ATI Pharmacology Proctored Exam Prep Document
2026/2027 | Medication Therapy, Clinical
Judgment & Safe Drug Administration | 60 Verified
Questions with Detailed Rationales
SECTION 1: CARDIOVASCULAR MEDICATIONS
1. A patient is prescribed digoxin for heart failure. The nurse should monitor for
which early sign of toxicity?
• A) Tachycardia
, • B) Anorexia, nausea, and vomiting
• C) Hyperkalemia
• D) Constipation
Correct Answer: B) Anorexia, nausea, and vomiting
Rationale: Gastrointestinal symptoms (anorexia, nausea, vomiting) are the earliest
signs of digoxin toxicity. Visual disturbances (yellow-green halos) and cardiac
dysrhythmias (bradycardia, heart block) occur later. Serum digoxin levels should be
monitored (therapeutic range 0.8-2.0 ng/mL). Hypokalemia increases the risk of
toxicity.
2. A patient on warfarin has an INR of 5.5. The patient is not bleeding. The nurse
should anticipate which order?
• A) Administer vitamin K 5 mg PO
• B) Administer protamine sulfate
• C) Hold warfarin and monitor INR
• D) Increase the warfarin dose
Correct Answer: C) Hold warfarin and monitor INR
Rationale: For an INR of 5.5 without bleeding, the standard practice is to hold the
warfarin and monitor INR. Vitamin K is typically reserved for INR > 10 or with
active bleeding. Protamine sulfate is the antidote for heparin, not warfarin.
Increasing the dose would worsen the elevated INR.
3. A patient is prescribed clopidogrel after a coronary stent placement. Which
finding indicates the medication is effective?
• A) Prolonged bleeding time
• B) Absence of chest pain
• C) Platelet inhibition confirmed by lab testing
• D) International normalized ratio (INR) 2.5
,Correct Answer: C) Platelet inhibition confirmed by lab testing
Rationale: Clopidogrel is an antiplatelet agent that inhibits ADP-mediated platelet
aggregation. Effectiveness is often monitored with platelet function assays
(VerifyNow or thromboelastography). Prolonged bleeding time is a side effect, not
the goal. INR reflects warfarin's effect, not clopidogrel's. Absence of chest pain is a
clinical outcome but not a direct measure of effectiveness.
4. A patient on amiodarone is scheduled for surgery. Which adverse effect is of
greatest concern?
• A) Hypothyroidism
• B) Photosensitivity
• C) Pulmonary toxicity
• D) Blue-gray skin discoloration
Correct Answer: C) Pulmonary toxicity
Rationale: Amiodarone can cause pulmonary toxicity, including interstitial
pneumonitis and pulmonary fibrosis, which can be fatal. Patients on chronic
amiodarone therapy undergoing surgery are at increased risk for acute respiratory
distress syndrome (ARDS). The nurse should assess for dyspnea, cough, and
decreased breath sounds. Other side effects include hypothyroidism,
photosensitivity, and blue-gray skin, but pulmonary toxicity is the most serious.
5. A patient with heart failure is prescribed lisinopril. Which side effect is most
concerning?
• A) Dry cough
• B) Hyperkalemia
• C) Angioedema
• D) Hypotension
Correct Answer: C) Angioedema
, Rationale: Angioedema is a rare but life-threatening side effect of ACE inhibitors
(lisinopril). It causes swelling of the lips, tongue, and airway, leading to respiratory
distress. The nurse should educate the patient to seek immediate care if swelling
occurs. Dry cough is a common side effect but not life-threatening. Hyperkalemia
and hypotension are important but can be monitored and managed.
6. A patient is prescribed atorvastatin for hyperlipidemia. Which baseline labs
should be obtained?
• A) Serum creatinine and BUN
• B) Liver function tests (AST, ALT)
• C) Serum potassium and sodium
• D) Complete blood count (CBC)
Correct Answer: B) Liver function tests (AST, ALT)
Rationale: Statins (atorvastatin) can cause hepatotoxicity. Baseline and periodic
liver function tests (AST, ALT) should be obtained. Signs of liver toxicity include
jaundice, dark urine, and fatigue. Creatinine kinase (CK) should also be monitored
for rhabdomyolysis, but LFTs are the standard baseline.
7. A patient on metoprolol for hypertension has a heart rate of 52 bpm and
reports dizziness. The nurse's priority action is:
• A) Administer the metoprolol as ordered
• B) Hold the metoprolol and notify the provider
• C) Increase the metoprolol dose
• D) Administer atropine IV
Correct Answer: B) Hold the metoprolol and notify the provider
Rationale: Metoprolol is a beta-blocker that slows heart rate. A heart rate of 52
with dizziness indicates symptomatic bradycardia. The nurse should hold the dose
and notify the provider for further instructions. The provider may order a dose
2026/2027 | Medication Therapy, Clinical
Judgment & Safe Drug Administration | 60 Verified
Questions with Detailed Rationales
SECTION 1: CARDIOVASCULAR MEDICATIONS
1. A patient is prescribed digoxin for heart failure. The nurse should monitor for
which early sign of toxicity?
