ATI RN Pharmacology 2026 Proctored
Exam
Level 3 Practice Questions and Answers with Detailed
Rationales
180 Practice Questions | Complete Answer Key | NCLEX-Style Rationales
How to Use This Practice Exam
This study guide contains 180 multiple-choice practice questions written in NCLEX/ATI
style, organized into ten content sections that mirror the major domains of the RN
pharmacology curriculum. Each question is followed by the correct answer and a
detailed rationale that explains why the answer is correct and why the key distractors
are incorrect. Work through one section at a time, answer every question before
checking the answer, and review every rationale, including the ones for questions you
answered correctly.
Scoring guide: 90% or higher (162+ correct) indicates Level 3 readiness; 80-89% (144-
161) indicates Level 2 proficiency; below 80% means you should re-study the flagged
sections and retake them after focused review. Questions marked with a star (*) cover
high-risk medications that appear frequently on proctored exams.
Section 1: Medication Administration and Safety (Questions 1-20)
1. A nurse is preparing to administer medications through a client's nasogastric (NG)
feeding tube. Which action should the nurse take?
A. Crush all medications together and instill them in one flush
B. Flush the tube with 15 to 30 mL of water before, between, and after each
medication
C. Add the crushed medication directly to the enteral feeding bag
D. Instill medications while the client lies flat in bed
Correct Answer: B
Rationale: Flushing with 15 to 30 mL of water before, between, and after each
medication prevents drug-drug interactions and tube occlusion. Crushing medications
together (A) can cause physical or chemical incompatibility; adding medication to the
1
,feeding bag (C) risks clogging the bag and tubing and makes the delivered dose
unreliable; a flat position (D) increases aspiration risk, so the head of the bed should be
at least 30 degrees during and after administration.
2. A nurse is preparing to administer an intramuscular injection to an adult client of
average size. Which needle length and gauge are most appropriate for the
ventrogluteal site?
A. 25-gauge, 5/8 inch
B. 18-gauge, 1 inch
C. 21 to 23-gauge, 1 to 1.5 inch
D. 27-gauge, 1/2 inch
Correct Answer: C
Rationale: Intramuscular injections into the ventrogluteal site require a needle long
enough to reach muscle tissue, typically 1 to 1.5 inches, and a 21 to 23-gauge needle
that allows viscous medications to flow while limiting tissue trauma. The 25-gauge, 5/8-
inch needle (A) is used for subcutaneous injections; an 18-gauge needle (B) causes
unnecessary trauma; the 27-gauge, 1/2-inch needle (D) is for intradermal injections and
would deposit medication into subcutaneous fat rather than muscle.
3. A nurse receives a prescription for 0.9% sodium chloride to be infused at 125 mL/hr.
The IV tubing delivers 15 gtt/mL. At what rate should the nurse set the IV pump drip
chamber? (Round to the nearest whole number.)
A. 21 gtt/min
B. 31 gtt/min
C. 42 gtt/min
D. 15 gtt/min
Correct Answer: B
Rationale: Using the drip rate formula, (125 mL/hr x 15 gtt/mL) divided by 60 min =
31.25, which rounds to 31 gtt/min. Option A results from using a 10 gtt/mL factor;
option C reflects a miscalculation with the wrong divisor; option D confuses the tubing
drop factor with the drip rate. Always verify the drop factor printed on the tubing
package before calculating.
4. A nurse is caring for a client who has a new prescription for warfarin. Which of the
following medications on the client's home medication list should the nurse identify as
increasing the risk of bleeding?
2
, A. Acetaminophen
B. Ibuprofen
C. Docusate sodium
D. Loratadine
Correct Answer: B
Rationale: Ibuprofen is an NSAID that inhibits platelet aggregation and irritates gastric
mucosa, so combining it with warfarin significantly increases bleeding risk.
Acetaminophen (A) is the preferred analgesic for clients on warfarin, although high
sustained doses can potentiate its effect; docusate (C) is a stool softener with no
antiplatelet effect; loratadine (D) is a second-generation antihistamine with no
significant interaction.
5. A nurse is preparing to administer a medication and notices the prescription reads
"morphine 2 mg IV q4h PRN severe pain." The pharmacy dispensed morphine 4
mg/mL. Which action should the nurse take?
A. Administer 0.5 mL of the medication
B. Administer 2 mL of the medication
C. Contact the provider to clarify the prescription
D. Withhold the medication and document the omission
Correct Answer: A
Rationale: The dose calculation is 2 mg divided by 4 mg/mL = 0.5 mL, so the prescription
is complete and safe to carry out; no clarification is needed. Option B would deliver 8
mg, four times the prescribed dose and a potentially fatal error with an opioid.
