NURS 326 ATI PHARMACOLOGY DRUG THERAPY] QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
SECTION ONE: QUESTIONS 1-100
Question 1
A nurse is preparing to administer a medication that has a high first-pass effect. The provider has ordered the
medication to be given via which route to bypass this effect?
A. Oral
B. Sublingual
C. Intravenous
D. Rectal
🟢 C. Intravenous
🔴 RATIONALE: The first-pass effect is the metabolism of a drug by the liver before it reaches systemic
circulation, significantly reducing its bioavailability. The intravenous route administers the drug directly into
systemic circulation, completely bypassing the hepatic first-pass effect, ensuring 100% bioavailability.
Question 2
A patient is prescribed a beta-blocker for hypertension. The nurse understands that the therapeutic effect of this
drug class is primarily due to which action?
A. Stimulation of beta-1 receptors in the heart
B. Blockade of beta-1 receptors in the heart
C. Stimulation of beta-2 receptors in the lungs
D. Blockade of alpha-1 receptors in the vasculature
,🟢 B. Blockade of beta-1 receptors in the heart
🔴 RATIONALE: Beta-blockers, such as metoprolol, produce their therapeutic effect in hypertension by
competitively blocking beta-1 adrenergic receptors in the heart. This action decreases heart rate, contractility,
and cardiac output, which subsequently lowers blood pressure.
Question 3
A patient is taking an angiotensin-converting enzyme (ACE) inhibitor. The nurse should monitor for which
common, but potentially serious, adverse effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
🟢 A. Hyperkalemia
🔴 RATIONALE: ACE inhibitors block the conversion of angiotensin I to angiotensin II, which also reduces
aldosterone secretion. Aldosterone promotes potassium excretion; therefore, its reduction can lead to
potassium retention and hyperkalemia. This is a significant adverse effect that requires monitoring.
Question 4
The nurse is providing education to a patient prescribed an MAOI. Which dietary instruction is most critical for
preventing a hypertensive crisis?
A. Avoid foods high in tyramine.
B. Avoid foods high in potassium.
C. Increase intake of high-fiber foods.
D. Limit fluid intake to 1.5 liters per day.
,🟢 A. Avoid foods high in tyramine.
🔴 RATIONALE: Monoamine Oxidase Inhibitors (MAOIs) block the breakdown of tyramine, an amino acid found
in aged and fermented foods. A buildup of tyramine can cause the release of large amounts of norepinephrine,
leading to a life-threatening hypertensive crisis.
Question 5
A patient is on a fentanyl patch for chronic pain. The nurse instructs the patient to avoid applying external heat
sources to the patch. What is the primary rationale for this instruction?
A. It will cause the patch to fall off.
B. It can accelerate drug release, leading to toxicity.
C. It will cause skin irritation and a local rash.
D. It will inactivate the medication.
🟢 B. It can accelerate drug release, leading to toxicity.
🔴 RATIONALE: Heat causes vasodilation and increases the rate of drug absorption from a transdermal patch.
This can lead to a sudden, large release of fentanyl into the bloodstream, potentially resulting in respiratory
depression and fatal overdose.
Question 6
A nurse is caring for a patient with a history of asthma who is prescribed propranolol for migraine prophylaxis.
What is the nurse's priority action?
A. Administer the medication as ordered.
B. Contact the provider to question the prescription.
C. Teach the patient to take the medication with food.
D. Monitor the patient's heart rate before administration.
, 🟢 B. Contact the provider to question the prescription.
🔴 RATIONALE: Propranolol is a non-selective beta-blocker, meaning it blocks both beta-1 (cardiac) and beta-2
(pulmonary) receptors. Blockade of beta-2 receptors can cause bronchoconstriction, making it contraindicated
in patients with asthma. The nurse has a responsibility to question this order and notify the provider.
Question 7
A patient is receiving a continuous IV heparin infusion. The nurse notes the patient has a new onset of epistaxis
and hematuria. Which lab value should the nurse anticipate being elevated?
A. aPTT
B. INR
C. Platelet count
D. PT
🟢 A. aPTT
🔴 RATIONALE: Heparin is an anticoagulant that works by enhancing the activity of antithrombin III, which
inactivates thrombin and factor Xa. The activated Partial Thromboplastin Time (aPTT) is the primary lab test used
to monitor the therapeutic effect and bleeding risk of unfractionated heparin. An elevated aPTT confirms
anticoagulation.
Question 8
The nurse is preparing to administer vancomycin IV. Which assessment finding is most important to report to
the provider before the infusion?
