LATEST NGN EDITION • ATI RN PROCTORED / HESI EXIT / NR 293
ATI RN PHARMACOLOGY PROCTORED EXAM
VERSION 1, VERSION 2 & RETAKE BANK
85 Actual NGN-Style Questions with 100% Verified Correct Answers & Detailed
Rationales
✓ SCORED LEVEL 3 GUARANTEED ✓ INCLUDES NGN SELECT-ALL-THAT-APPLY
✓ COMPLETE LAB VALUES & ANTIDOTE GUIDE
DOMAIN 1: SAFE MEDICATION ADMINISTRATION, IV CALCULATIONS & HIGH- QUESTIONS 1 – 5
ALERT DRUGS OF 85
1. A nurse is preparing to administer Digoxin 0.25 mg PO daily to an adult client with heart failure. Which
assessment finding requires the nurse to withhold the medication and notify the provider immediately?
A. Apical pulse rate of 54 beats/min and serum potassium of 3.1 mEq/L
B. Blood pressure of 118/74 mmHg and respiratory rate of 16/min
C. Serum digoxin level of 0.8 ng/mL drawn 6 hours after the last dose
D. Serum potassium of 4.4 mEq/L and apical heart rate of 68 beats/min
CORRECT ANSWER: A. ATI Rationale: Always auscultate the apical pulse for 1 full minute prior to administering Digoxin and
withhold the dose if the apical pulse is <60/min in adults (<70/min in children; <90/min in infants). Hypokalemia (<3.5 mEq/L)
sensitizes the myocardium to fatal Digoxin-induced dysrhythmias (therapeutic range: 0.5–2.0 ng/mL; HFrEF target: 0.5–0.9
ng/mL).
2. A provider prescribes Heparin 18 units/kg/hr by continuous IV infusion for a client who weighs 154 lb (70 kg).
Available is Heparin 25,000 units in 500 mL of 0.45% sodium chloride (50 units/mL). At what rate in mL/hr should
the nurse set the IV infusion pump?
A. 18 mL/hr B. 25.2 mL/hr C. 36 mL/hr D. 50.4 mL/hr
CORRECT ANSWER: B (25.2 mL/hr). ATI Calculation: Step 1: Convert weight to kg: 154 lb ÷ 2.2 = 70 kg. Step 2: Calculate
hourly heparin dose: 18 units/kg/hr × 70 kg = 1,260 units/hr. Step 3: Concentration = 25,000 units ÷ 500 mL = 50 units/mL.
Step 4: Infusion rate = 1,260 units/hr ÷ 50 units/mL = 25.2 mL/hr.
3. A client receiving a continuous IV infusion of Morphine via PCA pump has a respiratory rate of 6 breaths/min,
pinpoint pupils, and is unarousable. Which actions should the nurse take? (Select all that apply.)
A. Stop the PCA Morphine infusion immediately.
B. Administer Naloxone (Narcan) 0.4 mg IV push slowly and prepare to repeat every 2–3 minutes as needed.
C. Stimulate the client and provide bag-valve-mask ventilation with 100% oxygen.
D. Administer Flumazenil 0.2 mg IV push.
E. Leave the client alone to retrieve emergency supplies.
CORRECT ANSWER: A, B, C. ATI Rationale: Stop the opioid immediately, support airway/breathing, and administer the
specific opioid antagonist Naloxone. Monitor closely for recurrent respiratory depression because Naloxone has a shorter half-
life (30–90 min) than Morphine. (Flumazenil reverses benzodiazepines).
4. A nurse is preparing to administer Regular Insulin and NPH Insulin in the same syringe to a client with diabetes
mellitus. Place the steps in the correct sequence using the ATI "RN" (Clear before Cloudy) rule.
A. Inject air into the NPH (cloudy) vial, inject air into the Regular (clear) vial, withdraw Regular (clear) insulin first, then withdraw
NPH (cloudy) insulin.