Clarification (C) is only required when a prescription is unclear or unsafe, and
withholding (D) would leave the client's severe pain untreated.
6. A nurse is using the rights of medication administration. Which action best
demonstrates the right documentation?
A. Documenting the medication immediately after administration
B. Documenting the medication at the end of the shift
C. Documenting the medication before administering it
D. Asking another nurse to document the dose given
Correct Answer: A
Rationale: Documentation should occur immediately after administration, never before,
so the record reflects what the client actually received. Charting at the end of the shift
(B) invites omissions and duplicate doses; documenting before administration (C) is
3
, falsification if the dose is never given; documentation must be completed by the nurse
who administered the medication (D), not delegated to another nurse.
7. A nurse is administering eardrops to an adult client. Which action should the nurse
take?
A. Pull the pinna down and back
B. Pull the pinna up and back
C. Insert the dropper 1 cm into the ear canal
D. Chill the medication before instillation
Correct Answer: B
Rationale: In adults, the pinna is pulled up and back to straighten the ear canal so drops
reach the tympanic membrane. Pulling down and back (A) is the technique for children
under 3 years old. The dropper tip should not touch the ear canal (C) to avoid
contamination and injury, and cold medication causes vertigo and pain, so drops should
be warmed to body temperature (D).
8. A nurse is caring for a client receiving a continuous heparin infusion. Which
laboratory value requires immediate nursing action?
A. aPTT of 65 seconds (therapeutic range 60-80)
B. aPTT of 110 seconds
C. Hemoglobin of 13 g/dL
D. Platelet count of 250,000/mm3
Correct Answer: B
Rationale: An aPTT of 110 seconds is well above the therapeutic range and places the
client at serious risk for spontaneous hemorrhage; the nurse should hold or reduce the
infusion per protocol and notify the provider. An aPTT of 65 seconds (A) is therapeutic.
Hemoglobin (C) and platelets (D) are within normal limits, although a falling platelet
count would raise concern for heparin-induced thrombocytopenia.
9. A nurse is preparing to administer a transdermal nitroglycerin patch. Which action
should the nurse take?
A. Apply the new patch over the old one
B. Apply the patch to a hairy area of the chest
C. Remove the old patch and rotate sites before applying the new one
D. Cut the patch in half for a partial dose
Correct Answer: C
4
Exam
Level 3 Practice Questions and Answers with Detailed
Rationales
180 Practice Questions | Complete Answer Key | NCLEX-Style Rationales
How to Use This Practice Exam
This study guide contains 180 multiple-choice practice questions written in NCLEX/ATI
style, organized into ten content sections that mirror the major domains of the RN
pharmacology curriculum. Each question is followed by the correct answer and a
detailed rationale that explains why the answer is correct and why the key distractors
are incorrect. Work through one section at a time, answer every question before
checking the answer, and review every rationale, including the ones for questions you
answered correctly.
Scoring guide: 90% or higher (162+ correct) indicates Level 3 readiness; 80-89% (144-
161) indicates Level 2 proficiency; below 80% means you should re-study the flagged
sections and retake them after focused review. Questions marked with a star (*) cover
high-risk medications that appear frequently on proctored exams.
Section 1: Medication Administration and Safety (Questions 1-20)
1. A nurse is preparing to administer medications through a client's nasogastric (NG)
feeding tube. Which action should the nurse take?
A. Crush all medications together and instill them in one flush
B. Flush the tube with 15 to 30 mL of water before, between, and after each
medication
C. Add the crushed medication directly to the enteral feeding bag
D. Instill medications while the client lies flat in bed
Correct Answer: B
Rationale: Flushing with 15 to 30 mL of water before, between, and after each
medication prevents drug-drug interactions and tube occlusion. Crushing medications
together (A) can cause physical or chemical incompatibility; adding medication to the
1
,feeding bag (C) risks clogging the bag and tubing and makes the delivered dose
unreliable; a flat position (D) increases aspiration risk, so the head of the bed should be
at least 30 degrees during and after administration.
2. A nurse is preparing to administer an intramuscular injection to an adult client of
average size. Which needle length and gauge are most appropriate for the
ventrogluteal site?
A. 25-gauge, 5/8 inch
B. 18-gauge, 1 inch
C. 21 to 23-gauge, 1 to 1.5 inch
D. 27-gauge, 1/2 inch
Correct Answer: C
Rationale: Intramuscular injections into the ventrogluteal site require a needle long
enough to reach muscle tissue, typically 1 to 1.5 inches, and a 21 to 23-gauge needle
that allows viscous medications to flow while limiting tissue trauma. The 25-gauge, 5/8-
inch needle (A) is used for subcutaneous injections; an 18-gauge needle (B) causes
unnecessary trauma; the 27-gauge, 1/2-inch needle (D) is for intradermal injections and
would deposit medication into subcutaneous fat rather than muscle.
