ATI RN Pharmacology Exam with NGN 70 Questions | Self-Study Edition
ATI RN Pharmacology Exam
Next Generation NCLEX (NGN) Format | 70 Questions with Answers and
Rationales 2026 update
1. Aclient with heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor most closely?
A. Serum sodium 140 mEq/L
B. Serum potassium 3.0 mEq/L
C. Serum calcium 9.5 mg/dL
D. Serum chloride 100 mEq/L
Correct Answer: B. Serum potassium 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes increased excretion of
potassium, sodium, and water. Hypokalemia (potassium less than 3.5 mEq/L) is a
common and dangerous adverse effect that can lead to cardiac dysrhythmias. A
serum potassium of 3.0 mEq/L indicates hypokalemia and requires immediate
intervention such as potassium supplementation or potassium-sparing diuretic
adjustment. The nurse should monitor potassium levels closely and assess for signs
of hypokalemia including muscle weakness, fatigue, and irregular heart rate.
2. Anurse is administering digoxin (Lanoxin) to a client with atrial fibrillation. The
client's apical heart rate is 52 bpm. What is the nurse's best action?
A. Administer the dose as prescribed
B. Hold the dose and notify the provider
C. Administer half the prescribed dose
D. Give the dose with orange juice
Correct Answer: B. Hold the dose and notify the provider
Rationale: Digoxin slows conduction through the AV node and decreases heart rate.
The nurse must assess the apical heart rate for one full minute before administering
Page 1
,ATI RN Pharmacology Exam with NGN 70 Questions | Self-Study Edition
digoxin. If the apical heart rate is below 60 bpm (or below the provider-specified
parameter, which is often 60 bpm for adults), the nurse should hold the dose and
notify the prescribing provider.
Administering digoxin when the heart rate is already bradycardic increases the risk
of severe bradycardia, heart block, and digoxin toxicity.
Page 2
,ATI RN Pharmacology Exam with NGN 70 Questions | Self-Study Edition
[Multiple Choice (NGN)]
3. A
client is receiving heparin sodium via continuous IV infusion for a
pulmonary embolism. The aPTT is reported as 75 seconds. What should the
nurse do first?
A. Stop the infusion immediately
B. Increase the infusion rate as prescribed
C. Continue the current infusion rate
D. Administer protamine sulfate
Correct Answer: B. Increase the infusion rate as prescribed
Rationale: The therapeutic range for aPTT when a client is receiving heparin
therapy is typically 1.5 to 2.5 times the control value (approximately 60 to 80
seconds for most labs). An aPTT of 75 seconds falls within the therapeutic range,
indicating the heparin is effective. Since the aPTT is at the lower end of therapeutic
range, the nurse should anticipate the provider may increase the rate to achieve
optimal anticoagulation. The nurse should not stop the infusion or administer
protamine sulfate, as these actions are reserved for dangerously elevated aPTT
values or signs of bleeding.
[Select All That Apply (NGN)]
4. A nurse is teaching a client who is starting warfarin (Coumadin) therapy. Which
of the following statements by the client indicate an understanding of the
teaching? (Select all that apply)
A. "I should eat a consistent amount of green leafy vegetables."
B. "I will use a soft toothbrush to brush my teeth."
C. "I can take ibuprofen for my headaches."
D. "I will have my blood checked regularly."
E. "I should avoid alcohol while taking this medication."
Correct Answer: A, B, D, E
Rationale: Warfarin is a vitamin K antagonist anticoagulant. Clients should
maintain a consistent intake of vitamin K-rich foods (green leafy vegetables) because
sudden changes can alter INR levels. Using a soft toothbrush reduces bleeding risk.
Regular INR monitoring is essential for safe warfarin therapy. Alcohol should be
Page 3
, ATI RN Pharmacology Exam with NGN 70 Questions | Self-Study Edition
avoided because it potentiates warfarin's effects and increases bleeding risk.
Ibuprofen (a nonsteroidal anti-inflammatory drug) should be avoided because it
inhibits platelet aggregation and increases GI bleeding risk when combined with
anticoagulants. Acetaminophen is the preferred analgesic.
5. A
client with type 2 diabetes mellitus is prescribed metformin (Glucophage).
The nurse should instruct the client to report which symptom immediately?
A. Mild headache
B. Muscle pain and weakness
C. Occasional nausea after meals
D. Increased thirst and urination
Correct Answer: B. Muscle pain and weakness
Rationale: Metformin carries a black box warning for lactic acidosis, a rare but life-
threatening complication. Symptoms of lactic acidosis include muscle pain or
weakness, trouble breathing, dizziness, lightheadedness, feeling cold, and unusual
stomach discomfort. These symptoms require immediate medical attention. While
metformin can cause gastrointestinal side effects such as nausea, these are usually
mild and transient. Increased thirst and urination may indicate hyperglycemia but
are not the most urgent concern associated with metformin therapy. The risk of lactic
acidosis is higher in clients with renal impairment, liver disease, or heart failure.
