ATI Pharmacology Midterm Exam 2026-2027
Official Exam Blueprint Replica
SECTION 1: MEDICATION SAFETY & ERROR PREVENTION (Questions 1–12)
Q1: A nurse administers digoxin 0.25 mg to a patient with heart failure. One hour
later, the patient reports nausea and blurred vision. Which action should the
nurse take FIRST?
A. Administer digoxin immune Fab
B. Check the patient's apical pulse for one full minute
C. Hold the next dose of digoxin
D. Obtain a serum digoxin level
Correct Answer: D
Rationale: Correct because nausea and blurred vision are signs of digoxin
toxicity, and a serum digoxin level must be obtained immediately to confirm
toxicity before any further interventions.
Q2: A nurse is preparing to administer heparin 5,000 units subcutaneously. Which
action by the nurse demonstrates safe medication administration?
A. Massaging the injection site after administration
B. Injecting into the abdomen at least 2 inches from the umbilicus
C. Using a 1-inch, 22-gauge needle
D. Aspirating before injecting the medication
Correct Answer: B
Rationale: Correct because heparin should be injected into the abdomen above
the iliac crest, at least 2 inches from the umbilicus, without massaging or
aspirating to prevent tissue damage and bruising.
Q3: A nurse is reviewing a new prescription for warfarin 5 mg daily. Which
laboratory value should the nurse monitor to evaluate therapeutic effect?
A. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT) and International Normalized Ratio (INR)
C. Bleeding time
,D. Platelet count
Correct Answer: B
Rationale: Correct because PT and INR are the standardized laboratory tests used
to monitor warfarin therapy, with a therapeutic INR range typically of 2.0 to 3.0 for
most indications.
Q4: A patient receiving warfarin has an INR of 5.2. Which medication should the
nurse prepare to administer?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Fresh frozen plasma
D. Aminocaproic acid
Correct Answer: B
Rationale: Correct because vitamin K is the specific antidote for warfarin
overdose and works by restoring synthesis of vitamin K-dependent clotting
factors II, VII, IX, and X.
Q5: A nurse is verifying a medication order using the rights of medication
administration. Which right addresses ensuring the medication is appropriate for
the patient's condition?
A. Right dose
B. Right route
C. Right indication
D. Right time
Correct Answer: C
Rationale: Correct because the right indication ensures the medication is
appropriate for the patient's specific diagnosis and clinical condition, preventing
unnecessary or contraindicated drug therapy.
Q6: A nurse discovers a medication error after administering the wrong dose of
insulin. According to ATI guidelines, what is the nurse's FIRST priority action?
A. Complete an incident report
B. Assess the patient for adverse effects
,C. Notify the charge nurse
D. Document the error in the medical record
Correct Answer: B
Rationale: Correct because patient safety is the highest priority; the nurse must
first assess the patient for signs and symptoms of hypoglycemia or other adverse
effects before completing other required actions.
Q7: A patient is prescribed penicillin G benzathine 1.2 million units IM. The nurse
notes the patient has a documented allergy to penicillin. Which action should the
nurse take?
A. Administer the medication with diphenhydramine premedication
B. Hold the medication and notify the provider immediately
C. Administer a test dose before the full dose
D. Substitute with a cephalosporin without consulting the provider
Correct Answer: B
Rationale: Correct because a documented penicillin allergy is an absolute
contraindication; the nurse must hold the medication and notify the provider to
obtain an alternative antibiotic order.
Q8: A nurse is using bar-code medication administration (BCMA). The scanner
does not recognize the medication bar code. Which action should the nurse take?
A. Manually enter the medication information and administer
B. Verify the medication using the rights of administration and scan again
C. Administer the medication and document later
D. Return the medication to the pharmacy and request a replacement
Correct Answer: B
Rationale: Correct because BCMA is a safety system designed to prevent errors;
the nurse must verify the medication using the rights of administration and
attempt to rescan before proceeding.
Q9: A nurse is preparing to administer morphine 4 mg IV push. The available
concentration is morphine 10 mg/mL. How many mL should the nurse
administer? (Round to the nearest tenth.)
A. 0.2 mL
, B. 0.4 mL
C. 2.5 mL
D. 4.0 mL
Correct Answer: B
Rationale: Correct because using the formula D/H × V: 4 mg / 10 mg × 1 mL = 0.4
mL. This matches ATI dosage calculation guidelines for IV push medications.
Q10: A patient receiving heparin by continuous IV infusion has an aPTT of 90
seconds. The therapeutic range is 60 to 80 seconds. Which action should the
nurse take FIRST?
A. Stop the heparin infusion immediately
B. Reduce the infusion rate per protocol and notify the provider
C. Continue the current infusion rate and recheck in 4 hours
D. Administer protamine sulfate
Correct Answer: B
Rationale: Correct because an aPTT slightly above therapeutic range indicates
supratherapeutic anticoagulation; the nurse should reduce the infusion rate per
institutional protocol and notify the provider.
Q11: A nurse is reviewing a medication reconciliation form for a patient admitted
from home. The patient reports taking "a water pill and a blood thinner." Which
action by the nurse demonstrates best practice?
A. Document the medications as "diuretic and anticoagulant" in the medical
record
B. Ask the patient to bring in the medication bottles for verification
C. Contact the patient's pharmacy to verify the medications
D. Ask the patient to describe the color and shape of the pills
Correct Answer: B
Rationale: Correct because medication reconciliation requires verification of
exact medications, dosages, and frequencies; having the patient bring in actual
medication bottles is the most reliable method for accurate verification.
