ATI RN Pharmacology 2026 Proctored Exam With NGN
Level 3
Educational Assessment & Practice Question Sets
Paper 1: ATI RN Pharmacology 2026 Proctored Exam With NGN Level 3 – Assessment
Set A
Part I: Multiple Choice Questions (including NGN Items)
Question 1: A nurse is preparing to administer IV vancomycin to an adult client with a MRSA wound
infection. Which of the following lab values should the nurse review prior to initiating the infusion?
A. Serum creatinine and BUN
B. Prothrombin time (PT/INR)
C. Serum amylase and lipase
D. Total serum bilirubin
Answer & Rationale:
Correct Answer: A
Rationale: Vancomycin is potentially nephrotoxic and ototoxic. Renal function markers (serum creatinine and BUN),
as well as trough blood levels, must be monitored regularly to prevent nephrotoxicity.
Question 2: A nurse is caring for a client prescribed digoxin 0.25 mg PO daily for heart failure. Which of the
following clinical findings indicates early digoxin toxicity?
A. Photophobia and severe hypertension
B. Anorexia, nausea, and vomiting
C. Dry mouth and urinary retention
D. Tachypnea and hyperkalemia
Answer & Rationale:
Correct Answer: B
Rationale: Gastrointestinal symptoms such as anorexia, nausea, vomiting, and abdominal pain are usually the
earliest manifestations of digoxin toxicity, followed by visual disturbances (yellow-green halos) and cardiac
dysrhythmias.
Question 3: A nurse is teaching a client who has a new prescription for lithium carbonate for bipolar
, disorder. Which instruction should the nurse emphasize?
A. Maintain a consistent daily sodium and fluid intake.
B. Restrict sodium intake to less than 1,000 mg daily.
C. Take the medication on an empty stomach 1 hour before meals.
D. Discontinue medication if mild hand tremors occur.
Answer & Rationale:
Correct Answer: A
Rationale: Lithium excretion is closely tied to sodium levels. Low sodium levels or dehydration cause the kidneys to
reabsorb lithium, raising serum levels and risking toxicity. Consistent sodium and fluid intake is crucial.
Question 4: [NGN Clinical Scenario] A nurse is evaluating a client receiving a continuous IV infusion of
heparin for a deep vein thrombosis (DVT). The client's latest activated partial thromboplastin time (aPTT) is
110 seconds (control: 30-40 seconds). Which of the following actions is the nurse's priority?
A. Increase the IV heparin infusion rate by 10%.
B. Stop the heparin infusion and notify the provider.
C. Administer Vitamin K1 orally.
D. Obtain a prothrombin time (PT) immediately.
Answer & Rationale:
Correct Answer: B
Rationale: Target therapeutic aPTT during heparin therapy is typically 1.5 to 2.5 times the baseline control (approx.
60–80 seconds). An aPTT of 110 seconds indicates high risk for severe bleeding; the infusion must be held immediately
and the provider notified. Protamine sulfate is the specific reversal agent for heparin.
Question 15: A nurse is administering sublingual nitroglycerin to a client experiencing acute chest pain.
Which statement indicates proper administration guidelines?
A. Swallow the tablet immediately with a full glass of water.
B. Take up to 3 tablets 5 minutes apart; call 911 if pain persists after the first dose.
C. Take 1 tablet every 15 minutes up to 5 total doses.
D. Chew the tablet thoroughly before placing under the tongue.
Answer & Rationale:
Correct Answer: B
Rationale: For acute angina, the client places 1 tablet under the tongue. If chest pain is unrelieved after 5 minutes,
emergency services (911) should be called before taking a second tablet. A maximum of 3 tablets can be taken 5
minutes apart.
Question 75: A nurse is providing discharge teaching for a client starting lisinopril. Which adverse effect
Level 3
Educational Assessment & Practice Question Sets
Paper 1: ATI RN Pharmacology 2026 Proctored Exam With NGN Level 3 – Assessment
Set A
Part I: Multiple Choice Questions (including NGN Items)
Question 1: A nurse is preparing to administer IV vancomycin to an adult client with a MRSA wound
infection. Which of the following lab values should the nurse review prior to initiating the infusion?
A. Serum creatinine and BUN
B. Prothrombin time (PT/INR)
C. Serum amylase and lipase
D. Total serum bilirubin
Answer & Rationale:
Correct Answer: A
Rationale: Vancomycin is potentially nephrotoxic and ototoxic. Renal function markers (serum creatinine and BUN),
as well as trough blood levels, must be monitored regularly to prevent nephrotoxicity.
Question 2: A nurse is caring for a client prescribed digoxin 0.25 mg PO daily for heart failure. Which of the
following clinical findings indicates early digoxin toxicity?
A. Photophobia and severe hypertension
B. Anorexia, nausea, and vomiting
C. Dry mouth and urinary retention
D. Tachypnea and hyperkalemia
Answer & Rationale:
Correct Answer: B
Rationale: Gastrointestinal symptoms such as anorexia, nausea, vomiting, and abdominal pain are usually the
earliest manifestations of digoxin toxicity, followed by visual disturbances (yellow-green halos) and cardiac
dysrhythmias.
Question 3: A nurse is teaching a client who has a new prescription for lithium carbonate for bipolar
, disorder. Which instruction should the nurse emphasize?
A. Maintain a consistent daily sodium and fluid intake.
B. Restrict sodium intake to less than 1,000 mg daily.
C. Take the medication on an empty stomach 1 hour before meals.
D. Discontinue medication if mild hand tremors occur.
Answer & Rationale:
Correct Answer: A
Rationale: Lithium excretion is closely tied to sodium levels. Low sodium levels or dehydration cause the kidneys to
reabsorb lithium, raising serum levels and risking toxicity. Consistent sodium and fluid intake is crucial.
Question 4: [NGN Clinical Scenario] A nurse is evaluating a client receiving a continuous IV infusion of
heparin for a deep vein thrombosis (DVT). The client's latest activated partial thromboplastin time (aPTT) is
110 seconds (control: 30-40 seconds). Which of the following actions is the nurse's priority?
A. Increase the IV heparin infusion rate by 10%.
B. Stop the heparin infusion and notify the provider.
C. Administer Vitamin K1 orally.
D. Obtain a prothrombin time (PT) immediately.
Answer & Rationale:
Correct Answer: B
Rationale: Target therapeutic aPTT during heparin therapy is typically 1.5 to 2.5 times the baseline control (approx.
60–80 seconds). An aPTT of 110 seconds indicates high risk for severe bleeding; the infusion must be held immediately
and the provider notified. Protamine sulfate is the specific reversal agent for heparin.
Question 15: A nurse is administering sublingual nitroglycerin to a client experiencing acute chest pain.
Which statement indicates proper administration guidelines?
A. Swallow the tablet immediately with a full glass of water.
B. Take up to 3 tablets 5 minutes apart; call 911 if pain persists after the first dose.
C. Take 1 tablet every 15 minutes up to 5 total doses.
D. Chew the tablet thoroughly before placing under the tongue.
Answer & Rationale:
Correct Answer: B
Rationale: For acute angina, the client places 1 tablet under the tongue. If chest pain is unrelieved after 5 minutes,
emergency services (911) should be called before taking a second tablet. A maximum of 3 tablets can be taken 5
minutes apart.
Question 75: A nurse is providing discharge teaching for a client starting lisinopril. Which adverse effect
