ATI RN Pharmacology 2026 Proctored
Exam | Level 3 Practice Questions and
Answers with Rationales
1. A nurse is preparing to administer digoxin to a client who has heart failure.
Which of the following findings should the nurse identify as a
contraindication to administering the medication?
o A. Heart rate 58/min
o B. Potassium 3.8 mEq/L
o C. Heart rate 52/min
o D. Blood pressure 108/68 mm Hg
o Digoxin is a positive inotropic medication that also slows the
heart rate. A heart rate below 60/min in an adult is a contraindication
for administering digoxin. The nurse should withhold the dose and
notify the provider. A potassium level of 3.8 mEq/L is within the
expected reference range. A heart rate of 58/min is borderline, but
52/min is a clear indication to hold the medication. Blood pressure is
not a direct contraindication for digoxin administration.
2. A nurse is caring for a client who is receiving heparin therapy. Which of the
following laboratory values should the nurse monitor to evaluate the
effectiveness of the therapy?
o A. Prothrombin time (PT)
o B. Activated partial thromboplastin time (aPTT)
o C. International normalized ratio (INR)
o D. Bleeding time
, o The aPTT is the laboratory value used to monitor the
effectiveness of unfractionated heparin therapy. The therapeutic goal
is typically 1.5 to 2.5 times the control value. PT and INR are used to
monitor warfarin therapy. Bleeding time is a less specific test and is
not the primary monitoring tool for heparin.
3. A nurse is teaching a client who has a new prescription for metformin.
Which of the following instructions should the nurse include?
o A. "Take this medication with a high-fat meal."
o B. "You should expect to gain weight while taking this medication."
o C. "Report any muscle pain to your provider immediately."
o D. "This medication can cause hypoglycemia."
o Metformin can cause a rare but serious adverse effect called
lactic acidosis, which can present with muscle pain, malaise, and
hyperventilation. The client should report these symptoms
immediately. Metformin should be taken with food to minimize GI
upset, but not necessarily a high-fat meal. It is weight-neutral or can
cause slight weight loss. Unlike sulfonylureas, metformin alone does
not typically cause hypoglycemia.
4. A nurse is administering intravenous vancomycin to a client. The nurse
should monitor for which of the following adverse effects?
o A. Flushing of the face and neck
o B. Bradycardia
o C. Hypertension
o D. Constipation
o Flushing of the face, neck, and trunk, known as "vancomycin
infusion reaction" or "red man syndrome," is a common adverse
effect of IV vancomycin. It is caused by a rapid infusion rate and can
, be mitigated by infusing the medication over at least 60 minutes.
Tachycardia, hypotension, and diarrhea are other potential adverse
effects, not bradycardia, hypertension, or constipation.
5. A nurse is providing discharge teaching to a client who has a new
prescription for warfarin. Which of the following statements by the client
indicates an understanding of the teaching?
o A. "I will increase my intake of leafy green vegetables."
o B. "I will take aspirin for my headaches."
o C. "I will use a soft toothbrush to brush my teeth."
o D. "I will double my dose if I miss one."
o Warfarin is an anticoagulant, which increases the risk of bleeding.
Using a soft toothbrush helps prevent bleeding gums. Clients should
maintain a consistent intake of vitamin K-rich foods like leafy greens,
not increase it, as this can decrease the effectiveness of warfarin.
Aspirin and other NSAIDs increase the risk of bleeding and should be
avoided. Clients should never double a dose of warfarin.
6. A nurse is reviewing the medication administration record for a client who is
prescribed levothyroxine. The nurse should question this prescription if the
client has a history of which of the following?
o A. Diabetes insipidus
o B. Myocardial infarction
o C. Glaucoma
o D. Osteoarthritis
o Levothyroxine, a thyroid hormone replacement, increases
metabolic rate and cardiac workload. It is contraindicated in clients
with an acute myocardial infarction and should be used with caution
, in clients with cardiovascular disease. It is not contraindicated in
diabetes insipidus, glaucoma, or osteoarthritis.
7. A nurse is caring for a client who is prescribed filgrastim. The nurse should
monitor the client for which of the following therapeutic effects?
o A. Decreased platelet count
o B. Increased neutrophil count
o C. Decreased red blood cell count
o D. Increased lymphocyte count
o Filgrastim is a granulocyte colony-stimulating factor (G-CSF) used
to stimulate the production of neutrophils in clients with severe
neutropenia, often secondary to chemotherapy. The therapeutic
effect is an increased neutrophil count, which helps prevent infection.
8. A nurse is administering a prescribed dose of oral potassium chloride to a
client. Which of the following actions should the nurse take?
o A. Administer the medication on an empty stomach.
o B. Give the medication with a full glass of water and food.
o C. Crush the extended-release tablet and mix it with applesauce.
o D. Administer the medication at bedtime.
o Oral potassium chloride can cause severe gastrointestinal
irritation and ulceration. It should always be administered with a full
glass of water and with food to minimize this effect. It should not be
given on an empty stomach. Extended-release tablets should not be
crushed, as this can lead to a rapid absorption and potential
hyperkalemia.
9. A nurse is teaching a client who is starting therapy with omeprazole. The
nurse should instruct the client to take the medication at which of the
following times?