3. A nurse receives a prescription for 0.9% sodium chloride to be infused at 125 mL/hr.
The IV tubing delivers 15 gtt/mL. At what rate should the nurse set the IV pump drip
chamber? (Round to the nearest whole number.)
A. 21 gtt/min
B. 31 gtt/min
C. 42 gtt/min
D. 15 gtt/min
Correct Answer: B
Rationale: Using the drip rate formula, (125 mL/hr x 15 gtt/mL) divided by 60 min =
31.25, which rounds to 31 gtt/min. Option A results from using a 10 gtt/mL factor;
option C reflects a miscalculation with the wrong divisor; option D confuses the tubing
drop factor with the drip rate. Always verify the drop factor printed on the tubing
package before calculating.
4. A nurse is caring for a client who has a new prescription for warfarin. Which of the
following medications on the client's home medication list should the nurse identify as
increasing the risk of bleeding?
2
, A. Acetaminophen
B. Ibuprofen
C. Docusate sodium
D. Loratadine
Correct Answer: B
Rationale: Ibuprofen is an NSAID that inhibits platelet aggregation and irritates gastric
mucosa, so combining it with warfarin significantly increases bleeding risk.
Acetaminophen (A) is the preferred analgesic for clients on warfarin, although high
sustained doses can potentiate its effect; docusate (C) is a stool softener with no
antiplatelet effect; loratadine (D) is a second-generation antihistamine with no
significant interaction.
5. A nurse is preparing to administer a medication and notices the prescription reads
"morphine 2 mg IV q4h PRN severe pain." The pharmacy dispensed morphine 4
mg/mL. Which action should the nurse take?
A. Administer 0.5 mL of the medication
B. Administer 2 mL of the medication
C. Contact the provider to clarify the prescription
D. Withhold the medication and document the omission
Correct Answer: A
Rationale: The dose calculation is 2 mg divided by 4 mg/mL = 0.5 mL, so the prescription
is complete and safe to carry out; no clarification is needed. Option B would deliver 8
mg, four times the prescribed dose and a potentially fatal error with an opioid.
Clarification (C) is only required when a prescription is unclear or unsafe, and
withholding (D) would leave the client's severe pain untreated.
6. A nurse is using the rights of medication administration. Which action best
demonstrates the right documentation?
A. Documenting the medication immediately after administration
B. Documenting the medication at the end of the shift
C. Documenting the medication before administering it
D. Asking another nurse to document the dose given
Correct Answer: A
Rationale: Documentation should occur immediately after administration, never before,
so the record reflects what the client actually received. Charting at the end of the shift
(B) invites omissions and duplicate doses; documenting before administration (C) is
3
, falsification if the dose is never given; documentation must be completed by the nurse
who administered the medication (D), not delegated to another nurse.
7. A nurse is administering eardrops to an adult client. Which action should the nurse
take?
A. Pull the pinna down and back
B. Pull the pinna up and back
C. Insert the dropper 1 cm into the ear canal
D. Chill the medication before instillation
Correct Answer: B
Rationale: In adults, the pinna is pulled up and back to straighten the ear canal so drops
reach the tympanic membrane. Pulling down and back (A) is the technique for children
under 3 years old. The dropper tip should not touch the ear canal (C) to avoid
contamination and injury, and cold medication causes vertigo and pain, so drops should
be warmed to body temperature (D).
8. A nurse is caring for a client receiving a continuous heparin infusion. Which
laboratory value requires immediate nursing action?
A. aPTT of 65 seconds (therapeutic range 60-80)
B. aPTT of 110 seconds
C. Hemoglobin of 13 g/dL
D. Platelet count of 250,000/mm3
Correct Answer: B
Rationale: An aPTT of 110 seconds is well above the therapeutic range and places the
client at serious risk for spontaneous hemorrhage; the nurse should hold or reduce the
infusion per protocol and notify the provider. An aPTT of 65 seconds (A) is therapeutic.
Hemoglobin (C) and platelets (D) are within normal limits, although a falling platelet
count would raise concern for heparin-induced thrombocytopenia.
9. A nurse is preparing to administer a transdermal nitroglycerin patch. Which action
should the nurse take?
A. Apply the new patch over the old one
B. Apply the patch to a hairy area of the chest
C. Remove the old patch and rotate sites before applying the new one
D. Cut the patch in half for a partial dose
Correct Answer: C
4
