Actual ATI RN Pharmacology Exam
Retake 2023 with NGN Latest 2025
Version — 70 Real Retake Exam
Questions and 100% ATI Approved
Answers | Pass the RN ATI
Pharmacology Proctored Exam 2026
NGN BOW-TIE CASE 1 – Heparin-Induced Thrombocytopenia (HIT)
A 62-year-old client is receiving continuous IV heparin for a pulmonary embolism.
On day 5 of therapy, the client's platelet count drops from 240,000/µL to
80,000/µL. The client reports new-onset leg pain and shortness of breath.
QUESTION 1 (Bow-Tie Assessment – SATA)
Select all that apply. Which findings are consistent with heparin-induced
thrombocytopenia (HIT)?
A) Platelet count drop > 50% from baseline
B) New venous or arterial thromboembolism
C) Skin necrosis at heparin injection sites
D) Fever and chills
Correct Answers: A, B, C
Rationale: HIT is characterized by a > 50% platelet drop (A), new thrombosis (B)
,(paradoxical), and skin necrosis (C). Fever and chills (D) are more consistent with a
transfusion reaction or infection, not HIT.
QUESTION 2 (Bow-Tie Intervention)
The provider suspects HIT. Which action should the nurse take first?
A) Stop the heparin infusion immediately
B) Administer a platelet transfusion
C) Start a warfarin bridge
D) Increase the heparin rate to overcome resistance
Correct Answer: A) Stop the heparin infusion immediately
Rationale: All heparin products must be stopped immediately to prevent further
platelet activation and thrombosis. Platelet transfusions (B) are contraindicated
(can worsen thrombosis). Warfarin (C) is started later, but only after a direct
thrombin inhibitor is on board. Increasing heparin (D) is fatal.
QUESTION 3 (Bow-Tie Medication)
The provider orders argatroban (a direct thrombin inhibitor). Which laboratory
test should the nurse use to monitor this therapy?
A) INR
B) aPTT
C) Platelet count
D) Anti-factor Xa level
,Correct Answer: B) aPTT
Rationale: Argatroban is monitored using aPTT (target 1.5–3 times baseline). INR
(A) is for warfarin. Platelet count (C) is monitored for recovery but not for dosing.
Anti-Xa (D) is for unfractionated heparin or low-molecular-weight heparins.
QUESTION 4 (Bow-Tie Evaluation)
Three days after switching to argatroban, the platelet count rises to
150,000/µL. The provider wants to transition to warfarin. How should the nurse
manage this transition?
A) Stop argatroban and start warfarin simultaneously
B) Overlap argatroban and warfarin until INR is therapeutic for 2 consecutive days
C) Start warfarin only after platelet count normalizes
D) Give warfarin and argatroban together, but measure aPTT only
Correct Answer: B) Overlap argatroban and warfarin until INR is therapeutic for
2 consecutive days
Rationale: Warfarin causes a transient hypercoagulable state; overlap with a direct
thrombin inhibitor is required. Discontinue argatroban once INR is therapeutic on
warfarin alone for 2 days.
QUESTION 5 (Bow-Tie Teaching)
The client is discharged on warfarin. Which statement indicates understanding
of the new anticoagulant?
, A) "I will eat more green leafy vegetables to keep my blood thick."
B) "I will report any black, tarry stools to my provider."
C) "I will take ibuprofen for my headaches."
D) "I will stop warfarin if I get a bruise."
Correct Answer: B) "I will report any black, tarry stools to my provider."
Rationale: Black tarry stools indicate GI bleeding – must be reported. Green
vegetables (A) decrease warfarin effect. Ibuprofen (C) increases bleeding risk.
Bruises (D) are not an indication to stop.
NGN BOW-TIE CASE 2 – Aminoglycoside Toxicity (Questions 6–10)
A 55-year-old client is receiving IV gentamicin for a severe gram-negative infection.
The client reports ringing in the ears and dizziness. Current creatinine is 1.8 mg/dL
(baseline 0.9), and trough level is 2.5 mcg/mL (therapeutic trough < 2.0).
QUESTION 6 (Bow-Tie Assessment – SATA)
Select all that apply. Which assessments are priority for this client?
A) Audiometry for hearing loss
B) Serum creatinine and BUN
C) Urine output hourly
D) Serum potassium level
Correct Answers: A, B, C
Rationale: Gentamicin causes ototoxicity (A) and nephrotoxicity (B, C). Potassium
(D) is not directly affected by aminoglycosides (it is affected by loop diuretics).
