The ATI-RN Pharmacology Proctored Exam
1. Pharmacokinetics
Scenario: A 65-year-old male patient with chronic kidney disease is prescribed a medication that
is primarily excreted by the kidneys. The nurse understands that the patient may require a dosage
adjustment due to impaired renal function.
Question: Which of the following pharmacokinetic processes is most affected in this patient?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Correct Answer: D. Excretion
Rationale: The kidneys are primarily responsible for the excretion of many drugs. In patients
with chronic kidney disease, the excretion of drugs is impaired, leading to potential drug
accumulation and toxicity. Therefore, dosage adjustments are often necessary to ensure safe and
effective therapy.
2. Pharmacodynamics
Scenario: A patient is prescribed a beta-blocker for hypertension. The nurse explains that the
medication works by blocking beta-adrenergic receptors.
Question: Which of the following best describes the mechanism of action of beta-blockers?
A. They increase heart rate and contractility.
B. They block the effects of sympathetic nervous system stimulation.
C. They promote vasodilation by relaxing smooth muscle.
D. They enhance the release of norepinephrine.
Correct Answer: B. They block the effects of sympathetic nervous system stimulation.
Rationale: Beta-blockers work by blocking beta-adrenergic receptors, which inhibits the effects
of the sympathetic nervous system. This results in decreased heart rate, reduced contractility, and
lowered blood pressure.
3. Drug Classifications and Therapeutic Uses
Scenario: A patient with type 2 diabetes is prescribed metformin. The nurse is educating the
patient about the medication.
Question: Metformin belongs to which class of medications?
A. Sulfonylureas
B. Biguanides
C. Thiazolidinediones
D. DPP-4 inhibitors
,Correct Answer: B. Biguanides
Rationale: Metformin is a biguanide, which works by decreasing hepatic glucose production and
increasing insulin sensitivity in peripheral tissues. It is commonly used as a first-line treatment
for type 2 diabetes.
4. Safe Medication Administration
Scenario: A nurse is preparing to administer intravenous (IV) vancomycin to a patient with a
methicillin-resistant Staphylococcus aureus (MRSA) infection.
Question: Which of the following actions is most important for the nurse to take before
administering IV vancomycin?
A. Check the patient's blood glucose level.
B. Assess the patient's renal function.
C. Administer the medication over 5 minutes.
D. Monitor the patient's heart rate.
Correct Answer: B. Assess the patient's renal function.
Rationale: Vancomycin is primarily excreted by the kidneys, and impaired renal function can
lead to drug accumulation and toxicity. Therefore, it is crucial to assess the patient's renal
function before administration and adjust the dosage if necessary.
5. Adverse Effects
Scenario: A patient is prescribed amiodarone for the treatment of ventricular arrhythmias. The
nurse is monitoring the patient for potential adverse effects.
Question: Which of the following adverse effects is most commonly associated with amiodarone
therapy?
A. Hyperglycemia
B. Pulmonary fibrosis
C. Hypokalemia
D. Hypertension
Correct Answer: B. Pulmonary fibrosis
Rationale: Amiodarone is associated with a risk of pulmonary fibrosis, which can be life-
threatening. Other adverse effects include hepatotoxicity, thyroid dysfunction, and corneal
deposits.
6. Nursing Interventions
Scenario: A patient is receiving warfarin therapy for atrial fibrillation. The nurse is educating
the patient about dietary considerations.
Question: Which of the following foods should the nurse advise the patient to consume in
consistent amounts while taking warfarin?
A. Green leafy vegetables
,B. Dairy products
C. Citrus fruits
D. Whole grains
Correct Answer: A. Green leafy vegetables
Rationale: Green leafy vegetables are high in vitamin K, which can antagonize the effects of
warfarin. Consistent intake of vitamin K-rich foods is important to maintain stable
anticoagulation levels.
7. Patient Education
Scenario: A patient is prescribed a transdermal nitroglycerin patch for the management of
angina.
Question: Which of the following instructions should the nurse provide to the patient regarding
the use of the nitroglycerin patch?
A. Apply the patch to the same site every day.
B. Remove the patch before taking a shower.
C. Apply the patch to a hairy area for better adhesion.
D. Leave the patch on for 24 hours and then replace it with a new one.
Correct Answer: D. Leave the patch on for 24 hours and then replace it with a new one.
Rationale: Transdermal nitroglycerin patches are typically worn for 12 to 14 hours and then
removed to prevent tolerance. However, some patches are designed for 24-hour use. The patient
should follow the specific instructions provided with their prescription.
8. Pharmacokinetics
Scenario: A patient with liver cirrhosis is prescribed a medication that undergoes extensive first-
pass metabolism.
