the apical pulse is below 60 beats/min in adults (below 70 in children). Bradycardia
below 60 increases risk of digoxin toxicity and dangerous dysrhythmias.
Question 2 ● Cardiovascular
A nurse is monitoring a client receiving IV heparin infusion. Which laboratory value is the PRIORITY to
monitor?
ATI PN Pharmacology 2026 Study Guide | Page 1 of 48
,2
A. INR
B. aPTT
C. PT
D. Platelet count
✔ Correct Answer: Option B
Rationale: aPTT (activated partial thromboplastin time) is the primary lab used to monitor heparin therapy. Therapeutic
range is 1.5–2.5 times the control value (60–100 seconds). INR/PT monitor warfarin.
Question 3 ● Cardiovascular
A client is receiving warfarin (Coumadin). The INR is 5.8. Which action should the nurse take FIRST?
A. Administer vitamin K as prescribed
B. Hold the next scheduled dose
C. Continue warfarin and recheck INR in 24 hours
D. Administer protamine sulfate
✔ Correct Answer: Option A
Rationale: An INR of 5.8 is dangerously elevated (therapeutic is 2–3). Vitamin K is the antidote for warfarin overdose.
Protamine sulfate reverses heparin, not warfarin.
Question 4 ● Cardiovascular
A client taking atorvastatin (Lipitor) reports muscle pain and dark urine. Which nursing action is the
PRIORITY?
A. Reassure the client this is a common side effect
B. Hold the medication and notify the provider immediately
C. Administer acetaminophen for pain relief
D. Encourage increased fluid intake
✔ Correct Answer: Option B
Rationale: Muscle pain plus dark urine suggests rhabdomyolysis, a life-threatening adverse effect of statins. The
medication must be stopped immediately and the provider notified.
Question 5 ● Cardiovascular
A nurse is preparing to administer metoprolol (Lopressor) to a client with heart failure. Which finding is
a contraindication to giving this medication?
A. Blood pressure 130/80 mmHg
B. Heart rate 48 beats/min
C. Respiratory rate 16 breaths/min
D. Temperature 37.2°C
✔ Correct Answer: Option B
Rationale: Beta-blockers such as metoprolol are held when the heart rate is below 60 beats/min due to risk of severe
bradycardia and heart block.
Question 6 ● Cardiovascular
A client is prescribed lisinopril (Zestril). Which client statement indicates understanding of the
medication's side effects?
A. 'I should call my provider if I develop a persistent dry cough.'
B. 'I may notice my urine turns orange while on this medication.'
C. 'I should take this medication with antacids to reduce stomach upset.'
ATI PN Pharmacology 2026 Study Guide | Page 2 of 48
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D. 'I need to avoid foods high in calcium while taking this drug.'
✔ Correct Answer: Option A
Rationale: ACE inhibitors (lisinopril) commonly cause a persistent dry cough due to bradykinin accumulation. This is a
reason to switch to an ARB. Hyperkalemia, not calcium issues, is the main electrolyte concern.
Question 7 ● Cardiovascular
A nurse is teaching a client about nitroglycerin sublingual tablets. Which instruction is MOST important?
A. 'Take up to 5 tablets every 10 minutes if chest pain persists.'
B. 'Sit or lie down when taking this medication to prevent dizziness.'
C. 'Store extra tablets in a clear plastic bag in direct sunlight.'
D. 'Take the tablet with a full glass of water for best absorption.'
✔ Correct Answer: Option B
Rationale: Nitroglycerin causes significant vasodilation and hypotension. Sitting or lying down prevents syncope. Dose
is 1 tablet q5min × 3; if unrelieved, call 911. Store in original dark glass bottle.
Question 8 ● Cardiovascular
A client with atrial fibrillation is prescribed amiodarone. Which laboratory test is ESSENTIAL to monitor
during long-term therapy?
A. Serum calcium
B. Thyroid function tests
C. Blood glucose
D. Uric acid
✔ Correct Answer: Option B
Rationale: Amiodarone contains iodine and can cause hypo- or hyperthyroidism with long-term use. Pulmonary toxicity
and hepatotoxicity are also major concerns. Thyroid function must be monitored.
Question 9 ● Cardiovascular
Which statement by a client taking spironolactone (Aldactone) indicates a need for further teaching?
