ATI COMPREHENSIVE PN PHARMACOLOGY EXAM
2026/2027 – 140 QUESTIONS WITH NGN & SOLUTIONS
(GRADED A+)EXAM
1. A nurse is preparing to administer enoxaparin subcutaneously. Which action is
correct?
A. Aspirate before injecting to check for blood return
B. Insert the needle at a 15-degree angle
C. Administer into the abdomen while pinching a skinfold
D. Massage the injection site after administration
Correct answer: C – ✓✓ Administer into the abdomen while pinching a skinfold.
Rationale: *Enoxaparin is given subcutaneously into the abdomen, pinching a
skinfold to ensure proper delivery. Do not aspirate (risk of hematoma), use a 90-
degree angle, and never massage the site.*
2. A client is prescribed metoprolol succinate. Which finding indicates the
medication is effective?
A. Heart rate 110 bpm
B. Blood pressure 150/92 mmHg
C. Heart rate 65 bpm with controlled blood pressure
D. Wheezing on auscultation
Correct answer: C – ✓✓ Heart rate 65 bpm with controlled blood pressure.
Rationale: Metoprolol is a beta-blocker used for hypertension and heart failure.
Therapeutic effect includes lowered heart rate and blood pressure. Wheezing
suggests bronchospasm, an adverse effect.
3. NGN – A client with chronic kidney disease is prescribed sevelamer. Which three
findings indicate the medication is working? (Select all that apply)
A. Serum phosphorus level decreases from 6.5 to 4.2 mg/dL
B. Calcium level remains stable
C. Patient reports less pruritus
D. Blood glucose improves
E. Serum potassium decreases
, Correct answers: A, B, C – ✓✓ Decreased serum phosphorus, stable calcium, and
less pruritus.
Rationale: Sevelamer is a phosphate binder. Therapeutic effect is lowering
phosphorus, which also reduces itching (pruritus) and prevents calcium-phosphorus
imbalances. It does not affect glucose or potassium directly.
4. A client is prescribed amoxicillin for strep throat. Which statement by the client
indicates a need for further teaching?
A. “I should take the full course even if I feel better.”
B. “I can stop the medication when my fever goes away.”
C. “I should report any rash or difficulty breathing.”
D. “I can take this medication with food to reduce stomach upset.”
Correct answer: B – ✓✓ “I can stop the medication when my fever goes away.”
Rationale: Antibiotics must be taken for the full prescribed course to prevent
resistance and ensure eradication of infection. Stopping early when symptoms
improve risks relapse.
5. A client is prescribed fentanyl patch for chronic pain. Which instruction is most
important?
A. “Apply heat to the patch site to increase effectiveness.”
B. “Change the patch every 24 hours.”
C. “Avoid exposing the patch to direct heat sources like heating pads.”
D. “Cut the patch in half if you need a lower dose.”
Correct answer: C – ✓✓ “Avoid exposing the patch to direct heat sources like
heating pads.”
Rationale: Heat increases fentanyl absorption, leading to potentially fatal
overdose. Patches are changed every 72 hours, never cut, and should not be
exposed to heat.
6. A nurse is administering IV vancomycin. The client reports flushing and a rash on
the neck and chest. Which action should the nurse take first?
A. Stop the infusion immediately
B. Slow the infusion rate
C. Administer diphenhydramine as ordered
D. Notify the provider
Correct answer: B – ✓✓ Slow the infusion rate.
Rationale: These symptoms indicate red man syndrome, a rate-related reaction to
vancomycin. Slowing the infusion often resolves symptoms. Stopping is not
necessary unless severe; diphenhydramine may be given after slowing.
,7. A client with type 2 diabetes is prescribed sitagliptin. The nurse should teach that
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this medication works by:
k0 k0 k0 k0
A. Increasing insulin release from the pancreas k0 k0 k0 k0 k0
B. Decreasing glucose absorption from the intestines k0 k0 k0 k0 k0
C. Increasing incretin levels to enhance insulin secretion k0 k0 k0 k0 k0 k0
D. Blocking glucose reabsorption in the kidneys k0 k0 k0 k0 k0
Correct answer: C – ✓✓ Increasing incretin levels to enhance insulin secretion.