B. Inject air into Regular vial, withdraw NPH first, then withdraw Regular.
C. Mix NPH and Insulin Glargine in the same syringe.
D. Shake the NPH vial vigorously before drawing up the dose.
CORRECT ANSWER: A. ATI Rationale: Mnemonic: "Inject air into Cloudy, Inject air into Clear, Draw up Clear (Regular), Draw
up Cloudy (NPH)" — remember "RN" (Regular before NPH) so short-acting Regular insulin is never contaminated with
protamine from NPH. Roll NPH gently between palms; never shake. Never mix long-acting Glargine or Detemir with any other
insulin!
ATI RN Pharmacology Proctored Exam Test Bank (2026/2027) — Level 3 Verified Page 1 of 12
, DOMAIN 2: CARDIOVASCULAR, RENAL & HEMATOLOGIC NURSING QUESTIONS 6 – 13 OF
PHARMACOLOGY 85
6. A nurse is teaching a client how to use sublingual Nitroglycerin tablets for acute angina pectoris. Which
statement by the client indicates correct understanding of the ATI protocol?
A. "I will take up to 3 tablets 15 minutes apart before calling 911."
B. "At the onset of chest pain, I will sit or lie down, place 1 tablet under my tongue, and if pain is not relieved after 5 minutes, I
will call 911 immediately and take a second tablet (up to 3 tablets total, 5 minutes apart)."
C. "I will transfer my tablets into a clear plastic pill organizer and keep them for 2 years."
D. "I will swallow the tablet with a full glass of water."
CORRECT ANSWER: B. ATI Rationale: Current AHA/ATI guidelines instruct calling 911 if chest pain does not improve 5
minutes after the FIRST sublingual tablet, then taking a second tablet at 5 minutes and a third at 10 minutes (max 3 doses in
15 min). Store tablets in their original dark amber glass bottle (heat/light/moisture-sensitive) and replace 6 months after
opening.
7. A client with heart failure is prescribed Furosemide (Lasix) 40 mg IV push. Which nursing intervention prevents
the signature sensory adverse effect of rapid IV Loop Diuretic administration?
A. Infuse Furosemide slowly at a rate no faster than 20 mg/min (or 4 mg/min for high doses) to prevent irreversible or transient
ototoxicity (tinnitus, hearing loss, vertigo).
B. Administer Furosemide at bedtime to promote sleep.
C. Restrict dietary potassium and magnesium intake.
D. Co-administer Gentamicin at the same time to protect hearing.
CORRECT ANSWER: A. ATI Rationale: Rapid IV administration of Furosemide (>20 mg/min) damages cochlear hair cells in
the inner ear (ototoxicity). Encourage high-potassium foods (bananas, oranges, potatoes, spinach, avocados), administer in
the morning to avoid nocturia falls, and monitor blood pressure, weight, and K+ levels.
8. A nurse is caring for a client taking Spironolactone (Aldactone) 25 mg daily and Lisinopril 20 mg daily for heart
failure. Which dietary instruction is essential for this client?
A. Use potassium-containing salt substitutes (e.g., NoSalt / Nu-Salt) liberally on food.
B. Avoid potassium-rich salt substitutes and excessive high-potassium foods, and report muscle weakness, paresthesias, or
palpitations immediately (signs of life-threatening Hyperkalemia >5.0 mEq/L).
C. Drink 1 liter of grapefruit juice daily.
D. Take ibuprofen daily for mild headaches.
CORRECT ANSWER: B. ATI Rationale: Both Spironolactone (aldosterone antagonist / K+-sparing diuretic) and Lisinopril
(ACE inhibitor) suppress aldosterone-mediated potassium excretion. Salt substitutes contain high concentrations of potassium
chloride (KCl) and can trigger fatal hyperkalemic cardiac arrest (peaked T waves, widened QRS).
