ATI RN Pharmacology Proctored Exam 2026/2027 |
Questions with 100% Verified Answers & Rationales
(NGN Included
📋 Section 1: Pharmacokinetics, Dosage & Safety (Q1–Q15)
Question 1
A nurse is preparing to administer an intramuscular (IM) injection to an adult client. Which of
the following needle gauge and length combinations is most appropriate for a deep IM
injection into the ventrogluteal muscle of an average-weight adult?
A) 25-gauge, 5/8-inch
B) 20-gauge, 1.5-inch
C) 18-gauge, 2-inch
D) 27-gauge, 1/2-inch
Correct Answer: B
Rationale: A 20- to 22-gauge, 1.5-inch needle is standard for deep intramuscular injections
in ventrogluteal sites on average-weight adults to ensure deposition into the muscle belly
rather than subcutaneous tissue.
Question 2
A nurse receives a verbal medication prescription from a provider: "Give morphine 4 mg IV
push now." Which of the following actions should the nurse take first?
, A) Administer the medication immediately.
B) Read back the complete order to the provider for confirmation.
C) Document the order in the electronic health record.
D) Ask a second nurse to witness the order entry.
Correct Answer: B
Rationale: When receiving a verbal or telephone order, the nurse must immediately perform
a read-back of the full prescription to the provider to prevent medication errors before
carrying out the intervention.
Question 3
A client with end-stage renal disease (ESRD) is prescribed a medication that is primarily
excreted by the kidneys. The nurse should recognize that this client is at highest risk for
which of the following outcomes?
A) Decreased peak therapeutic level
B) Rapid drug clearance
C) Drug toxicity due to accumulation
D) Impaired first-pass metabolism in the liver
Correct Answer: C
Rationale: Renal impairment reduces drug excretion, leading to higher serum
concentrations and an increased risk of accumulation and toxicity. Dosages typically need
downward adjustment.
Question 4
,A nurse is preparing to mix NPH insulin and regular insulin in a single syringe. In which
order should the nurse draw up the insulins?
A) NPH insulin first, followed by regular insulin.
B) Regular insulin first, followed by NPH insulin.
C) Either insulin first as long as total volume is accurate.
D) Mix them in two separate syringes and inject sequentially.
Correct Answer: B
Rationale: To prevent contamination of the short-acting regular insulin vial with
intermediate-acting NPH insulin, air is injected into NPH first, then regular; then regular
insulin is drawn up before NPH (remember: "Clear before Cloudy").
Question 5
A nurse is administering a transdermal fentanyl patch to a client experiencing chronic pain.
Which of the following instructions is correct?
A) Apply a heating pad over the patch to accelerate absorption.
B) Cut the patch in half if a lower dose is needed.
C) Cleanse the site with soap and water, dry completely, and apply to an hairless
area.
D) Flush used patches down the toilet without folding.
Correct Answer: C
Rationale: Transdermal patches should be applied to clean, dry, intact, non-hairy skin. Heat
increases absorption dangerously (causing toxicity). Patches should never be cut as this
, alters controlled release, and spent patches must be folded sticky-side in and disposed of
per facility safety policy.
Question 6
A client reports taking an over-the-counter herbal supplement, St. John's Wort. The nurse
should educate the client that St. John's Wort can significantly decrease the effectiveness of
which prescribed medication?
A) Acetaminophen
B) Oral contraceptives
C) Levothyroxine
D) Diphenhydramine
Correct Answer: B
Rationale: St. John's Wort induces liver enzymes (CYP3A4), accelerating the metabolism of
oral contraceptives, cyclosporine, warfarin, and antiretrovirals, thereby reducing their
therapeutic efficacy.
Question 7
A nurse is reconstituting a powdered medication. Which of the following information must
the nurse write on the vial label after reconstitution?
A) Date and time of reconstitution, initials, and concentration/expiration date.
B) Client's medical record number and primary diagnosis.
C) Manufacturer lot number and pharmacy phone number.