Question: How is the bioavailability of the medication likely to be affected in this patient?
A. Decreased bioavailability
B. Increased bioavailability
C. No change in bioavailability
D. Variable bioavailability
Correct Answer: B. Increased bioavailability
Rationale: First-pass metabolism occurs in the liver, where a significant portion of a drug is
metabolized before it reaches systemic circulation. In patients with liver cirrhosis, liver function
is impaired, leading to reduced first-pass metabolism and increased bioavailability of the drug.
9. Drug Classifications and Therapeutic Uses
Scenario: A patient with rheumatoid arthritis is prescribed methotrexate. The nurse is explaining
the medication to the patient.
, Question: Methotrexate belongs to which class of medications?
A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
B. Disease-modifying antirheumatic drugs (DMARDs)
C. Corticosteroids
D. Biologic response modifiers
Correct Answer: B. Disease-modifying antirheumatic drugs (DMARDs)
Rationale: Methotrexate is a DMARD, which works by inhibiting dihydrofolate reductase,
thereby suppressing the immune system and reducing inflammation in rheumatoid arthritis.
10. Adverse Effects
Scenario: A patient is prescribed a statin for hyperlipidemia. The nurse is monitoring the patient
for potential adverse effects.
Question: Which of the following adverse effects is most commonly associated with statin
therapy?
A. Hypoglycemia
B. Myopathy
C. Hyperkalemia
D. Hypertension
Correct Answer: B. Myopathy
Rationale: Statins are associated with a risk of myopathy, which can progress to
rhabdomyolysis, a serious condition involving muscle breakdown. Patients should be advised to
report any unexplained muscle pain or weakness.
11. Pharmacokinetics
Scenario: A 45-year-old patient with a history of gastric bypass surgery is prescribed an oral
medication. The nurse is concerned about the drug's absorption.
Question: Which of the following factors is most likely to affect the absorption of the
medication in this patient?
A. Increased gastric pH
B. Reduced intestinal surface area
C. Enhanced first-pass metabolism
D. Decreased renal excretion
Correct Answer: B. Reduced intestinal surface area
Rationale: Gastric bypass surgery often reduces the surface area available for drug absorption in
the gastrointestinal tract. This can significantly impact the bioavailability of orally administered
medications.
12. Pharmacodynamics
1. Pharmacokinetics
Scenario: A 65-year-old male patient with chronic kidney disease is prescribed a medication that
is primarily excreted by the kidneys. The nurse understands that the patient may require a dosage
adjustment due to impaired renal function.
Question: Which of the following pharmacokinetic processes is most affected in this patient?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Correct Answer: D. Excretion
Rationale: The kidneys are primarily responsible for the excretion of many drugs. In patients
with chronic kidney disease, the excretion of drugs is impaired, leading to potential drug
accumulation and toxicity. Therefore, dosage adjustments are often necessary to ensure safe and
effective therapy.
2. Pharmacodynamics
Scenario: A patient is prescribed a beta-blocker for hypertension. The nurse explains that the
medication works by blocking beta-adrenergic receptors.
Question: Which of the following best describes the mechanism of action of beta-blockers?
A. They increase heart rate and contractility.
B. They block the effects of sympathetic nervous system stimulation.
C. They promote vasodilation by relaxing smooth muscle.
D. They enhance the release of norepinephrine.
Correct Answer: B. They block the effects of sympathetic nervous system stimulation.
Rationale: Beta-blockers work by blocking beta-adrenergic receptors, which inhibits the effects
of the sympathetic nervous system. This results in decreased heart rate, reduced contractility, and
lowered blood pressure.
3. Drug Classifications and Therapeutic Uses
Scenario: A patient with type 2 diabetes is prescribed metformin. The nurse is educating the
patient about the medication.
Question: Metformin belongs to which class of medications?
A. Sulfonylureas
B. Biguanides
C. Thiazolidinediones
D. DPP-4 inhibitors
,Correct Answer: B. Biguanides
Rationale: Metformin is a biguanide, which works by decreasing hepatic glucose production and
increasing insulin sensitivity in peripheral tissues. It is commonly used as a first-line treatment
for type 2 diabetes.
4. Safe Medication Administration
Scenario: A nurse is preparing to administer intravenous (IV) vancomycin to a patient with a
methicillin-resistant Staphylococcus aureus (MRSA) infection.
Question: Which of the following actions is most important for the nurse to take before
administering IV vancomycin?
A. Check the patient's blood glucose level.
B. Assess the patient's renal function.
C. Administer the medication over 5 minutes.
D. Monitor the patient's heart rate.
Correct Answer: B. Assess the patient's renal function.
