ATI PN Mental Health, virtual, pharmacology and
fundamentals Proctored Exam with NGN 2023–
2026 | 75 Questions and Answers with verified
rationales and multiple choices | GRADEDA+ ||
100 % GUARANTEED PASS
A nurse is reviewing the medication administration record of a client who has a
nasogastric (NG) tube. Which of the following medications should the nurse plan to
administer through the NG tube?
A. Enteric-coated aspirin
B. Sustained-release nifedipine
C. Lovastatin
D. Sublingual nitroglycerin
Correct Answer: C. Lovastatin
Rationale:
Lovastatin is available in an immediate-release tablet that may be crushed (if it is not an
extended-release formulation) and administered through a nasogastric (NG) tube according
to institutional policy and manufacturer recommendations. Before administration, the nurse
should verify that the medication formulation is appropriate for crushing. After
administering the medication, the nurse should flush the tube with water before and after
medication administration to prevent tube occlusion and ensure complete delivery of the
drug.
• Option A: Enteric-coated aspirin is incorrect because enteric-coated tablets should
never be crushed. Crushing destroys the protective coating, increasing the risk of
gastric irritation and gastrointestinal bleeding while altering the intended site of
absorption.
• Option B: Sustained-release nifedipine is incorrect because extended-release or
sustained-release medications must never be crushed or administered through an
NG tube. Crushing these formulations results in dose dumping, leading to rapid
absorption and potentially severe hypotension.
, • Option D: Sublingual nitroglycerin is incorrect because it must dissolve under the
tongue for rapid absorption through the oral mucosa. Administration through an NG
tube significantly reduces its effectiveness.
Exam Tip: Never crush enteric-coated (EC), sustained-release (SR), extended-release (ER, XR,
XL), delayed-release (DR), or sublingual medications unless specifically approved.
A nurse is collecting data from a client who is taking lithium carbonate to treat bipolar
disorder. Which of the following findings should the nurse monitor and report to the
provider?
A. Mild dry mouth
B. Tremor
C. Increased appetite
D. Occasional constipation
Correct Answer: B. Tremor
Rationale:
Tremor is one of the earliest manifestations of lithium toxicity and should be reported
promptly. Although a mild fine tremor can occur during therapeutic use, worsening tremors,
coarse tremors, muscle weakness, confusion, ataxia, slurred speech, persistent
gastrointestinal symptoms, and seizures suggest lithium toxicity. Because lithium has a very
narrow therapeutic index (0.6–1.2 mEq/L), clients require frequent monitoring of serum
lithium levels, kidney function, hydration status, and sodium intake.
• Option A: Mild dry mouth is a relatively common side effect and can usually be
managed with adequate hydration and sugar-free gum. It does not typically indicate
toxicity.
• Option C: Increased appetite is not a classic indicator of lithium toxicity.
• Option D: Occasional constipation may occur with several medications but is not a
hallmark sign of lithium toxicity.
Clinical Pearl: Dehydration, excessive sweating, vomiting, diarrhea, low sodium intake, and
diuretics increase the risk of lithium toxicity because lithium is reabsorbed when sodium
levels fall.
A nurse is caring for a client who has prescriptions for spironolactone and lisinopril. The
nurse should monitor for which of the following adverse effects?
,A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Correct Answer: C. Hyperkalemia
Rationale:
Both spironolactone and lisinopril increase serum potassium levels through different
mechanisms. Spironolactone is a potassium-sparing diuretic that inhibits aldosterone,
reducing potassium excretion. Lisinopril, an ACE inhibitor, decreases aldosterone secretion,
which also reduces potassium excretion. When used together, these medications
substantially increase the risk of hyperkalemia.
Manifestations include muscle weakness, paresthesia, fatigue, bradycardia, cardiac
conduction abnormalities, and life-threatening dysrhythmias. The nurse should monitor
serum potassium levels, renal function, and electrocardiogram (ECG) changes.
• Option A: Hypokalemia is incorrect because spironolactone conserves potassium.
• Option B: Hypernatremia is not the primary concern with this medication
combination.
• Option D: Hypocalcemia is unrelated to the pharmacologic actions of these
medications.
NCLEX Tip: Whenever ACE inhibitors are combined with potassium-sparing diuretics or
potassium supplements, immediately think hyperkalemia.