D) Prescriber name and facility room number.
Questions with 100% Verified Answers & Rationales
(NGN Included
📋 Section 1: Pharmacokinetics, Dosage & Safety (Q1–Q15)
Question 1
A nurse is preparing to administer an intramuscular (IM) injection to an adult client. Which of
the following needle gauge and length combinations is most appropriate for a deep IM
injection into the ventrogluteal muscle of an average-weight adult?
A) 25-gauge, 5/8-inch
B) 20-gauge, 1.5-inch
C) 18-gauge, 2-inch
D) 27-gauge, 1/2-inch
Correct Answer: B
Rationale: A 20- to 22-gauge, 1.5-inch needle is standard for deep intramuscular injections
in ventrogluteal sites on average-weight adults to ensure deposition into the muscle belly
rather than subcutaneous tissue.
Question 2
A nurse receives a verbal medication prescription from a provider: "Give morphine 4 mg IV
push now." Which of the following actions should the nurse take first?
, A) Administer the medication immediately.
B) Read back the complete order to the provider for confirmation.
C) Document the order in the electronic health record.
D) Ask a second nurse to witness the order entry.
Correct Answer: B
Rationale: When receiving a verbal or telephone order, the nurse must immediately perform
a read-back of the full prescription to the provider to prevent medication errors before
carrying out the intervention.
Question 3
A client with end-stage renal disease (ESRD) is prescribed a medication that is primarily
excreted by the kidneys. The nurse should recognize that this client is at highest risk for
which of the following outcomes?
A) Decreased peak therapeutic level
B) Rapid drug clearance
C) Drug toxicity due to accumulation
D) Impaired first-pass metabolism in the liver
Correct Answer: C
Rationale: Renal impairment reduces drug excretion, leading to higher serum
concentrations and an increased risk of accumulation and toxicity. Dosages typically need
downward adjustment.
Question 4
,A nurse is preparing to mix NPH insulin and regular insulin in a single syringe. In which
order should the nurse draw up the insulins?
A) NPH insulin first, followed by regular insulin.
B) Regular insulin first, followed by NPH insulin.
C) Either insulin first as long as total volume is accurate.
D) Mix them in two separate syringes and inject sequentially.
Correct Answer: B
Rationale: To prevent contamination of the short-acting regular insulin vial with
intermediate-acting NPH insulin, air is injected into NPH first, then regular; then regular
insulin is drawn up before NPH (remember: "Clear before Cloudy").
Question 5
A nurse is administering a transdermal fentanyl patch to a client experiencing chronic pain.
Which of the following instructions is correct?
A) Apply a heating pad over the patch to accelerate absorption.
B) Cut the patch in half if a lower dose is needed.
C) Cleanse the site with soap and water, dry completely, and apply to an hairless
area.
D) Flush used patches down the toilet without folding.
Correct Answer: C
Rationale: Transdermal patches should be applied to clean, dry, intact, non-hairy skin. Heat
increases absorption dangerously (causing toxicity). Patches should never be cut as this
, alters controlled release, and spent patches must be folded sticky-side in and disposed of
per facility safety policy.
Question 6
A client reports taking an over-the-counter herbal supplement, St. John's Wort. The nurse
should educate the client that St. John's Wort can significantly decrease the effectiveness of
which prescribed medication?
A) Acetaminophen
B) Oral contraceptives
C) Levothyroxine
D) Diphenhydramine
Correct Answer: B
Rationale: St. John's Wort induces liver enzymes (CYP3A4), accelerating the metabolism of
oral contraceptives, cyclosporine, warfarin, and antiretrovirals, thereby reducing their
therapeutic efficacy.
Question 7
A nurse is reconstituting a powdered medication. Which of the following information must
the nurse write on the vial label after reconstitution?
A) Date and time of reconstitution, initials, and concentration/expiration date.
B) Client's medical record number and primary diagnosis.
C) Manufacturer lot number and pharmacy phone number.
D) Prescriber name and facility room number.