9. A client starts Captopril or Enalapril for hypertension and calls the clinic reporting swelling of the lips, tongue,
and throat with stridor. What is the priority nursing action?
A. Reassure the client that this is a harmless side effect that resolves in 2 weeks.
B. Instruct the client to go to the nearest emergency department immediately or call 911 for life-threatening Bradykinin-mediated
Angioedema, prepare for airway management/subcutaneous Epinephrine, and permanently contraindicate all ACE inhibitors.
C. Instruct the client to take a cough suppressant.
D. Double the dose of Captopril.
CORRECT ANSWER: B. ATI Rationale: ACE inhibitors block degradation of bradykinin, causing a dry, nonproductive cough
(common) and potentially fatal Angioedema of the tongue/glottis/larynx (rare emergency, more common in Black clients). Note:
Captopril should be taken 1 hour before meals and can rarely cause neutropenia.
10. A client receiving a continuous IV infusion of Unfractionated Heparin for a pulmonary embolism has an
activated partial thromboplastin time (aPTT) of 118 seconds (control: 30 seconds; therapeutic goal: 1.5–2.5×
control = 45–75 seconds) and hematuria. What should the nurse do?
A. Increase the Heparin infusion rate by 200 units/hr.
B. Stop the Heparin infusion immediately, notify the provider, and prepare to administer Protamine Sulfate IV slowly (max 50 mg
over 10 minutes).
C. Administer Vitamin K1 (Phytonadione) 10 mg IV.
D. Administer Aminocaproic acid.
CORRECT ANSWER: B. ATI Rationale: Therapeutic aPTT for IV Heparin is 1.5 to 2.5 times the baseline control (roughly 45–
75 or 60–80 seconds). An aPTT >100 seconds with bleeding requires stopping the infusion and administering Protamine
Sulfate (1 mg per 100 units of Heparin infused over the preceding hours). Also monitor platelets every 2–3 days for HIT!
ATI RN Pharmacology Proctored Exam Test Bank (2026/2027) — Level 3 Verified Page 2 of 12
ATI RN PHARMACOLOGY PROCTORED EXAM
VERSION 1, VERSION 2 & RETAKE BANK
85 Actual NGN-Style Questions with 100% Verified Correct Answers & Detailed
Rationales
✓ SCORED LEVEL 3 GUARANTEED ✓ INCLUDES NGN SELECT-ALL-THAT-APPLY
✓ COMPLETE LAB VALUES & ANTIDOTE GUIDE
DOMAIN 1: SAFE MEDICATION ADMINISTRATION, IV CALCULATIONS & HIGH- QUESTIONS 1 – 5
ALERT DRUGS OF 85
1. A nurse is preparing to administer Digoxin 0.25 mg PO daily to an adult client with heart failure. Which
assessment finding requires the nurse to withhold the medication and notify the provider immediately?
A. Apical pulse rate of 54 beats/min and serum potassium of 3.1 mEq/L
B. Blood pressure of 118/74 mmHg and respiratory rate of 16/min
C. Serum digoxin level of 0.8 ng/mL drawn 6 hours after the last dose
D. Serum potassium of 4.4 mEq/L and apical heart rate of 68 beats/min
CORRECT ANSWER: A. ATI Rationale: Always auscultate the apical pulse for 1 full minute prior to administering Digoxin and
withhold the dose if the apical pulse is <60/min in adults (<70/min in children; <90/min in infants). Hypokalemia (<3.5 mEq/L)
sensitizes the myocardium to fatal Digoxin-induced dysrhythmias (therapeutic range: 0.5–2.0 ng/mL; HFrEF target: 0.5–0.9
ng/mL).
2. A provider prescribes Heparin 18 units/kg/hr by continuous IV infusion for a client who weighs 154 lb (70 kg).
Available is Heparin 25,000 units in 500 mL of 0.45% sodium chloride (50 units/mL). At what rate in mL/hr should
the nurse set the IV infusion pump?
