ATI RN Pharmacology Proctored Exam 2026/2027 – 3
Versions Question Bank with Verified Answers and
Rationales | instant pdf download
ANSWER KEY SUMMARY
Section Questions Focus Area
1 1-30 Cardiovascular Medications
2 21-40 Anticoagulants & Hematologic Agents
3 31-50 Antibiotics & Antinfectives
4 51-70 Antidiabetic Agents
5 71-90 Antidepressants & Psychiatric Medications
6 81-95 Respiratory & Allergy Medications
7 91-110 Oncology & Immunosuppressants
8 101-120 Gastrointestinal Medications
9 111-130 Pain Management & Musculoskeletal
10 121-200 Miscellaneous & Comprehensive Review
SECTION 1: CARDIOVASCULAR MEDICATIONS (Questions 1-30)
Q1. A nurse is administering digoxin to a client with heart failure. Which finding
should prompt the nurse to withhold the medication?
A. Heart rate 62/min
B. *Serum potassium 3.2 mEq/L*
C. Blood pressure 118/74 mmHg
D. Respiratory rate 16/min
* Hypokalemia (K+ <3.5 mEq/L) increases the risk of digoxin toxicity. The nurse should
withhold digoxin and notify the provider. Other findings are within normal limits .*
Q2. A client prescribed warfarin has an INR of 4.5. Which action should the nurse
take?
A. Administer vitamin K immediately
, B. Hold the next warfarin dose
C. Increase the warfarin dose
D. Give protamine sulfate
* INR goal for most indications is 2-3. An INR of 4.5 requires holding the warfarin dose.
Vitamin K is reserved for serious bleeding or INR >10. Protamine sulfate is for heparin
reversal .*
Q3. Which medication is used to reverse heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Flumazenil
Protamine sulfate binds to heparin, neutralizing its anticoagulant effect. Vitamin K reverses
warfarin. Naloxone reverses opioids. Flumazenil reverses benzodiazepines .
Q4. A client is prescribed lisinopril. Which adverse effect requires immediate
discontinuation?
A. Persistent dry cough
B. Swelling of the lips, tongue, and oropharynx
C. Serum potassium of 4.8 mEq/L
D. Mild hypotension
Angioedema (swelling of lips, tongue, oropharynx) is a life-threatening hypersensitivity
reaction to ACE inhibitors that requires immediate discontinuation and airway management.
A dry cough is a common, non-lethal side effect .
Q5. A nurse is monitoring a client receiving a continuous IV heparin infusion. Which
finding indicates a therapeutic response?
A. INR of 2.5
B. *aPTT 60-80 seconds (1.5-2.5 times control)*
C. Platelets 150,000/mm³
D. PT of 12 seconds
,* Heparin therapy is monitored using aPTT. The therapeutic range is 1.5-2.5 times the
normal control value. INR monitors warfarin therapy .*
Q6. A client is prescribed atorvastatin. Which adverse effect should the client report
immediately?
A. Mild constipation
B. Headache
C. Unexplained muscle pain or weakness
D. Flatulence
Muscle pain may indicate rhabdomyolysis, a serious adverse effect of statins that can lead
to kidney damage. Clients should report any unexplained muscle pain, tenderness, or
weakness immediately .
Q7. Which beta blocker is cardioselective (beta-1 selective)?
A. Propranolol
B. Metoprolol
C. Carvedilol
D. Labetalol
* Metoprolol is a beta-1 selective (cardioselective) antagonist, which primarily affects the
heart with less risk of bronchospasm. Propranolol, carvedilol, and labetalol are non-
selective .*
Q8. A client taking spironolactone should be advised to avoid which supplement?
A. Calcium
B. Potassium
C. Magnesium
D. Zinc
Spironolactone is a potassium-sparing diuretic. Potassium supplements can cause life-
threatening hyperkalemia .
Q9. A nurse is teaching a client about sublingual nitroglycerin. Which instruction is
correct?
, A. "Swallow the tablet with a full glass of water."
B. "Sit or lie down before taking the medication."
C. "Take a tablet every 15 minutes for chest pain."
D. "Store the tablets in the refrigerator."
Nitroglycerin can cause hypotension and syncope. Clients should sit or lie down when
taking sublingual nitroglycerin to prevent falls from dizziness .
Q10. Which medication is strictly contraindicated during pregnancy due to
fetotoxicity?
A. Labetalol
B. Nifedipine
C. Atenolol
D. Methyldopa
According to current AHA guidelines, atenolol is contraindicated in pregnancy due to risk of
fetal growth restriction. Labetalol, nifedipine, and methyldopa are safer alternatives .
Q11. A client is prescribed furosemide. Which finding requires immediate notification
of the provider?
A. Weight loss of 2 lbs in 24 hours
B. Client reports difficulty hearing
C. Serum potassium of 4.0 mEq/L
D. Increased urine output
Furosemide can cause ototoxicity (hearing loss), which may be irreversible. The nurse
should notify the provider immediately if the client reports hearing changes .
Q12. A nurse is administering IV furosemide. Which action should the nurse take
first?
