ATI Pharmacology CMS Proctored Exam
2025/2026 (Forms A, B & C) | Verified
Questions & Answers with Detailed
Rationales | Complete PDF Study Guide
• This comprehensive ATI Pharmacology CMS Proctored Exam prep covers 200
verified questions spanning all high-yield drug classes, mechanisms, nursing
considerations, and patient safety priorities tested across Forms A, B, and C.
• Study by reading each question carefully, selecting your answer before revealing
the correct response, then using the detailed EXPERT RATIONALE to reinforce
clinical reasoning and pharmacology principles.
1. A nurse is preparing to administer metformin to a client with type 2
diabetes. Which of the following conditions is a contraindication for this
medication?
A. Hypertension
B. Hyperlipidemia
C. Renal impairment
D. Hypothyroidism
E. Osteoarthritis
Correct Answer: C. Renal impairment
EXPERT RATIONALE: Metformin is contraindicated in renal impairment because it
is renally excreted and accumulates in the body when kidney function is reduced,
significantly increasing the risk of lactic acidosis, a rare but potentially fatal
complication.
2. A nurse is teaching a client who has a new prescription for warfarin. Which
of the following foods should the nurse instruct the client to avoid in large
amounts?
A. Bananas
,B. Oranges
C. Spinach
D. Apples
E. Carrots
Correct Answer: C. Spinach
EXPERT RATIONALE: Spinach is high in vitamin K, which directly antagonizes the
anticoagulant effect of warfarin. Clients on warfarin should maintain consistent
vitamin K intake and avoid large fluctuations in consumption of leafy green
vegetables.
3. A nurse is caring for a client who has been prescribed lithium for bipolar
disorder. Which of the following laboratory values requires immediate
intervention?
A. Serum lithium level 0.8 mEq/L
B. Serum sodium level 140 mEq/L
C. Serum lithium level 2.5 mEq/L
D. Serum potassium level 4.0 mEq/L
E. BUN 15 mg/dL
Correct Answer: C. Serum lithium level 2.5 mEq/L
EXPERT RATIONALE: The therapeutic range for lithium is 0.6–1.2 mEq/L for
maintenance. A level of 2.5 mEq/L indicates severe toxicity and requires immediate
intervention, as levels above 2.0 mEq/L can cause seizures, cardiac dysrhythmias,
irreversible neurological damage, and death.
4. A nurse is administering IV vancomycin to a client. The client develops
flushing, erythema, and hypotension during the infusion. Which of the
following actions should the nurse take first?
,A. Administer diphenhydramine IV
B. Notify the provider immediately
C. Slow the infusion rate
D. Discontinue the infusion entirely
E. Apply a cool compress to the face
Correct Answer: C. Slow the infusion rate
EXPERT RATIONALE: The client is experiencing Red Man Syndrome, a rate-
dependent reaction to vancomycin caused by too-rapid infusion. It is not a true
allergic reaction. The first intervention is to slow the infusion rate. Vancomycin
should be administered over at least 60 minutes to prevent this reaction.
5. A nurse is caring for a client prescribed digoxin. Which of the following
findings should the nurse report to the provider before administering the
medication?
A. Blood pressure 118/76 mmHg
B. Apical pulse of 54 beats per minute
C. Serum potassium 4.2 mEq/L
D. Respiratory rate of 16 breaths per minute
E. Temperature 98.6°F
Correct Answer: B. Apical pulse of 54 beats per minute
EXPERT RATIONALE: Digoxin slows the heart rate and should be withheld if the
apical pulse is below 60 beats per minute in adults. The nurse should hold the dose
and notify the provider, as administering digoxin with bradycardia increases the
risk of complete heart block and life-threatening dysrhythmias.
6. A nurse is teaching a client about taking oral iron supplements. Which of
the following instructions should the nurse include?
, A. Take iron with milk to reduce GI upset
B. Expect stools to turn bright red during therapy
C. Take iron with orange juice to enhance absorption
D. Take iron with antacids to improve tolerability
E. Avoid all physical activity while taking iron
Correct Answer: C. Take iron with orange juice to enhance absorption
EXPERT RATIONALE: Vitamin C found in orange juice converts ferric iron to ferrous
iron, which is more readily absorbed in the GI tract. Dairy products and antacids
reduce iron absorption by binding to the mineral. Stools typically turn dark or tarry,
not bright red, during iron therapy.
7. A nurse is reviewing medications for a client with a penicillin allergy. The
provider has prescribed cephalexin. Which of the following actions should the
nurse take?
A. Administer the medication as prescribed
B. Substitute ampicillin for cephalexin
C. Hold the medication and notify the provider
D. Administer a test dose of cephalexin first
E. Premedicate with diphenhydramine before administration
Correct Answer: C. Hold the medication and notify the provider
EXPERT RATIONALE: There is a cross-sensitivity between penicillins and
cephalosporins. Clients with penicillin allergy have an increased risk of allergic
reaction to cephalosporins. The nurse should hold the medication and consult the
provider before administering. Cross-reactivity risk is estimated at approximately 1–
2%.