A. 18 mL/hr B. 25.2 mL/hr C. 36 mL/hr D. 50.4 mL/hr
CORRECT ANSWER: B (25.2 mL/hr). ATI Calculation: Step 1: Convert weight to kg: 154 lb ÷ 2.2 = 70 kg. Step 2: Calculate
hourly heparin dose: 18 units/kg/hr × 70 kg = 1,260 units/hr. Step 3: Concentration = 25,000 units ÷ 500 mL = 50 units/mL.
Step 4: Infusion rate = 1,260 units/hr ÷ 50 units/mL = 25.2 mL/hr.
3. A client receiving a continuous IV infusion of Morphine via PCA pump has a respiratory rate of 6 breaths/min,
pinpoint pupils, and is unarousable. Which actions should the nurse take? (Select all that apply.)
A. Stop the PCA Morphine infusion immediately.
B. Administer Naloxone (Narcan) 0.4 mg IV push slowly and prepare to repeat every 2–3 minutes as needed.
C. Stimulate the client and provide bag-valve-mask ventilation with 100% oxygen.
D. Administer Flumazenil 0.2 mg IV push.
E. Leave the client alone to retrieve emergency supplies.
CORRECT ANSWER: A, B, C. ATI Rationale: Stop the opioid immediately, support airway/breathing, and administer the
specific opioid antagonist Naloxone. Monitor closely for recurrent respiratory depression because Naloxone has a shorter half-
life (30–90 min) than Morphine. (Flumazenil reverses benzodiazepines).
4. A nurse is preparing to administer Regular Insulin and NPH Insulin in the same syringe to a client with diabetes
mellitus. Place the steps in the correct sequence using the ATI "RN" (Clear before Cloudy) rule.
A. Inject air into the NPH (cloudy) vial, inject air into the Regular (clear) vial, withdraw Regular (clear) insulin first, then withdraw
NPH (cloudy) insulin.
B. Inject air into Regular vial, withdraw NPH first, then withdraw Regular.
C. Mix NPH and Insulin Glargine in the same syringe.
D. Shake the NPH vial vigorously before drawing up the dose.
CORRECT ANSWER: A. ATI Rationale: Mnemonic: "Inject air into Cloudy, Inject air into Clear, Draw up Clear (Regular), Draw
up Cloudy (NPH)" — remember "RN" (Regular before NPH) so short-acting Regular insulin is never contaminated with
protamine from NPH. Roll NPH gently between palms; never shake. Never mix long-acting Glargine or Detemir with any other
insulin!
ATI RN Pharmacology Proctored Exam Test Bank (2026/2027) — Level 3 Verified Page 1 of 12
, DOMAIN 2: CARDIOVASCULAR, RENAL & HEMATOLOGIC NURSING QUESTIONS 6 – 13 OF
PHARMACOLOGY 85
6. A nurse is teaching a client how to use sublingual Nitroglycerin tablets for acute angina pectoris. Which
statement by the client indicates correct understanding of the ATI protocol?
A. "I will take up to 3 tablets 15 minutes apart before calling 911."
B. "At the onset of chest pain, I will sit or lie down, place 1 tablet under my tongue, and if pain is not relieved after 5 minutes, I
will call 911 immediately and take a second tablet (up to 3 tablets total, 5 minutes apart)."
C. "I will transfer my tablets into a clear plastic pill organizer and keep them for 2 years."
D. "I will swallow the tablet with a full glass of water."
CORRECT ANSWER: B. ATI Rationale: Current AHA/ATI guidelines instruct calling 911 if chest pain does not improve 5
minutes after the FIRST sublingual tablet, then taking a second tablet at 5 minutes and a third at 10 minutes (max 3 doses in
15 min). Store tablets in their original dark amber glass bottle (heat/light/moisture-sensitive) and replace 6 months after
opening.