A. 'I will avoid salt substitutes and potassium supplements.'
B. 'I should report muscle weakness or irregular heartbeat.'
C. 'I need to eat more bananas and oranges while on this drug.'
D. 'I may notice more frequent urination.
✔ Correct Answer: Option C
Rationale: Spironolactone is a potassium-sparing diuretic. Eating potassium-rich foods (bananas, oranges) increases
hyperkalemia risk. Clients should AVOID additional potassium, not supplement it.
Question 10 ● Cardiovascular
A client is receiving IV furosemide (Lasix). Which electrolyte imbalance is the PRIORITY to monitor?
A. Hyponatremia
B. Hyperphosphatemia
C. Hypokalemia
D. Hypercalcemia
✔ Correct Answer: Option C
Rationale: Furosemide is a loop diuretic that wastes potassium. Hypokalemia is the most common and priority
electrolyte concern, as it can cause cardiac dysrhythmias, especially in clients also taking digoxin.
ATI PN Pharmacology 2026 Study Guide | Page 3 of 48
, 4
Question 91 ● Cardiovascular
A client prescribed nifedipine (Procardia) extended-release tablets asks if they can crush it for easier
swallowing. The nurse's BEST response is:
A. 'Yes, crushing helps it work faster.'
B. 'No, crushing an extended-release tablet releases the entire dose at once and can be dangerous.'
C. 'Yes, mix it with applesauce for ease.'
D. 'Only crush it if your symptoms are severe.'
✔ Correct Answer: Option B
Rationale: Extended-release, sustained-release (SR/XL/ER/XR/LA/CD) formulations must NEVER be crushed or
chewed. Crushing dumps the entire dose at once, causing severe hypotension, reflex tachycardia, and potential toxicity.
Question 92 ● Cardiovascular
A client is receiving IV dobutamine for acute heart failure. Which assessment is the PRIORITY?
A. Respiratory rate every 4 hours
B. Continuous cardiac monitoring for tachycardia and dysrhythmias
C. Blood glucose monitoring every 6 hours
D. Daily weight measurements
✔ Correct Answer: Option B
Rationale: Dobutamine is a positive inotropic/chronotropic agent (beta-1 agonist). It can cause tachycardia,
hypertension, and life-threatening ventricular dysrhythmias. Continuous cardiac monitoring is mandatory during
administration.
Question 93 ● Cardiovascular
A client prescribed clopidogrel (Plavix) after a coronary stent placement reports needing elective dental
surgery. Which instruction is CORRECT?
A. 'Stop clopidogrel 24 hours before surgery to reduce bleeding.'
B. 'Do not stop clopidogrel without consulting your cardiologist — stopping increases stent
thrombosis risk.'
C. 'Double your dose before the procedure for protection.'
D. 'Clopidogrel can safely be held for up to 2 weeks without risk.'
✔ Correct Answer: Option B
Rationale: Stopping antiplatelet therapy (clopidogrel) prematurely after coronary stent placement causes acute stent
thrombosis, which can be fatal (MI). The cardiologist must be consulted before stopping — often the procedure can
proceed with the patient on the medication.
Question 94 ● Cardiovascular
A nurse is preparing IV sodium nitroprusside for a hypertensive emergency. Which precaution is MOST
important during administration?
A. Administer through a peripheral IV line only
B. Protect the solution and tubing from light exposure
C. Use D5W as the only compatible diluent
D. Administer via rapid IV push for fastest effect
✔ Correct Answer: Option B
ATI PN Pharmacology 2026 Study Guide | Page 4 of 48
ATI PN PHARMACOLOGY
2023 Latest — 2025/2026 Proctored Exam
with NGN | 180 Real Exam Questions & 100%
Correct Answers
Most Tested, Most Difficult — Complete with Rationales
Includes: Multiple Choice • NGN Extended Items • Clinical Judgment
Pass Your 2026 ATI PN Pharmacology Proctored Exam
HOW TO USE THIS STUDY GUIDE
This comprehensive 180-question ATI PN Pharmacology study guide mirrors the format and difficulty of
the official 2025/2026 ATI Proctored Pharmacology Exam. The guide includes:
• Traditional multiple-choice questions (Most Tested Topics)
• Next-Generation NCLEX (NGN) style items: Extended Multiple Response, Matrix, Cloze, Bowtie,
Trend, Priority
• Complete rationales for every question explaining the correct and incorrect options
• Organized by pharmacological category for focused study
ATI Level Mapping: Level 1 (Proficiency 1), Level 2 (Proficiency 2 — Target), Level 3 (Proficiency 3 —
Exemplary). Questions in this guide are weighted toward Levels 2–3.