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
Rationale: *Sitagliptin is a DPP-4 inhibitor that increases incretin hormones,
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
which enhance insulin secretion and reduce glucagon. It does not directly affect
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
intestinal absorption or kidney reabsorption.*
k0 k0 k0 k0 k0
8. A client is prescribed lithium. Which lab value should the nurse monitor most
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
closely?
k0
A. Serum calcium k0
B. Serum sodium k0
C. Serum magnesium k0
D. Serum creatinine k0
Correct answer: D – ✓✓ Serum creatinine.
k0 k0 k0 k0 k0 k0
Rationale: Lithium is excreted by the kidneys and can cause nephrotoxicity. Serum
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
creatinine is essential to monitor renal function. Sodium levels affect lithium
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
levels but creatinine monitors damage.
k0 k0 k0 k0 k0
9. A client is taking warfarin and reports black, tarry stools. Which action should the
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
nurse take first?
k0 k0 k0
A. Check the INR k0 k0
B. Administer vitamin K orally k0 k0 k0
C. Hold the next dose of warfarin and notify the provider
k0 k0 k0 k0 k0 k0 k0 k0 k0
D. Instruct the client to eat more green vegetables k0 k0 k0 k0 k0 k0 k0
Correct answer: C – ✓✓ Hold the next dose of warfarin and notify the provider.
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
Rationale: Black, tarry stools indicate gastrointestinal bleeding. The nurse
k0 k0 k0 k0 k0 k0 k0 k0 k0
should hold warfarin and notify the provider immediately. Checking INR is
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
important but not the first action; vitamin K may be ordered later.
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
10. NGN – A client is receiving IV furosemide. Which three findings indicate the need
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
to hold the next dose? (Select all that apply)
k0 k0 k0 k0 k0 k0 k0 k0 k0
A. Urine output 400 mL in 8 hours k0 k0 k0 k0 k0 k0
B. Serum potassium 2.9 mEq/L k0 k0 k0
C. Blood pressure 85/50 mmHg k0 k0 k0
D. Weight loss of 1 kg in 24 hours k0 k0 k0 k0 k0 k0 k0
E. Dizziness when standing k0 k0
Correct answers: B, C, E – ✓✓ *Hypokalemia (2.9), hypotension (85/50), and
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
, orthostatic dizziness.* k0
Rationale: *Severe hypokalemia, hypotension, and symptomatic orthostasis are
k0 k0 k0 k0 k0 k0 k0
signs of excessive diuresis. Urine output 400 mL in 8 hours (50 mL/hr) is
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
therapeutic; weight loss of 1 kg is expected.*
k0 k0 k0 k0 k0 k0 k0 k0
11. A client is prescribed metronidazole for bacterial vaginosis. Which instruction is
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
most important?
k0 k0
A. “Take with a full glass of milk.”k0 k0 k0 k0 k0 k0
B. “Avoid alcohol for at least 48 hours after finishing the medication.”
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
C. “This medication may turn your urine blue.”
k0 k0 k0 k0 k0 k0
D. “You may stop taking it once symptoms improve.”
k0 k0 k0 k0 k0 k0 k0
Correct answer: B – ✓✓ “Avoid alcohol for at least 48 hours after finishing the
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
medication.”
k0
Rationale: *Metronidazole causes a disulfiram-like reaction with alcohol
k0 k0 k0 k0 k0 k0 k0
(flushing, vomiting, tachycardia). Alcohol must be avoided during and for 48
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
hours after treatment. Urine may turn dark, not blue.*
k0 k0 k0 k0 k0 k0 k0 k0 k0
12. A client is prescribed clozapine. Which monitoring is required weekly at the start
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
of therapy?
k0 k0
A. Blood glucose k0
B. Absolute neutrophil count (ANC) k0 k0 k0
C. Liver function tests k0 k0
D. ECG
Correct answer: B – ✓✓ Absolute neutrophil count (ANC).
k0 k0 k0 k0 k0 k0 k0 k0
Rationale: Clozapine causes agranulocytosis; ANC must be monitored weekly for
k0 k0 k0 k0 k0 k0 k0 k0 k0
the first 6 months, then every 2 weeks. Glucose and LFTs are monitored but not
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
weekly.
k0
13. A nurse is teaching a client about sublingual nitroglycerin. Which statement
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
indicates correct understanding?
k0 k0 k0
A. “I will take one tablet every 5 minutes up to 3 doses for chest pain.”
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
B. “I will swallow the tablet with a sip of water.”
k0 k0 k0 k0 k0 k0 k0 k0 k0
C. “I will store the tablets in the refrigerator.”
k0 k0 k0 k0 k0 k0 k0
D. “I will take the tablet only when I am lying down.”
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
Correct answer: A – ✓✓ “I will take one tablet every 5 minutes up to 3 doses for
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
chest pain.”
k0 k0
Rationale: Standard dosing for sublingual nitroglycerin is one tablet every 5
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
minutes for up to three doses; if pain persists, call 911. Tablets are placed under the
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
tongue, not swallowed. Store in original container at room temperature.