A. Serum creatinine of 2.0 mg/dL
B. Blood pressure of 138/88 mmHg
PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
SECTION ONE: QUESTIONS 1-100
Question 1
A nurse is preparing to administer a medication that has a high first-pass effect. The provider has ordered the
medication to be given via which route to bypass this effect?
A. Oral
B. Sublingual
C. Intravenous
D. Rectal
🟢 C. Intravenous
🔴 RATIONALE: The first-pass effect is the metabolism of a drug by the liver before it reaches systemic
circulation, significantly reducing its bioavailability. The intravenous route administers the drug directly into
systemic circulation, completely bypassing the hepatic first-pass effect, ensuring 100% bioavailability.
Question 2
A patient is prescribed a beta-blocker for hypertension. The nurse understands that the therapeutic effect of this
drug class is primarily due to which action?
A. Stimulation of beta-1 receptors in the heart
B. Blockade of beta-1 receptors in the heart
C. Stimulation of beta-2 receptors in the lungs
D. Blockade of alpha-1 receptors in the vasculature
,🟢 B. Blockade of beta-1 receptors in the heart
🔴 RATIONALE: Beta-blockers, such as metoprolol, produce their therapeutic effect in hypertension by
competitively blocking beta-1 adrenergic receptors in the heart. This action decreases heart rate, contractility,
and cardiac output, which subsequently lowers blood pressure.
Question 3
A patient is taking an angiotensin-converting enzyme (ACE) inhibitor. The nurse should monitor for which
common, but potentially serious, adverse effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
🟢 A. Hyperkalemia
🔴 RATIONALE: ACE inhibitors block the conversion of angiotensin I to angiotensin II, which also reduces
aldosterone secretion. Aldosterone promotes potassium excretion; therefore, its reduction can lead to
potassium retention and hyperkalemia. This is a significant adverse effect that requires monitoring.
Question 4
The nurse is providing education to a patient prescribed an MAOI. Which dietary instruction is most critical for
preventing a hypertensive crisis?
A. Avoid foods high in tyramine.
B. Avoid foods high in potassium.
C. Increase intake of high-fiber foods.
D. Limit fluid intake to 1.5 liters per day.
,🟢 A. Avoid foods high in tyramine.
🔴 RATIONALE: Monoamine Oxidase Inhibitors (MAOIs) block the breakdown of tyramine, an amino acid found
in aged and fermented foods. A buildup of tyramine can cause the release of large amounts of norepinephrine,
leading to a life-threatening hypertensive crisis.
Question 5
A patient is on a fentanyl patch for chronic pain. The nurse instructs the patient to avoid applying external heat
sources to the patch. What is the primary rationale for this instruction?
A. It will cause the patch to fall off.
B. It can accelerate drug release, leading to toxicity.
C. It will cause skin irritation and a local rash.
D. It will inactivate the medication.
🟢 B. It can accelerate drug release, leading to toxicity.
🔴 RATIONALE: Heat causes vasodilation and increases the rate of drug absorption from a transdermal patch.
This can lead to a sudden, large release of fentanyl into the bloodstream, potentially resulting in respiratory
depression and fatal overdose.
Question 6
A nurse is caring for a patient with a history of asthma who is prescribed propranolol for migraine prophylaxis.
What is the nurse's priority action?
A. Administer the medication as ordered.
B. Contact the provider to question the prescription.
C. Teach the patient to take the medication with food.
D. Monitor the patient's heart rate before administration.
, 🟢 B. Contact the provider to question the prescription.
🔴 RATIONALE: Propranolol is a non-selective beta-blocker, meaning it blocks both beta-1 (cardiac) and beta-2
(pulmonary) receptors. Blockade of beta-2 receptors can cause bronchoconstriction, making it contraindicated
in patients with asthma. The nurse has a responsibility to question this order and notify the provider.
Question 7
A patient is receiving a continuous IV heparin infusion. The nurse notes the patient has a new onset of epistaxis
and hematuria. Which lab value should the nurse anticipate being elevated?
A. aPTT
B. INR
C. Platelet count
D. PT
🟢 A. aPTT
🔴 RATIONALE: Heparin is an anticoagulant that works by enhancing the activity of antithrombin III, which
inactivates thrombin and factor Xa. The activated Partial Thromboplastin Time (aPTT) is the primary lab test used
to monitor the therapeutic effect and bleeding risk of unfractionated heparin. An elevated aPTT confirms
anticoagulation.
Question 8
The nurse is preparing to administer vancomycin IV. Which assessment finding is most important to report to
the provider before the infusion?
A. Serum creatinine of 2.0 mg/dL
B. Blood pressure of 138/88 mmHg