Retake 2023 with NGN Latest 2025
Version — 70 Real Retake Exam
Questions and 100% ATI Approved
Answers | Pass the RN ATI
Pharmacology Proctored Exam 2026
NGN BOW-TIE CASE 1 – Heparin-Induced Thrombocytopenia (HIT)
A 62-year-old client is receiving continuous IV heparin for a pulmonary embolism.
On day 5 of therapy, the client's platelet count drops from 240,000/µL to
80,000/µL. The client reports new-onset leg pain and shortness of breath.
QUESTION 1 (Bow-Tie Assessment – SATA)
Select all that apply. Which findings are consistent with heparin-induced
thrombocytopenia (HIT)?
A) Platelet count drop > 50% from baseline
B) New venous or arterial thromboembolism
C) Skin necrosis at heparin injection sites
D) Fever and chills
Correct Answers: A, B, C
Rationale: HIT is characterized by a > 50% platelet drop (A), new thrombosis (B)
,(paradoxical), and skin necrosis (C). Fever and chills (D) are more consistent with a
transfusion reaction or infection, not HIT.
QUESTION 2 (Bow-Tie Intervention)
The provider suspects HIT. Which action should the nurse take first?
A) Stop the heparin infusion immediately
B) Administer a platelet transfusion
C) Start a warfarin bridge
D) Increase the heparin rate to overcome resistance
Correct Answer: A) Stop the heparin infusion immediately
Rationale: All heparin products must be stopped immediately to prevent further
platelet activation and thrombosis. Platelet transfusions (B) are contraindicated
(can worsen thrombosis). Warfarin (C) is started later, but only after a direct
thrombin inhibitor is on board. Increasing heparin (D) is fatal.
QUESTION 3 (Bow-Tie Medication)
The provider orders argatroban (a direct thrombin inhibitor). Which laboratory
test should the nurse use to monitor this therapy?
A) INR
B) aPTT
C) Platelet count
D) Anti-factor Xa level
,Correct Answer: B) aPTT
Rationale: Argatroban is monitored using aPTT (target 1.5–3 times baseline). INR
(A) is for warfarin. Platelet count (C) is monitored for recovery but not for dosing.
Anti-Xa (D) is for unfractionated heparin or low-molecular-weight heparins.
QUESTION 4 (Bow-Tie Evaluation)
Three days after switching to argatroban, the platelet count rises to
150,000/µL. The provider wants to transition to warfarin. How should the nurse
manage this transition?
A) Stop argatroban and start warfarin simultaneously
B) Overlap argatroban and warfarin until INR is therapeutic for 2 consecutive days
C) Start warfarin only after platelet count normalizes
D) Give warfarin and argatroban together, but measure aPTT only
Correct Answer: B) Overlap argatroban and warfarin until INR is therapeutic for
2 consecutive days
Rationale: Warfarin causes a transient hypercoagulable state; overlap with a direct
thrombin inhibitor is required. Discontinue argatroban once INR is therapeutic on
warfarin alone for 2 days.
QUESTION 5 (Bow-Tie Teaching)
The client is discharged on warfarin. Which statement indicates understanding
of the new anticoagulant?
, A) "I will eat more green leafy vegetables to keep my blood thick."
B) "I will report any black, tarry stools to my provider."
C) "I will take ibuprofen for my headaches."
D) "I will stop warfarin if I get a bruise."
Correct Answer: B) "I will report any black, tarry stools to my provider."
Rationale: Black tarry stools indicate GI bleeding – must be reported. Green
vegetables (A) decrease warfarin effect. Ibuprofen (C) increases bleeding risk.
Bruises (D) are not an indication to stop.
NGN BOW-TIE CASE 2 – Aminoglycoside Toxicity (Questions 6–10)
A 55-year-old client is receiving IV gentamicin for a severe gram-negative infection.
The client reports ringing in the ears and dizziness. Current creatinine is 1.8 mg/dL
(baseline 0.9), and trough level is 2.5 mcg/mL (therapeutic trough < 2.0).
QUESTION 6 (Bow-Tie Assessment – SATA)
Select all that apply. Which assessments are priority for this client?
A) Audiometry for hearing loss
B) Serum creatinine and BUN
C) Urine output hourly
D) Serum potassium level
Correct Answers: A, B, C
Rationale: Gentamicin causes ototoxicity (A) and nephrotoxicity (B, C). Potassium
(D) is not directly affected by aminoglycosides (it is affected by loop diuretics).