A nurse is preparing to administer acetaminophen 650 mg rectally. Which of the following
actions should the nurse take?
A. Insert the suppository 2 cm (1 in) into the rectum.
B. Insert the suppository 5 cm (2 in) into the client's rectum.
C. Lubricate the blunt end of the suppository.
D. Ask the client to remain in a supine position after insertion.
Correct Answer: B. Insert the suppository 5 cm (2 in) into the client's rectum.
Rationale:
For adults, rectal suppositories should be inserted approximately 5 cm (2 inches) beyond the
anal sphincter. Proper placement prevents expulsion and allows adequate absorption
through the rectal mucosa. The client should remain lying on the side for approximately 5 to
10 minutes after insertion to facilitate retention.
, • Option A: One inch is generally insufficient for adult insertion and increases the
likelihood of the suppository being expelled.
• Option C: The pointed end—not the blunt end—is lubricated and inserted first
because it passes more easily through the anal sphincter.
• Option D: Clients should remain in the left lateral (Sims') position rather than supine
immediately after administration.
Clinical Tip: Inserting the suppository past the internal sphincter improves medication
retention and therapeutic effectiveness.
A nurse is collecting data from a client who takes furosemide daily for heart failure. Which
of the following laboratory values should the nurse review before administering the
medication?
A. Serum sodium
B. Hemoglobin
C. Serum potassium
D. Platelet count
Correct Answer: C. Serum potassium
Rationale:
Furosemide is a loop diuretic that promotes significant potassium excretion. Hypokalemia is
one of its most common and potentially dangerous adverse effects because low potassium
levels increase the risk of ventricular dysrhythmias, especially in clients with heart disease or
those taking digoxin.
The nurse should assess potassium levels before administration and monitor for
manifestations such as muscle weakness, fatigue, constipation, leg cramps, and irregular
cardiac rhythms.
• Option A: Sodium may decrease with diuretic therapy, but potassium monitoring is
the priority because of the immediate cardiac risks.
• Option B: Hemoglobin is not routinely monitored before administering furosemide.
• Option D: Platelet count is unrelated to routine furosemide therapy.
Exam Tip: Remember the common adverse effects of loop diuretics:
• Hypokalemia
• Hyponatremia
• Hypomagnesemia
fundamentals Proctored Exam with NGN 2023–
2026 | 75 Questions and Answers with verified
rationales and multiple choices | GRADEDA+ ||
100 % GUARANTEED PASS
A nurse is reviewing the medication administration record of a client who has a
nasogastric (NG) tube. Which of the following medications should the nurse plan to
administer through the NG tube?
A. Enteric-coated aspirin
B. Sustained-release nifedipine
C. Lovastatin
D. Sublingual nitroglycerin
Correct Answer: C. Lovastatin
Rationale:
Lovastatin is available in an immediate-release tablet that may be crushed (if it is not an
extended-release formulation) and administered through a nasogastric (NG) tube according
to institutional policy and manufacturer recommendations. Before administration, the nurse
should verify that the medication formulation is appropriate for crushing. After
administering the medication, the nurse should flush the tube with water before and after
medication administration to prevent tube occlusion and ensure complete delivery of the
drug.
• Option A: Enteric-coated aspirin is incorrect because enteric-coated tablets should
never be crushed. Crushing destroys the protective coating, increasing the risk of
gastric irritation and gastrointestinal bleeding while altering the intended site of
absorption.
• Option B: Sustained-release nifedipine is incorrect because extended-release or
sustained-release medications must never be crushed or administered through an
NG tube. Crushing these formulations results in dose dumping, leading to rapid
absorption and potentially severe hypotension.
, • Option D: Sublingual nitroglycerin is incorrect because it must dissolve under the
tongue for rapid absorption through the oral mucosa. Administration through an NG
tube significantly reduces its effectiveness.
Exam Tip: Never crush enteric-coated (EC), sustained-release (SR), extended-release (ER, XR,
XL), delayed-release (DR), or sublingual medications unless specifically approved.
A nurse is collecting data from a client who is taking lithium carbonate to treat bipolar
disorder. Which of the following findings should the nurse monitor and report to the
provider?