7. A client with heart failure is prescribed Furosemide (Lasix) 40 mg IV push. Which nursing intervention prevents
the signature sensory adverse effect of rapid IV Loop Diuretic administration?
A. Infuse Furosemide slowly at a rate no faster than 20 mg/min (or 4 mg/min for high doses) to prevent irreversible or transient
ototoxicity (tinnitus, hearing loss, vertigo).
B. Administer Furosemide at bedtime to promote sleep.
C. Restrict dietary potassium and magnesium intake.
D. Co-administer Gentamicin at the same time to protect hearing.
CORRECT ANSWER: A. ATI Rationale: Rapid IV administration of Furosemide (>20 mg/min) damages cochlear hair cells in
the inner ear (ototoxicity). Encourage high-potassium foods (bananas, oranges, potatoes, spinach, avocados), administer in
the morning to avoid nocturia falls, and monitor blood pressure, weight, and K+ levels.
8. A nurse is caring for a client taking Spironolactone (Aldactone) 25 mg daily and Lisinopril 20 mg daily for heart
failure. Which dietary instruction is essential for this client?
A. Use potassium-containing salt substitutes (e.g., NoSalt / Nu-Salt) liberally on food.
B. Avoid potassium-rich salt substitutes and excessive high-potassium foods, and report muscle weakness, paresthesias, or
palpitations immediately (signs of life-threatening Hyperkalemia >5.0 mEq/L).
C. Drink 1 liter of grapefruit juice daily.
D. Take ibuprofen daily for mild headaches.
CORRECT ANSWER: B. ATI Rationale: Both Spironolactone (aldosterone antagonist / K+-sparing diuretic) and Lisinopril
(ACE inhibitor) suppress aldosterone-mediated potassium excretion. Salt substitutes contain high concentrations of potassium
chloride (KCl) and can trigger fatal hyperkalemic cardiac arrest (peaked T waves, widened QRS).
9. A client starts Captopril or Enalapril for hypertension and calls the clinic reporting swelling of the lips, tongue,
and throat with stridor. What is the priority nursing action?
A. Reassure the client that this is a harmless side effect that resolves in 2 weeks.
B. Instruct the client to go to the nearest emergency department immediately or call 911 for life-threatening Bradykinin-mediated
Angioedema, prepare for airway management/subcutaneous Epinephrine, and permanently contraindicate all ACE inhibitors.
C. Instruct the client to take a cough suppressant.
D. Double the dose of Captopril.
CORRECT ANSWER: B. ATI Rationale: ACE inhibitors block degradation of bradykinin, causing a dry, nonproductive cough
(common) and potentially fatal Angioedema of the tongue/glottis/larynx (rare emergency, more common in Black clients). Note:
Captopril should be taken 1 hour before meals and can rarely cause neutropenia.
10. A client receiving a continuous IV infusion of Unfractionated Heparin for a pulmonary embolism has an
activated partial thromboplastin time (aPTT) of 118 seconds (control: 30 seconds; therapeutic goal: 1.5–2.5×
control = 45–75 seconds) and hematuria. What should the nurse do?
A. Increase the Heparin infusion rate by 200 units/hr.
B. Stop the Heparin infusion immediately, notify the provider, and prepare to administer Protamine Sulfate IV slowly (max 50 mg
over 10 minutes).
C. Administer Vitamin K1 (Phytonadione) 10 mg IV.
D. Administer Aminocaproic acid.
CORRECT ANSWER: B. ATI Rationale: Therapeutic aPTT for IV Heparin is 1.5 to 2.5 times the baseline control (roughly 45–
75 or 60–80 seconds). An aPTT >100 seconds with bleeding requires stopping the infusion and administering Protamine
Sulfate (1 mg per 100 units of Heparin infused over the preceding hours). Also monitor platelets every 2–3 days for HIT!
ATI RN Pharmacology Proctored Exam Test Bank (2026/2027) — Level 3 Verified Page 2 of 12