Key Topics Covered: Cardiovascular • Antibiotics • Pain Management • Diabetes • Respiratory •
CNS/Mental Health • Anticoagulants • GI • Endocrine • Neurological • Oncology • Renal • Musculoskeletal •
Women's Health • IV Therapy • Medication Safety • Geriatric • Hematologic • Immune • Pediatric • NGN
Clinical Judgment
— CARDIOVASCULAR MEDICATIONS —
Question 1 ● Cardiovascular
A client is prescribed digoxin 0.125 mg PO daily. Which assessment finding requires the nurse to
HOLD the medication and notify the provider?
A. Heart rate of 62 beats/min
B. Heart rate of 52 beats/min
C. Blood pressure of 110/70 mmHg
D. Serum potassium of 4.0 mEq/L
✔ Correct Answer: Option B
Rationale: Digoxin is held when the apical pulse is below 60 beats/min in adults (below 70 in children). Bradycardia
below 60 increases risk of digoxin toxicity and dangerous dysrhythmias.
Question 2 ● Cardiovascular
A nurse is monitoring a client receiving IV heparin infusion. Which laboratory value is the PRIORITY to
monitor?
ATI PN Pharmacology 2026 Study Guide | Page 1 of 48
,2
A. INR
B. aPTT
C. PT
D. Platelet count
✔ Correct Answer: Option B
Rationale: aPTT (activated partial thromboplastin time) is the primary lab used to monitor heparin therapy. Therapeutic
range is 1.5–2.5 times the control value (60–100 seconds). INR/PT monitor warfarin.
Question 3 ● Cardiovascular
A client is receiving warfarin (Coumadin). The INR is 5.8. Which action should the nurse take FIRST?
A. Administer vitamin K as prescribed
B. Hold the next scheduled dose
C. Continue warfarin and recheck INR in 24 hours
D. Administer protamine sulfate
✔ Correct Answer: Option A
Rationale: An INR of 5.8 is dangerously elevated (therapeutic is 2–3). Vitamin K is the antidote for warfarin overdose.
Protamine sulfate reverses heparin, not warfarin.
Question 4 ● Cardiovascular
A client taking atorvastatin (Lipitor) reports muscle pain and dark urine. Which nursing action is the
PRIORITY?
A. Reassure the client this is a common side effect
B. Hold the medication and notify the provider immediately
C. Administer acetaminophen for pain relief
D. Encourage increased fluid intake
✔ Correct Answer: Option B
Rationale: Muscle pain plus dark urine suggests rhabdomyolysis, a life-threatening adverse effect of statins. The
medication must be stopped immediately and the provider notified.
Question 5 ● Cardiovascular
A nurse is preparing to administer metoprolol (Lopressor) to a client with heart failure. Which finding is
a contraindication to giving this medication?
A. Blood pressure 130/80 mmHg
B. Heart rate 48 beats/min
C. Respiratory rate 16 breaths/min
D. Temperature 37.2°C
✔ Correct Answer: Option B
Rationale: Beta-blockers such as metoprolol are held when the heart rate is below 60 beats/min due to risk of severe
bradycardia and heart block.
Question 6 ● Cardiovascular
A client is prescribed lisinopril (Zestril). Which client statement indicates understanding of the
medication's side effects?
A. 'I should call my provider if I develop a persistent dry cough.'
B. 'I may notice my urine turns orange while on this medication.'
C. 'I should take this medication with antacids to reduce stomach upset.'
ATI PN Pharmacology 2026 Study Guide | Page 2 of 48
,3
D. 'I need to avoid foods high in calcium while taking this drug.'
✔ Correct Answer: Option A
Rationale: ACE inhibitors (lisinopril) commonly cause a persistent dry cough due to bradykinin accumulation. This is a
reason to switch to an ARB. Hyperkalemia, not calcium issues, is the main electrolyte concern.
Question 7 ● Cardiovascular
A nurse is teaching a client about nitroglycerin sublingual tablets. Which instruction is MOST important?
A. 'Take up to 5 tablets every 10 minutes if chest pain persists.'
B. 'Sit or lie down when taking this medication to prevent dizziness.'
C. 'Store extra tablets in a clear plastic bag in direct sunlight.'
D. 'Take the tablet with a full glass of water for best absorption.'
✔ Correct Answer: Option B
Rationale: Nitroglycerin causes significant vasodilation and hypotension. Sitting or lying down prevents syncope. Dose
is 1 tablet q5min × 3; if unrelieved, call 911. Store in original dark glass bottle.