A. Mild dry mouth
B. Tremor
C. Increased appetite
D. Occasional constipation
Correct Answer: B. Tremor
Rationale:
Tremor is one of the earliest manifestations of lithium toxicity and should be reported
promptly. Although a mild fine tremor can occur during therapeutic use, worsening tremors,
coarse tremors, muscle weakness, confusion, ataxia, slurred speech, persistent
gastrointestinal symptoms, and seizures suggest lithium toxicity. Because lithium has a very
narrow therapeutic index (0.6–1.2 mEq/L), clients require frequent monitoring of serum
lithium levels, kidney function, hydration status, and sodium intake.
• Option A: Mild dry mouth is a relatively common side effect and can usually be
managed with adequate hydration and sugar-free gum. It does not typically indicate
toxicity.
• Option C: Increased appetite is not a classic indicator of lithium toxicity.
• Option D: Occasional constipation may occur with several medications but is not a
hallmark sign of lithium toxicity.
Clinical Pearl: Dehydration, excessive sweating, vomiting, diarrhea, low sodium intake, and
diuretics increase the risk of lithium toxicity because lithium is reabsorbed when sodium
levels fall.
A nurse is caring for a client who has prescriptions for spironolactone and lisinopril. The
nurse should monitor for which of the following adverse effects?
,A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Correct Answer: C. Hyperkalemia
Rationale:
Both spironolactone and lisinopril increase serum potassium levels through different
mechanisms. Spironolactone is a potassium-sparing diuretic that inhibits aldosterone,
reducing potassium excretion. Lisinopril, an ACE inhibitor, decreases aldosterone secretion,
which also reduces potassium excretion. When used together, these medications
substantially increase the risk of hyperkalemia.
Manifestations include muscle weakness, paresthesia, fatigue, bradycardia, cardiac
conduction abnormalities, and life-threatening dysrhythmias. The nurse should monitor
serum potassium levels, renal function, and electrocardiogram (ECG) changes.
• Option A: Hypokalemia is incorrect because spironolactone conserves potassium.
• Option B: Hypernatremia is not the primary concern with this medication
combination.
• Option D: Hypocalcemia is unrelated to the pharmacologic actions of these
medications.
NCLEX Tip: Whenever ACE inhibitors are combined with potassium-sparing diuretics or
potassium supplements, immediately think hyperkalemia.
A nurse is preparing to administer acetaminophen 650 mg rectally. Which of the following
actions should the nurse take?
A. Insert the suppository 2 cm (1 in) into the rectum.
B. Insert the suppository 5 cm (2 in) into the client's rectum.
C. Lubricate the blunt end of the suppository.
D. Ask the client to remain in a supine position after insertion.
Correct Answer: B. Insert the suppository 5 cm (2 in) into the client's rectum.
Rationale:
For adults, rectal suppositories should be inserted approximately 5 cm (2 inches) beyond the
anal sphincter. Proper placement prevents expulsion and allows adequate absorption
through the rectal mucosa. The client should remain lying on the side for approximately 5 to
10 minutes after insertion to facilitate retention.
, • Option A: One inch is generally insufficient for adult insertion and increases the
likelihood of the suppository being expelled.
• Option C: The pointed end—not the blunt end—is lubricated and inserted first
because it passes more easily through the anal sphincter.
• Option D: Clients should remain in the left lateral (Sims') position rather than supine
immediately after administration.
Clinical Tip: Inserting the suppository past the internal sphincter improves medication
retention and therapeutic effectiveness.
A nurse is collecting data from a client who takes furosemide daily for heart failure. Which
of the following laboratory values should the nurse review before administering the
medication?
A. Serum sodium
B. Hemoglobin
C. Serum potassium
D. Platelet count
Correct Answer: C. Serum potassium
Rationale:
Furosemide is a loop diuretic that promotes significant potassium excretion. Hypokalemia is
one of its most common and potentially dangerous adverse effects because low potassium
levels increase the risk of ventricular dysrhythmias, especially in clients with heart disease or
those taking digoxin.
The nurse should assess potassium levels before administration and monitor for
manifestations such as muscle weakness, fatigue, constipation, leg cramps, and irregular
cardiac rhythms.
• Option A: Sodium may decrease with diuretic therapy, but potassium monitoring is
the priority because of the immediate cardiac risks.
• Option B: Hemoglobin is not routinely monitored before administering furosemide.
• Option D: Platelet count is unrelated to routine furosemide therapy.
Exam Tip: Remember the common adverse effects of loop diuretics:
• Hypokalemia
• Hyponatremia
• Hypomagnesemia