2025/2026 (Forms A, B & C) | Verified
Questions & Answers with Detailed
Rationales | Complete PDF Study Guide
• This comprehensive ATI Pharmacology CMS Proctored Exam prep covers 200
verified questions spanning all high-yield drug classes, mechanisms, nursing
considerations, and patient safety priorities tested across Forms A, B, and C.
• Study by reading each question carefully, selecting your answer before revealing
the correct response, then using the detailed EXPERT RATIONALE to reinforce
clinical reasoning and pharmacology principles.
1. A nurse is preparing to administer metformin to a client with type 2
diabetes. Which of the following conditions is a contraindication for this
medication?
A. Hypertension
B. Hyperlipidemia
C. Renal impairment
D. Hypothyroidism
E. Osteoarthritis
Correct Answer: C. Renal impairment
EXPERT RATIONALE: Metformin is contraindicated in renal impairment because it
is renally excreted and accumulates in the body when kidney function is reduced,
significantly increasing the risk of lactic acidosis, a rare but potentially fatal
complication.
2. A nurse is teaching a client who has a new prescription for warfarin. Which
of the following foods should the nurse instruct the client to avoid in large
amounts?
A. Bananas
,B. Oranges
C. Spinach
D. Apples
E. Carrots
Correct Answer: C. Spinach
EXPERT RATIONALE: Spinach is high in vitamin K, which directly antagonizes the
anticoagulant effect of warfarin. Clients on warfarin should maintain consistent
vitamin K intake and avoid large fluctuations in consumption of leafy green
vegetables.
3. A nurse is caring for a client who has been prescribed lithium for bipolar
disorder. Which of the following laboratory values requires immediate
intervention?
A. Serum lithium level 0.8 mEq/L
B. Serum sodium level 140 mEq/L
C. Serum lithium level 2.5 mEq/L
D. Serum potassium level 4.0 mEq/L
E. BUN 15 mg/dL
Correct Answer: C. Serum lithium level 2.5 mEq/L
EXPERT RATIONALE: The therapeutic range for lithium is 0.6–1.2 mEq/L for
maintenance. A level of 2.5 mEq/L indicates severe toxicity and requires immediate
intervention, as levels above 2.0 mEq/L can cause seizures, cardiac dysrhythmias,
irreversible neurological damage, and death.
4. A nurse is administering IV vancomycin to a client. The client develops
flushing, erythema, and hypotension during the infusion. Which of the
following actions should the nurse take first?
,A. Administer diphenhydramine IV
B. Notify the provider immediately
C. Slow the infusion rate
D. Discontinue the infusion entirely
E. Apply a cool compress to the face
Correct Answer: C. Slow the infusion rate
EXPERT RATIONALE: The client is experiencing Red Man Syndrome, a rate-
dependent reaction to vancomycin caused by too-rapid infusion. It is not a true
allergic reaction. The first intervention is to slow the infusion rate. Vancomycin
should be administered over at least 60 minutes to prevent this reaction.
5. A nurse is caring for a client prescribed digoxin. Which of the following
findings should the nurse report to the provider before administering the
medication?
A. Blood pressure 118/76 mmHg
B. Apical pulse of 54 beats per minute
C. Serum potassium 4.2 mEq/L
D. Respiratory rate of 16 breaths per minute
E. Temperature 98.6°F
Correct Answer: B. Apical pulse of 54 beats per minute
EXPERT RATIONALE: Digoxin slows the heart rate and should be withheld if the
apical pulse is below 60 beats per minute in adults. The nurse should hold the dose
and notify the provider, as administering digoxin with bradycardia increases the
risk of complete heart block and life-threatening dysrhythmias.
6. A nurse is teaching a client about taking oral iron supplements. Which of
the following instructions should the nurse include?
, A. Take iron with milk to reduce GI upset
B. Expect stools to turn bright red during therapy
C. Take iron with orange juice to enhance absorption
D. Take iron with antacids to improve tolerability
E. Avoid all physical activity while taking iron
Correct Answer: C. Take iron with orange juice to enhance absorption
EXPERT RATIONALE: Vitamin C found in orange juice converts ferric iron to ferrous
iron, which is more readily absorbed in the GI tract. Dairy products and antacids
reduce iron absorption by binding to the mineral. Stools typically turn dark or tarry,
not bright red, during iron therapy.
7. A nurse is reviewing medications for a client with a penicillin allergy. The
provider has prescribed cephalexin. Which of the following actions should the
nurse take?
A. Administer the medication as prescribed
B. Substitute ampicillin for cephalexin
C. Hold the medication and notify the provider
D. Administer a test dose of cephalexin first
E. Premedicate with diphenhydramine before administration
Correct Answer: C. Hold the medication and notify the provider
EXPERT RATIONALE: There is a cross-sensitivity between penicillins and
cephalosporins. Clients with penicillin allergy have an increased risk of allergic
reaction to cephalosporins. The nurse should hold the medication and consult the
provider before administering. Cross-reactivity risk is estimated at approximately 1–
2%.