Question 8 ● Cardiovascular
A client with atrial fibrillation is prescribed amiodarone. Which laboratory test is ESSENTIAL to monitor
during long-term therapy?
A. Serum calcium
B. Thyroid function tests
C. Blood glucose
D. Uric acid
✔ Correct Answer: Option B
Rationale: Amiodarone contains iodine and can cause hypo- or hyperthyroidism with long-term use. Pulmonary toxicity
and hepatotoxicity are also major concerns. Thyroid function must be monitored.
Question 9 ● Cardiovascular
Which statement by a client taking spironolactone (Aldactone) indicates a need for further teaching?
A. 'I will avoid salt substitutes and potassium supplements.'
B. 'I should report muscle weakness or irregular heartbeat.'
C. 'I need to eat more bananas and oranges while on this drug.'
D. 'I may notice more frequent urination.
✔ Correct Answer: Option C
Rationale: Spironolactone is a potassium-sparing diuretic. Eating potassium-rich foods (bananas, oranges) increases
hyperkalemia risk. Clients should AVOID additional potassium, not supplement it.
Question 10 ● Cardiovascular
A client is receiving IV furosemide (Lasix). Which electrolyte imbalance is the PRIORITY to monitor?
A. Hyponatremia
B. Hyperphosphatemia
C. Hypokalemia
D. Hypercalcemia
✔ Correct Answer: Option C
Rationale: Furosemide is a loop diuretic that wastes potassium. Hypokalemia is the most common and priority
electrolyte concern, as it can cause cardiac dysrhythmias, especially in clients also taking digoxin.
ATI PN Pharmacology 2026 Study Guide | Page 3 of 48
, 4
Question 91 ● Cardiovascular
A client prescribed nifedipine (Procardia) extended-release tablets asks if they can crush it for easier
swallowing. The nurse's BEST response is:
A. 'Yes, crushing helps it work faster.'
B. 'No, crushing an extended-release tablet releases the entire dose at once and can be dangerous.'
C. 'Yes, mix it with applesauce for ease.'
D. 'Only crush it if your symptoms are severe.'
✔ Correct Answer: Option B
Rationale: Extended-release, sustained-release (SR/XL/ER/XR/LA/CD) formulations must NEVER be crushed or
chewed. Crushing dumps the entire dose at once, causing severe hypotension, reflex tachycardia, and potential toxicity.
Question 92 ● Cardiovascular
A client is receiving IV dobutamine for acute heart failure. Which assessment is the PRIORITY?
A. Respiratory rate every 4 hours
B. Continuous cardiac monitoring for tachycardia and dysrhythmias
C. Blood glucose monitoring every 6 hours
D. Daily weight measurements
✔ Correct Answer: Option B
Rationale: Dobutamine is a positive inotropic/chronotropic agent (beta-1 agonist). It can cause tachycardia,
hypertension, and life-threatening ventricular dysrhythmias. Continuous cardiac monitoring is mandatory during
administration.
Question 93 ● Cardiovascular
A client prescribed clopidogrel (Plavix) after a coronary stent placement reports needing elective dental
surgery. Which instruction is CORRECT?
A. 'Stop clopidogrel 24 hours before surgery to reduce bleeding.'
B. 'Do not stop clopidogrel without consulting your cardiologist — stopping increases stent
thrombosis risk.'
C. 'Double your dose before the procedure for protection.'
D. 'Clopidogrel can safely be held for up to 2 weeks without risk.'
✔ Correct Answer: Option B
Rationale: Stopping antiplatelet therapy (clopidogrel) prematurely after coronary stent placement causes acute stent
thrombosis, which can be fatal (MI). The cardiologist must be consulted before stopping — often the procedure can
proceed with the patient on the medication.
Question 94 ● Cardiovascular
A nurse is preparing IV sodium nitroprusside for a hypertensive emergency. Which precaution is MOST
important during administration?
A. Administer through a peripheral IV line only
B. Protect the solution and tubing from light exposure
C. Use D5W as the only compatible diluent
D. Administer via rapid IV push for fastest effect
✔ Correct Answer: Option B
ATI PN Pharmacology 2026 Study Guide | Page 4 of 48