Exam | Level 3 Practice Questions and
Answers with Rationales
1. A nurse is preparing to administer digoxin to a client who has heart failure.
Which of the following findings should the nurse identify as a
contraindication to administering the medication?
o A. Heart rate 58/min
o B. Potassium 3.8 mEq/L
o C. Heart rate 52/min
o D. Blood pressure 108/68 mm Hg
o Digoxin is a positive inotropic medication that also slows the
heart rate. A heart rate below 60/min in an adult is a contraindication
for administering digoxin. The nurse should withhold the dose and
notify the provider. A potassium level of 3.8 mEq/L is within the
expected reference range. A heart rate of 58/min is borderline, but
52/min is a clear indication to hold the medication. Blood pressure is
not a direct contraindication for digoxin administration.
2. A nurse is caring for a client who is receiving heparin therapy. Which of the
following laboratory values should the nurse monitor to evaluate the
effectiveness of the therapy?
o A. Prothrombin time (PT)
o B. Activated partial thromboplastin time (aPTT)
o C. International normalized ratio (INR)
o D. Bleeding time
, o The aPTT is the laboratory value used to monitor the
effectiveness of unfractionated heparin therapy. The therapeutic goal
is typically 1.5 to 2.5 times the control value. PT and INR are used to
monitor warfarin therapy. Bleeding time is a less specific test and is
not the primary monitoring tool for heparin.
3. A nurse is teaching a client who has a new prescription for metformin.
Which of the following instructions should the nurse include?
o A. "Take this medication with a high-fat meal."
o B. "You should expect to gain weight while taking this medication."
o C. "Report any muscle pain to your provider immediately."
o D. "This medication can cause hypoglycemia."
o Metformin can cause a rare but serious adverse effect called
lactic acidosis, which can present with muscle pain, malaise, and
hyperventilation. The client should report these symptoms
immediately. Metformin should be taken with food to minimize GI
upset, but not necessarily a high-fat meal. It is weight-neutral or can
cause slight weight loss. Unlike sulfonylureas, metformin alone does
not typically cause hypoglycemia.
4. A nurse is administering intravenous vancomycin to a client. The nurse
should monitor for which of the following adverse effects?
o A. Flushing of the face and neck
o B. Bradycardia
o C. Hypertension
o D. Constipation
o Flushing of the face, neck, and trunk, known as "vancomycin
infusion reaction" or "red man syndrome," is a common adverse
effect of IV vancomycin. It is caused by a rapid infusion rate and can
, be mitigated by infusing the medication over at least 60 minutes.
Tachycardia, hypotension, and diarrhea are other potential adverse
effects, not bradycardia, hypertension, or constipation.
5. A nurse is providing discharge teaching to a client who has a new
prescription for warfarin. Which of the following statements by the client
indicates an understanding of the teaching?
o A. "I will increase my intake of leafy green vegetables."
o B. "I will take aspirin for my headaches."
o C. "I will use a soft toothbrush to brush my teeth."
o D. "I will double my dose if I miss one."
o Warfarin is an anticoagulant, which increases the risk of bleeding.
Using a soft toothbrush helps prevent bleeding gums. Clients should
maintain a consistent intake of vitamin K-rich foods like leafy greens,
not increase it, as this can decrease the effectiveness of warfarin.
Aspirin and other NSAIDs increase the risk of bleeding and should be
avoided. Clients should never double a dose of warfarin.
6. A nurse is reviewing the medication administration record for a client who is
prescribed levothyroxine. The nurse should question this prescription if the
client has a history of which of the following?
o A. Diabetes insipidus
o B. Myocardial infarction
o C. Glaucoma
o D. Osteoarthritis
o Levothyroxine, a thyroid hormone replacement, increases
metabolic rate and cardiac workload. It is contraindicated in clients
with an acute myocardial infarction and should be used with caution
, in clients with cardiovascular disease. It is not contraindicated in
diabetes insipidus, glaucoma, or osteoarthritis.
7. A nurse is caring for a client who is prescribed filgrastim. The nurse should
monitor the client for which of the following therapeutic effects?
o A. Decreased platelet count
o B. Increased neutrophil count
o C. Decreased red blood cell count
o D. Increased lymphocyte count
o Filgrastim is a granulocyte colony-stimulating factor (G-CSF) used
to stimulate the production of neutrophils in clients with severe
neutropenia, often secondary to chemotherapy. The therapeutic
effect is an increased neutrophil count, which helps prevent infection.
8. A nurse is administering a prescribed dose of oral potassium chloride to a
client. Which of the following actions should the nurse take?
o A. Administer the medication on an empty stomach.
o B. Give the medication with a full glass of water and food.
o C. Crush the extended-release tablet and mix it with applesauce.
o D. Administer the medication at bedtime.
o Oral potassium chloride can cause severe gastrointestinal
irritation and ulceration. It should always be administered with a full
glass of water and with food to minimize this effect. It should not be
given on an empty stomach. Extended-release tablets should not be
crushed, as this can lead to a rapid absorption and potential
hyperkalemia.
9. A nurse is teaching a client who is starting therapy with omeprazole. The
nurse should instruct the client to take the medication at which of the
following times?