Official Exam Blueprint Replica
SECTION 1: MEDICATION SAFETY & ERROR PREVENTION (Questions 1–12)
Q1: A nurse administers digoxin 0.25 mg to a patient with heart failure. One hour
later, the patient reports nausea and blurred vision. Which action should the
nurse take FIRST?
A. Administer digoxin immune Fab
B. Check the patient's apical pulse for one full minute
C. Hold the next dose of digoxin
D. Obtain a serum digoxin level
Correct Answer: D
Rationale: Correct because nausea and blurred vision are signs of digoxin
toxicity, and a serum digoxin level must be obtained immediately to confirm
toxicity before any further interventions.
Q2: A nurse is preparing to administer heparin 5,000 units subcutaneously. Which
action by the nurse demonstrates safe medication administration?
A. Massaging the injection site after administration
B. Injecting into the abdomen at least 2 inches from the umbilicus
C. Using a 1-inch, 22-gauge needle
D. Aspirating before injecting the medication
Correct Answer: B
Rationale: Correct because heparin should be injected into the abdomen above
the iliac crest, at least 2 inches from the umbilicus, without massaging or
aspirating to prevent tissue damage and bruising.
Q3: A nurse is reviewing a new prescription for warfarin 5 mg daily. Which
laboratory value should the nurse monitor to evaluate therapeutic effect?
A. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT) and International Normalized Ratio (INR)
C. Bleeding time
,D. Platelet count
Correct Answer: B
Rationale: Correct because PT and INR are the standardized laboratory tests used
to monitor warfarin therapy, with a therapeutic INR range typically of 2.0 to 3.0 for
most indications.
Q4: A patient receiving warfarin has an INR of 5.2. Which medication should the
nurse prepare to administer?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Fresh frozen plasma
D. Aminocaproic acid
Correct Answer: B
Rationale: Correct because vitamin K is the specific antidote for warfarin
overdose and works by restoring synthesis of vitamin K-dependent clotting
factors II, VII, IX, and X.
Q5: A nurse is verifying a medication order using the rights of medication
administration. Which right addresses ensuring the medication is appropriate for
the patient's condition?
A. Right dose
B. Right route
C. Right indication
D. Right time
Correct Answer: C
Rationale: Correct because the right indication ensures the medication is
appropriate for the patient's specific diagnosis and clinical condition, preventing
unnecessary or contraindicated drug therapy.
Q6: A nurse discovers a medication error after administering the wrong dose of
insulin. According to ATI guidelines, what is the nurse's FIRST priority action?
A. Complete an incident report
B. Assess the patient for adverse effects
,C. Notify the charge nurse
D. Document the error in the medical record
Correct Answer: B
Rationale: Correct because patient safety is the highest priority; the nurse must
first assess the patient for signs and symptoms of hypoglycemia or other adverse
effects before completing other required actions.
Q7: A patient is prescribed penicillin G benzathine 1.2 million units IM. The nurse
notes the patient has a documented allergy to penicillin. Which action should the
nurse take?
A. Administer the medication with diphenhydramine premedication
B. Hold the medication and notify the provider immediately
C. Administer a test dose before the full dose
D. Substitute with a cephalosporin without consulting the provider
Correct Answer: B
Rationale: Correct because a documented penicillin allergy is an absolute
contraindication; the nurse must hold the medication and notify the provider to
obtain an alternative antibiotic order.
Q8: A nurse is using bar-code medication administration (BCMA). The scanner
does not recognize the medication bar code. Which action should the nurse take?
A. Manually enter the medication information and administer
B. Verify the medication using the rights of administration and scan again
C. Administer the medication and document later
D. Return the medication to the pharmacy and request a replacement
Correct Answer: B
Rationale: Correct because BCMA is a safety system designed to prevent errors;
the nurse must verify the medication using the rights of administration and
attempt to rescan before proceeding.
Q9: A nurse is preparing to administer morphine 4 mg IV push. The available
concentration is morphine 10 mg/mL. How many mL should the nurse
administer? (Round to the nearest tenth.)
A. 0.2 mL
, B. 0.4 mL
C. 2.5 mL
D. 4.0 mL
Correct Answer: B
Rationale: Correct because using the formula D/H × V: 4 mg / 10 mg × 1 mL = 0.4
mL. This matches ATI dosage calculation guidelines for IV push medications.
Q10: A patient receiving heparin by continuous IV infusion has an aPTT of 90
seconds. The therapeutic range is 60 to 80 seconds. Which action should the
nurse take FIRST?
A. Stop the heparin infusion immediately
B. Reduce the infusion rate per protocol and notify the provider
C. Continue the current infusion rate and recheck in 4 hours
D. Administer protamine sulfate
Correct Answer: B
Rationale: Correct because an aPTT slightly above therapeutic range indicates
supratherapeutic anticoagulation; the nurse should reduce the infusion rate per
institutional protocol and notify the provider.
Q11: A nurse is reviewing a medication reconciliation form for a patient admitted
from home. The patient reports taking "a water pill and a blood thinner." Which
action by the nurse demonstrates best practice?
A. Document the medications as "diuretic and anticoagulant" in the medical
record
B. Ask the patient to bring in the medication bottles for verification
C. Contact the patient's pharmacy to verify the medications
D. Ask the patient to describe the color and shape of the pills
Correct Answer: B
Rationale: Correct because medication reconciliation requires verification of
exact medications, dosages, and frequencies; having the patient bring in actual
medication bottles is the most reliable method for accurate verification.