• A) Tachycardia
, • B) Anorexia, nausea, and vomiting
• C) Hyperkalemia
• D) Constipation
Correct Answer: B) Anorexia, nausea, and vomiting
Rationale: Gastrointestinal symptoms (anorexia, nausea, vomiting) are the earliest
signs of digoxin toxicity. Visual disturbances (yellow-green halos) and cardiac
dysrhythmias (bradycardia, heart block) occur later. Serum digoxin levels should be
monitored (therapeutic range 0.8-2.0 ng/mL). Hypokalemia increases the risk of
toxicity.
2. A patient on warfarin has an INR of 5.5. The patient is not bleeding. The nurse
should anticipate which order?
• A) Administer vitamin K 5 mg PO
• B) Administer protamine sulfate
• C) Hold warfarin and monitor INR
• D) Increase the warfarin dose
Correct Answer: C) Hold warfarin and monitor INR
Rationale: For an INR of 5.5 without bleeding, the standard practice is to hold the
warfarin and monitor INR. Vitamin K is typically reserved for INR > 10 or with
active bleeding. Protamine sulfate is the antidote for heparin, not warfarin.
Increasing the dose would worsen the elevated INR.
3. A patient is prescribed clopidogrel after a coronary stent placement. Which
finding indicates the medication is effective?
• A) Prolonged bleeding time
• B) Absence of chest pain
• C) Platelet inhibition confirmed by lab testing
• D) International normalized ratio (INR) 2.5
,Correct Answer: C) Platelet inhibition confirmed by lab testing
Rationale: Clopidogrel is an antiplatelet agent that inhibits ADP-mediated platelet
aggregation. Effectiveness is often monitored with platelet function assays
(VerifyNow or thromboelastography). Prolonged bleeding time is a side effect, not
the goal. INR reflects warfarin's effect, not clopidogrel's. Absence of chest pain is a
clinical outcome but not a direct measure of effectiveness.
4. A patient on amiodarone is scheduled for surgery. Which adverse effect is of
greatest concern?
• A) Hypothyroidism
• B) Photosensitivity
• C) Pulmonary toxicity
• D) Blue-gray skin discoloration
Correct Answer: C) Pulmonary toxicity
Rationale: Amiodarone can cause pulmonary toxicity, including interstitial
pneumonitis and pulmonary fibrosis, which can be fatal. Patients on chronic
amiodarone therapy undergoing surgery are at increased risk for acute respiratory
distress syndrome (ARDS). The nurse should assess for dyspnea, cough, and
decreased breath sounds. Other side effects include hypothyroidism,
photosensitivity, and blue-gray skin, but pulmonary toxicity is the most serious.
5. A patient with heart failure is prescribed lisinopril. Which side effect is most
concerning?
• A) Dry cough
• B) Hyperkalemia
• C) Angioedema
• D) Hypotension
Correct Answer: C) Angioedema
, Rationale: Angioedema is a rare but life-threatening side effect of ACE inhibitors
(lisinopril). It causes swelling of the lips, tongue, and airway, leading to respiratory
distress. The nurse should educate the patient to seek immediate care if swelling
occurs. Dry cough is a common side effect but not life-threatening. Hyperkalemia
and hypotension are important but can be monitored and managed.
6. A patient is prescribed atorvastatin for hyperlipidemia. Which baseline labs
should be obtained?
• A) Serum creatinine and BUN
• B) Liver function tests (AST, ALT)
• C) Serum potassium and sodium
• D) Complete blood count (CBC)
Correct Answer: B) Liver function tests (AST, ALT)
Rationale: Statins (atorvastatin) can cause hepatotoxicity. Baseline and periodic
liver function tests (AST, ALT) should be obtained. Signs of liver toxicity include
jaundice, dark urine, and fatigue. Creatinine kinase (CK) should also be monitored
for rhabdomyolysis, but LFTs are the standard baseline.
7. A patient on metoprolol for hypertension has a heart rate of 52 bpm and
reports dizziness. The nurse's priority action is:
• A) Administer the metoprolol as ordered
• B) Hold the metoprolol and notify the provider
• C) Increase the metoprolol dose
• D) Administer atropine IV
Correct Answer: B) Hold the metoprolol and notify the provider
Rationale: Metoprolol is a beta-blocker that slows heart rate. A heart rate of 52
with dizziness indicates symptomatic bradycardia. The nurse should hold the dose
and notify the provider for further instructions. The provider may order a dose