Page 4
ATI RN Pharmacology Exam
Next Generation NCLEX (NGN) Format | 70 Questions with Answers and
Rationales 2026 update
1. Aclient with heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor most closely?
A. Serum sodium 140 mEq/L
B. Serum potassium 3.0 mEq/L
C. Serum calcium 9.5 mg/dL
D. Serum chloride 100 mEq/L
Correct Answer: B. Serum potassium 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes increased excretion of
potassium, sodium, and water. Hypokalemia (potassium less than 3.5 mEq/L) is a
common and dangerous adverse effect that can lead to cardiac dysrhythmias. A
serum potassium of 3.0 mEq/L indicates hypokalemia and requires immediate
intervention such as potassium supplementation or potassium-sparing diuretic
adjustment. The nurse should monitor potassium levels closely and assess for signs
of hypokalemia including muscle weakness, fatigue, and irregular heart rate.
2. Anurse is administering digoxin (Lanoxin) to a client with atrial fibrillation. The
client's apical heart rate is 52 bpm. What is the nurse's best action?
A. Administer the dose as prescribed
B. Hold the dose and notify the provider
C. Administer half the prescribed dose
D. Give the dose with orange juice
Correct Answer: B. Hold the dose and notify the provider
Rationale: Digoxin slows conduction through the AV node and decreases heart rate.
The nurse must assess the apical heart rate for one full minute before administering
Page 1
,ATI RN Pharmacology Exam with NGN 70 Questions | Self-Study Edition
digoxin. If the apical heart rate is below 60 bpm (or below the provider-specified
parameter, which is often 60 bpm for adults), the nurse should hold the dose and
notify the prescribing provider.
Administering digoxin when the heart rate is already bradycardic increases the risk
of severe bradycardia, heart block, and digoxin toxicity.
Page 2
,ATI RN Pharmacology Exam with NGN 70 Questions | Self-Study Edition
[Multiple Choice (NGN)]
3. A
client is receiving heparin sodium via continuous IV infusion for a
pulmonary embolism. The aPTT is reported as 75 seconds. What should the
nurse do first?
A. Stop the infusion immediately
B. Increase the infusion rate as prescribed
C. Continue the current infusion rate
D. Administer protamine sulfate
Correct Answer: B. Increase the infusion rate as prescribed
Rationale: The therapeutic range for aPTT when a client is receiving heparin
therapy is typically 1.5 to 2.5 times the control value (approximately 60 to 80
seconds for most labs). An aPTT of 75 seconds falls within the therapeutic range,
indicating the heparin is effective. Since the aPTT is at the lower end of therapeutic
range, the nurse should anticipate the provider may increase the rate to achieve
optimal anticoagulation. The nurse should not stop the infusion or administer
protamine sulfate, as these actions are reserved for dangerously elevated aPTT
values or signs of bleeding.
[Select All That Apply (NGN)]
4. A nurse is teaching a client who is starting warfarin (Coumadin) therapy. Which
of the following statements by the client indicate an understanding of the
teaching? (Select all that apply)
A. "I should eat a consistent amount of green leafy vegetables."
B. "I will use a soft toothbrush to brush my teeth."
C. "I can take ibuprofen for my headaches."
D. "I will have my blood checked regularly."
E. "I should avoid alcohol while taking this medication."
Correct Answer: A, B, D, E
Rationale: Warfarin is a vitamin K antagonist anticoagulant. Clients should
maintain a consistent intake of vitamin K-rich foods (green leafy vegetables) because
sudden changes can alter INR levels. Using a soft toothbrush reduces bleeding risk.
Regular INR monitoring is essential for safe warfarin therapy. Alcohol should be
Page 3
, ATI RN Pharmacology Exam with NGN 70 Questions | Self-Study Edition
avoided because it potentiates warfarin's effects and increases bleeding risk.
Ibuprofen (a nonsteroidal anti-inflammatory drug) should be avoided because it
inhibits platelet aggregation and increases GI bleeding risk when combined with
anticoagulants. Acetaminophen is the preferred analgesic.
5. A
client with type 2 diabetes mellitus is prescribed metformin (Glucophage).
The nurse should instruct the client to report which symptom immediately?
A. Mild headache
B. Muscle pain and weakness
C. Occasional nausea after meals
D. Increased thirst and urination
Correct Answer: B. Muscle pain and weakness
Rationale: Metformin carries a black box warning for lactic acidosis, a rare but life-
threatening complication. Symptoms of lactic acidosis include muscle pain or
weakness, trouble breathing, dizziness, lightheadedness, feeling cold, and unusual
stomach discomfort. These symptoms require immediate medical attention. While
metformin can cause gastrointestinal side effects such as nausea, these are usually
mild and transient. Increased thirst and urination may indicate hyperglycemia but
are not the most urgent concern associated with metformin therapy. The risk of lactic
acidosis is higher in clients with renal impairment, liver disease, or heart failure.
Page 4