Rationale: Vancomycin is primarily excreted by the kidneys, and impaired renal function can
lead to drug accumulation and toxicity. Therefore, it is crucial to assess the patient's renal
function before administration and adjust the dosage if necessary.
5. Adverse Effects
Scenario: A patient is prescribed amiodarone for the treatment of ventricular arrhythmias. The
nurse is monitoring the patient for potential adverse effects.
Question: Which of the following adverse effects is most commonly associated with amiodarone
therapy?
A. Hyperglycemia
B. Pulmonary fibrosis
C. Hypokalemia
D. Hypertension
Correct Answer: B. Pulmonary fibrosis
Rationale: Amiodarone is associated with a risk of pulmonary fibrosis, which can be life-
threatening. Other adverse effects include hepatotoxicity, thyroid dysfunction, and corneal
deposits.
6. Nursing Interventions
Scenario: A patient is receiving warfarin therapy for atrial fibrillation. The nurse is educating
the patient about dietary considerations.
Question: Which of the following foods should the nurse advise the patient to consume in
consistent amounts while taking warfarin?
A. Green leafy vegetables
,B. Dairy products
C. Citrus fruits
D. Whole grains
Correct Answer: A. Green leafy vegetables
Rationale: Green leafy vegetables are high in vitamin K, which can antagonize the effects of
warfarin. Consistent intake of vitamin K-rich foods is important to maintain stable
anticoagulation levels.
7. Patient Education
Scenario: A patient is prescribed a transdermal nitroglycerin patch for the management of
angina.
Question: Which of the following instructions should the nurse provide to the patient regarding
the use of the nitroglycerin patch?
A. Apply the patch to the same site every day.
B. Remove the patch before taking a shower.
C. Apply the patch to a hairy area for better adhesion.
D. Leave the patch on for 24 hours and then replace it with a new one.
Correct Answer: D. Leave the patch on for 24 hours and then replace it with a new one.
Rationale: Transdermal nitroglycerin patches are typically worn for 12 to 14 hours and then
removed to prevent tolerance. However, some patches are designed for 24-hour use. The patient
should follow the specific instructions provided with their prescription.
8. Pharmacokinetics
Scenario: A patient with liver cirrhosis is prescribed a medication that undergoes extensive first-
pass metabolism.
Question: How is the bioavailability of the medication likely to be affected in this patient?
A. Decreased bioavailability
B. Increased bioavailability
C. No change in bioavailability
D. Variable bioavailability
Correct Answer: B. Increased bioavailability
Rationale: First-pass metabolism occurs in the liver, where a significant portion of a drug is
metabolized before it reaches systemic circulation. In patients with liver cirrhosis, liver function
is impaired, leading to reduced first-pass metabolism and increased bioavailability of the drug.
9. Drug Classifications and Therapeutic Uses
Scenario: A patient with rheumatoid arthritis is prescribed methotrexate. The nurse is explaining
the medication to the patient.
, Question: Methotrexate belongs to which class of medications?
A. Nonsteroidal anti-inflammatory drugs (NSAIDs)
B. Disease-modifying antirheumatic drugs (DMARDs)
C. Corticosteroids
D. Biologic response modifiers
Correct Answer: B. Disease-modifying antirheumatic drugs (DMARDs)
Rationale: Methotrexate is a DMARD, which works by inhibiting dihydrofolate reductase,
thereby suppressing the immune system and reducing inflammation in rheumatoid arthritis.
10. Adverse Effects
Scenario: A patient is prescribed a statin for hyperlipidemia. The nurse is monitoring the patient
for potential adverse effects.
Question: Which of the following adverse effects is most commonly associated with statin
therapy?
A. Hypoglycemia
B. Myopathy
C. Hyperkalemia
D. Hypertension
Correct Answer: B. Myopathy
Rationale: Statins are associated with a risk of myopathy, which can progress to
rhabdomyolysis, a serious condition involving muscle breakdown. Patients should be advised to
report any unexplained muscle pain or weakness.
11. Pharmacokinetics
Scenario: A 45-year-old patient with a history of gastric bypass surgery is prescribed an oral
medication. The nurse is concerned about the drug's absorption.
Question: Which of the following factors is most likely to affect the absorption of the
medication in this patient?
A. Increased gastric pH
B. Reduced intestinal surface area
C. Enhanced first-pass metabolism
D. Decreased renal excretion
Correct Answer: B. Reduced intestinal surface area
Rationale: Gastric bypass surgery often reduces the surface area available for drug absorption in
the gastrointestinal tract. This can significantly impact the bioavailability of orally administered
medications.
12. Pharmacodynamics