A. Monitor blood pressure
B. Determine medication adherence by the client
C. Check serum potassium
Versions Question Bank with Verified Answers and
Rationales | instant pdf download
ANSWER KEY SUMMARY
Section Questions Focus Area
1 1-30 Cardiovascular Medications
2 21-40 Anticoagulants & Hematologic Agents
3 31-50 Antibiotics & Antinfectives
4 51-70 Antidiabetic Agents
5 71-90 Antidepressants & Psychiatric Medications
6 81-95 Respiratory & Allergy Medications
7 91-110 Oncology & Immunosuppressants
8 101-120 Gastrointestinal Medications
9 111-130 Pain Management & Musculoskeletal
10 121-200 Miscellaneous & Comprehensive Review
SECTION 1: CARDIOVASCULAR MEDICATIONS (Questions 1-30)
Q1. A nurse is administering digoxin to a client with heart failure. Which finding
should prompt the nurse to withhold the medication?
A. Heart rate 62/min
B. *Serum potassium 3.2 mEq/L*
C. Blood pressure 118/74 mmHg
D. Respiratory rate 16/min
* Hypokalemia (K+ <3.5 mEq/L) increases the risk of digoxin toxicity. The nurse should
withhold digoxin and notify the provider. Other findings are within normal limits .*
Q2. A client prescribed warfarin has an INR of 4.5. Which action should the nurse
take?
A. Administer vitamin K immediately
, B. Hold the next warfarin dose
C. Increase the warfarin dose
D. Give protamine sulfate
* INR goal for most indications is 2-3. An INR of 4.5 requires holding the warfarin dose.
Vitamin K is reserved for serious bleeding or INR >10. Protamine sulfate is for heparin
reversal .*
Q3. Which medication is used to reverse heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Flumazenil
Protamine sulfate binds to heparin, neutralizing its anticoagulant effect. Vitamin K reverses
warfarin. Naloxone reverses opioids. Flumazenil reverses benzodiazepines .
Q4. A client is prescribed lisinopril. Which adverse effect requires immediate
discontinuation?
A. Persistent dry cough
B. Swelling of the lips, tongue, and oropharynx
C. Serum potassium of 4.8 mEq/L
D. Mild hypotension
Angioedema (swelling of lips, tongue, oropharynx) is a life-threatening hypersensitivity
reaction to ACE inhibitors that requires immediate discontinuation and airway management.
A dry cough is a common, non-lethal side effect .
Q5. A nurse is monitoring a client receiving a continuous IV heparin infusion. Which
finding indicates a therapeutic response?
A. INR of 2.5
B. *aPTT 60-80 seconds (1.5-2.5 times control)*
C. Platelets 150,000/mm³
D. PT of 12 seconds
,* Heparin therapy is monitored using aPTT. The therapeutic range is 1.5-2.5 times the
normal control value. INR monitors warfarin therapy .*
Q6. A client is prescribed atorvastatin. Which adverse effect should the client report
immediately?
A. Mild constipation
B. Headache
C. Unexplained muscle pain or weakness
D. Flatulence
Muscle pain may indicate rhabdomyolysis, a serious adverse effect of statins that can lead
to kidney damage. Clients should report any unexplained muscle pain, tenderness, or
weakness immediately .
Q7. Which beta blocker is cardioselective (beta-1 selective)?
A. Propranolol
B. Metoprolol
C. Carvedilol
D. Labetalol
* Metoprolol is a beta-1 selective (cardioselective) antagonist, which primarily affects the
heart with less risk of bronchospasm. Propranolol, carvedilol, and labetalol are non-
selective .*
Q8. A client taking spironolactone should be advised to avoid which supplement?
A. Calcium
B. Potassium
C. Magnesium
D. Zinc
Spironolactone is a potassium-sparing diuretic. Potassium supplements can cause life-
threatening hyperkalemia .
Q9. A nurse is teaching a client about sublingual nitroglycerin. Which instruction is
correct?
, A. "Swallow the tablet with a full glass of water."
B. "Sit or lie down before taking the medication."
C. "Take a tablet every 15 minutes for chest pain."
D. "Store the tablets in the refrigerator."
Nitroglycerin can cause hypotension and syncope. Clients should sit or lie down when
taking sublingual nitroglycerin to prevent falls from dizziness .
Q10. Which medication is strictly contraindicated during pregnancy due to
fetotoxicity?
A. Labetalol
B. Nifedipine
C. Atenolol
D. Methyldopa
According to current AHA guidelines, atenolol is contraindicated in pregnancy due to risk of
fetal growth restriction. Labetalol, nifedipine, and methyldopa are safer alternatives .
Q11. A client is prescribed furosemide. Which finding requires immediate notification
of the provider?
A. Weight loss of 2 lbs in 24 hours
B. Client reports difficulty hearing
C. Serum potassium of 4.0 mEq/L
D. Increased urine output
Furosemide can cause ototoxicity (hearing loss), which may be irreversible. The nurse
should notify the provider immediately if the client reports hearing changes .
Q12. A nurse is administering IV furosemide. Which action should the nurse take
first?
A. Monitor blood pressure
B. Determine medication adherence by the client
C. Check serum potassium