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
2026/2027 – 140 QUESTIONS WITH NGN & SOLUTIONS
(GRADED A+)EXAM
1. A nurse is preparing to administer enoxaparin subcutaneously. Which action is
correct?
A. Aspirate before injecting to check for blood return
B. Insert the needle at a 15-degree angle
C. Administer into the abdomen while pinching a skinfold
D. Massage the injection site after administration
Correct answer: C – ✓✓ Administer into the abdomen while pinching a skinfold.
Rationale: *Enoxaparin is given subcutaneously into the abdomen, pinching a
skinfold to ensure proper delivery. Do not aspirate (risk of hematoma), use a 90-
degree angle, and never massage the site.*
2. A client is prescribed metoprolol succinate. Which finding indicates the
medication is effective?
A. Heart rate 110 bpm
B. Blood pressure 150/92 mmHg
C. Heart rate 65 bpm with controlled blood pressure
D. Wheezing on auscultation
Correct answer: C – ✓✓ Heart rate 65 bpm with controlled blood pressure.
Rationale: Metoprolol is a beta-blocker used for hypertension and heart failure.
Therapeutic effect includes lowered heart rate and blood pressure. Wheezing
suggests bronchospasm, an adverse effect.
3. NGN – A client with chronic kidney disease is prescribed sevelamer. Which three
findings indicate the medication is working? (Select all that apply)
A. Serum phosphorus level decreases from 6.5 to 4.2 mg/dL
B. Calcium level remains stable
C. Patient reports less pruritus
D. Blood glucose improves
E. Serum potassium decreases
, Correct answers: A, B, C – ✓✓ Decreased serum phosphorus, stable calcium, and
less pruritus.
Rationale: Sevelamer is a phosphate binder. Therapeutic effect is lowering
phosphorus, which also reduces itching (pruritus) and prevents calcium-phosphorus
imbalances. It does not affect glucose or potassium directly.
4. A client is prescribed amoxicillin for strep throat. Which statement by the client
indicates a need for further teaching?
A. “I should take the full course even if I feel better.”
B. “I can stop the medication when my fever goes away.”
C. “I should report any rash or difficulty breathing.”
D. “I can take this medication with food to reduce stomach upset.”
Correct answer: B – ✓✓ “I can stop the medication when my fever goes away.”
Rationale: Antibiotics must be taken for the full prescribed course to prevent
resistance and ensure eradication of infection. Stopping early when symptoms
improve risks relapse.
5. A client is prescribed fentanyl patch for chronic pain. Which instruction is most
important?
A. “Apply heat to the patch site to increase effectiveness.”
B. “Change the patch every 24 hours.”
C. “Avoid exposing the patch to direct heat sources like heating pads.”
D. “Cut the patch in half if you need a lower dose.”
Correct answer: C – ✓✓ “Avoid exposing the patch to direct heat sources like
heating pads.”
Rationale: Heat increases fentanyl absorption, leading to potentially fatal
overdose. Patches are changed every 72 hours, never cut, and should not be
exposed to heat.
6. A nurse is administering IV vancomycin. The client reports flushing and a rash on
the neck and chest. Which action should the nurse take first?
A. Stop the infusion immediately
B. Slow the infusion rate
C. Administer diphenhydramine as ordered
D. Notify the provider
Correct answer: B – ✓✓ Slow the infusion rate.
Rationale: These symptoms indicate red man syndrome, a rate-related reaction to
vancomycin. Slowing the infusion often resolves symptoms. Stopping is not
necessary unless severe; diphenhydramine may be given after slowing.
,7. A client with type 2 diabetes is prescribed sitagliptin. The nurse should teach that
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
this medication works by:
k0 k0 k0 k0
A. Increasing insulin release from the pancreas k0 k0 k0 k0 k0
B. Decreasing glucose absorption from the intestines k0 k0 k0 k0 k0
C. Increasing incretin levels to enhance insulin secretion k0 k0 k0 k0 k0 k0
D. Blocking glucose reabsorption in the kidneys k0 k0 k0 k0 k0
Correct answer: C – ✓✓ Increasing incretin levels to enhance insulin secretion.
