ATI RN Pharmacology — Level 3 NGN Practice Exam | Complete
Questions with Verified Correct Answers & Detailed
Explanations –2026/2027 update | Graded A+
Format: NGN Case Studies + Clinical Judgment + Multiple Response + Matrix +
Bow-Tie
CASE STUDY 1 — Heart Failure and Digoxin
A 72-year-old client with heart failure and atrial fibrillation is prescribed
digoxin 0.125 mg PO daily and furosemide 40 mg PO daily. During morning
assessment, the nurse notes:
Apical pulse: 52/min
BP: 104/66 mmHg
Potassium: 3.0 mEq/L
Creatinine: 1.6 mg/dL
Client reports nausea and poor appetite
Client states that "lights sometimes look yellow."
Question 1 — NGN Multiple Response
Which findings require the nurse's immediate attention? Select all that
apply.
A. Apical pulse of 52/min
B. Potassium of 3.0 mEq/L
C. Creatinine of 1.6 mg/dL
D. Nausea and poor appetite
E. Yellow visual disturbances
F. BP of 104/66 mmHg
Correct Answers: A, B, D, E
Rationale:
The combination of bradycardia, hypokalemia, gastrointestinal
symptoms, and yellow visual disturbances strongly suggests digoxin
1
,toxicity. Hypokalemia caused by furosemide increases myocardial sensitivity
to digoxin. Renal impairment can also reduce digoxin clearance. The nurse
should withhold digoxin and notify the provider.
Question 2 — NGN Matrix
For each finding, determine whether it increases the client's risk for digoxin
toxicity, is a possible manifestation of toxicity, or is not specifically
associated with digoxin toxicity.
Not Specifically
Finding Risk Factor Manifestation
Associated
Potassium 3.0
✓
mEq/L
Nausea ✓
Yellow vision ✓
Elevated creatinine ✓
Apical pulse 52/min ✓
BP 104/66 mmHg ✓
Rationale:
Hypokalemia and impaired renal clearance increase toxicity risk. Nausea,
visual disturbances, and bradycardia are recognized manifestations. A BP of
104/66 mmHg alone is not diagnostic of digoxin toxicity.
Question 3 — NGN Bow-Tie
The nurse suspects digoxin toxicity.
Select the most appropriate actions and anticipated parameters.
Condition:
The client is experiencing:
A. Digoxin toxicity
B. Acute hypoglycemia
2
,C. Serotonin syndrome
D. Opioid toxicity
Actions:
A. Hold digoxin
B. Administer the next dose early
C. Notify the provider
D. Encourage potassium restriction
E. Place the client on cardiac monitoring
F. Administer an additional dose of furosemide
Parameters to monitor:
A. Cardiac rhythm
B. Serum potassium
C. Serum digoxin concentration
D. Respiratory rate only
E. Blood glucose only
Correct Answers:
Condition: A
Actions: A, C, E
Parameters: A, B, C
Rationale:
Suspected digoxin toxicity requires withholding the drug, notifying the
provider, and monitoring cardiac rhythm. Potassium and digoxin levels are
important because electrolyte abnormalities can worsen toxicity and serum
concentrations can help guide treatment.
CASE STUDY 2 — Anticoagulant Safety
A 68-year-old client with atrial fibrillation takes warfarin. The client reports
taking an over-the-counter medication for back pain every day. The nurse
reviews the medication list and notes:
Warfarin 5 mg daily
3
, Ibuprofen 400 mg three times daily
Aspirin 81 mg daily
INR: 5.8
Hemoglobin: decreased from 13.2 to 10.7 g/dL
Client reports dark, tarry stools.
Question 4 — NGN Multiple Response
Which findings are most concerning? Select all that apply.
A. INR 5.8
B. Daily ibuprofen use
C. Daily aspirin use
D. Dark, tarry stools
E. Hemoglobin 10.7 g/dL
F. History of atrial fibrillation
Correct Answers: A, B, C, D, E
Rationale:
The client has multiple indicators of excessive anticoagulation and possible
gastrointestinal bleeding. Warfarin combined with aspirin and NSAIDs
increases bleeding risk. The elevated INR and declining hemoglobin further
support concern for significant bleeding.
Question 5 — NGN Cloze
Complete the statement.
The nurse should first _____ the warfarin and _____ the provider because the
client is experiencing possible _____.
Answers:
Hold
Notify
Gastrointestinal bleeding
4
Questions with Verified Correct Answers & Detailed
Explanations –2026/2027 update | Graded A+
Format: NGN Case Studies + Clinical Judgment + Multiple Response + Matrix +
Bow-Tie
CASE STUDY 1 — Heart Failure and Digoxin
A 72-year-old client with heart failure and atrial fibrillation is prescribed
digoxin 0.125 mg PO daily and furosemide 40 mg PO daily. During morning
assessment, the nurse notes:
Apical pulse: 52/min
BP: 104/66 mmHg
Potassium: 3.0 mEq/L
Creatinine: 1.6 mg/dL
Client reports nausea and poor appetite
Client states that "lights sometimes look yellow."
Question 1 — NGN Multiple Response
Which findings require the nurse's immediate attention? Select all that
apply.
A. Apical pulse of 52/min
B. Potassium of 3.0 mEq/L
C. Creatinine of 1.6 mg/dL
D. Nausea and poor appetite
E. Yellow visual disturbances
F. BP of 104/66 mmHg
Correct Answers: A, B, D, E
Rationale:
The combination of bradycardia, hypokalemia, gastrointestinal
symptoms, and yellow visual disturbances strongly suggests digoxin
1
,toxicity. Hypokalemia caused by furosemide increases myocardial sensitivity
to digoxin. Renal impairment can also reduce digoxin clearance. The nurse
should withhold digoxin and notify the provider.
Question 2 — NGN Matrix
For each finding, determine whether it increases the client's risk for digoxin
toxicity, is a possible manifestation of toxicity, or is not specifically
associated with digoxin toxicity.
Not Specifically
Finding Risk Factor Manifestation
Associated
Potassium 3.0
✓
mEq/L
Nausea ✓
Yellow vision ✓
Elevated creatinine ✓
Apical pulse 52/min ✓
BP 104/66 mmHg ✓
Rationale:
Hypokalemia and impaired renal clearance increase toxicity risk. Nausea,
visual disturbances, and bradycardia are recognized manifestations. A BP of
104/66 mmHg alone is not diagnostic of digoxin toxicity.
Question 3 — NGN Bow-Tie
The nurse suspects digoxin toxicity.
Select the most appropriate actions and anticipated parameters.
Condition:
The client is experiencing:
A. Digoxin toxicity
B. Acute hypoglycemia
2
,C. Serotonin syndrome
D. Opioid toxicity
Actions:
A. Hold digoxin
B. Administer the next dose early
C. Notify the provider
D. Encourage potassium restriction
E. Place the client on cardiac monitoring
F. Administer an additional dose of furosemide
Parameters to monitor:
A. Cardiac rhythm
B. Serum potassium
C. Serum digoxin concentration
D. Respiratory rate only
E. Blood glucose only
Correct Answers:
Condition: A
Actions: A, C, E
Parameters: A, B, C
Rationale:
Suspected digoxin toxicity requires withholding the drug, notifying the
provider, and monitoring cardiac rhythm. Potassium and digoxin levels are
important because electrolyte abnormalities can worsen toxicity and serum
concentrations can help guide treatment.
CASE STUDY 2 — Anticoagulant Safety
A 68-year-old client with atrial fibrillation takes warfarin. The client reports
taking an over-the-counter medication for back pain every day. The nurse
reviews the medication list and notes:
Warfarin 5 mg daily
3
, Ibuprofen 400 mg three times daily
Aspirin 81 mg daily
INR: 5.8
Hemoglobin: decreased from 13.2 to 10.7 g/dL
Client reports dark, tarry stools.
Question 4 — NGN Multiple Response
Which findings are most concerning? Select all that apply.
A. INR 5.8
B. Daily ibuprofen use
C. Daily aspirin use
D. Dark, tarry stools
E. Hemoglobin 10.7 g/dL
F. History of atrial fibrillation
Correct Answers: A, B, C, D, E
Rationale:
The client has multiple indicators of excessive anticoagulation and possible
gastrointestinal bleeding. Warfarin combined with aspirin and NSAIDs
increases bleeding risk. The elevated INR and declining hemoglobin further
support concern for significant bleeding.
Question 5 — NGN Cloze
Complete the statement.
The nurse should first _____ the warfarin and _____ the provider because the
client is experiencing possible _____.
Answers:
Hold
Notify
Gastrointestinal bleeding
4