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
Rationale: *Sitagliptin is a DPP-4 inhibitor that increases incretin hormones,
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
which enhance insulin secretion and reduce glucagon. It does not directly affect
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
intestinal absorption or kidney reabsorption.*
k0 k0 k0 k0 k0
8. A client is prescribed lithium. Which lab value should the nurse monitor most
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
closely?
k0
A. Serum calcium k0
B. Serum sodium k0
C. Serum magnesium k0
D. Serum creatinine k0
Correct answer: D – ✓✓ Serum creatinine.
k0 k0 k0 k0 k0 k0
Rationale: Lithium is excreted by the kidneys and can cause nephrotoxicity. Serum
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
creatinine is essential to monitor renal function. Sodium levels affect lithium
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
levels but creatinine monitors damage.
k0 k0 k0 k0 k0
9. A client is taking warfarin and reports black, tarry stools. Which action should the
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
nurse take first?
k0 k0 k0
A. Check the INR k0 k0
B. Administer vitamin K orally k0 k0 k0
C. Hold the next dose of warfarin and notify the provider
k0 k0 k0 k0 k0 k0 k0 k0 k0
D. Instruct the client to eat more green vegetables k0 k0 k0 k0 k0 k0 k0
Correct answer: C – ✓✓ Hold the next dose of warfarin and notify the provider.
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
Rationale: Black, tarry stools indicate gastrointestinal bleeding. The nurse
k0 k0 k0 k0 k0 k0 k0 k0 k0
should hold warfarin and notify the provider immediately. Checking INR is
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
important but not the first action; vitamin K may be ordered later.
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
10. NGN – A client is receiving IV furosemide. Which three findings indicate the need
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
to hold the next dose? (Select all that apply)
k0 k0 k0 k0 k0 k0 k0 k0 k0
A. Urine output 400 mL in 8 hours k0 k0 k0 k0 k0 k0
B. Serum potassium 2.9 mEq/L k0 k0 k0
C. Blood pressure 85/50 mmHg k0 k0 k0
D. Weight loss of 1 kg in 24 hours k0 k0 k0 k0 k0 k0 k0
E. Dizziness when standing k0 k0
Correct answers: B, C, E – ✓✓ *Hypokalemia (2.9), hypotension (85/50), and
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
, orthostatic dizziness.* k0
Rationale: *Severe hypokalemia, hypotension, and symptomatic orthostasis are
k0 k0 k0 k0 k0 k0 k0
signs of excessive diuresis. Urine output 400 mL in 8 hours (50 mL/hr) is
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
therapeutic; weight loss of 1 kg is expected.*
k0 k0 k0 k0 k0 k0 k0 k0
11. A client is prescribed metronidazole for bacterial vaginosis. Which instruction is
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
most important?
k0 k0
A. “Take with a full glass of milk.”k0 k0 k0 k0 k0 k0
B. “Avoid alcohol for at least 48 hours after finishing the medication.”
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
C. “This medication may turn your urine blue.”
k0 k0 k0 k0 k0 k0
D. “You may stop taking it once symptoms improve.”
k0 k0 k0 k0 k0 k0 k0
Correct answer: B – ✓✓ “Avoid alcohol for at least 48 hours after finishing the
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
medication.”
k0
Rationale: *Metronidazole causes a disulfiram-like reaction with alcohol
k0 k0 k0 k0 k0 k0 k0
(flushing, vomiting, tachycardia). Alcohol must be avoided during and for 48
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
hours after treatment. Urine may turn dark, not blue.*
k0 k0 k0 k0 k0 k0 k0 k0 k0
12. A client is prescribed clozapine. Which monitoring is required weekly at the start
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
of therapy?
k0 k0
A. Blood glucose k0
B. Absolute neutrophil count (ANC) k0 k0 k0
C. Liver function tests k0 k0
D. ECG
Correct answer: B – ✓✓ Absolute neutrophil count (ANC).
k0 k0 k0 k0 k0 k0 k0 k0
Rationale: Clozapine causes agranulocytosis; ANC must be monitored weekly for
k0 k0 k0 k0 k0 k0 k0 k0 k0
the first 6 months, then every 2 weeks. Glucose and LFTs are monitored but not
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
weekly.
k0
13. A nurse is teaching a client about sublingual nitroglycerin. Which statement
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
indicates correct understanding?
k0 k0 k0
A. “I will take one tablet every 5 minutes up to 3 doses for chest pain.”
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
B. “I will swallow the tablet with a sip of water.”
k0 k0 k0 k0 k0 k0 k0 k0 k0
C. “I will store the tablets in the refrigerator.”
k0 k0 k0 k0 k0 k0 k0
D. “I will take the tablet only when I am lying down.”
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
Correct answer: A – ✓✓ “I will take one tablet every 5 minutes up to 3 doses for
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
chest pain.”
k0 k0
Rationale: Standard dosing for sublingual nitroglycerin is one tablet every 5
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
minutes for up to three doses; if pain persists, call 911. Tablets are placed under the
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
tongue, not swallowed. Store in original container at room temperature.
k0 k0 k0 k0 k0 k0 k0 k0 k0 k0
