ATI RN Pharmacology Proctored Exam 2024 – 200
NCLEX-Style Questions with Rationales & A+ Verified
Solutions
Pharmacology Questions
Question 1: A nurse is preparing to administer digoxin 0.125 mg PO to a client with heart failure.
Which assessment should the nurse prioritize before administration?
a) Blood glucose level
b) Apical pulse rate
c) Respiratory rate
d) Urine output
Answer: b) Apical pulse rate
Rationale: Digoxin slows heart rate and increases contractility. Checking the apical pulse
for 1 minute is critical to ensure it is above 60 bpm, as bradycardia is a potential adverse
effect. Holding the dose and notifying the provider is necessary if the pulse is too low.
Question 2: A client receiving warfarin reports bleeding gums. Which action should the nurse take
first?
a) Administer vitamin K
b) Assess the client’s INR
c) Encourage oral hygiene
d) Stop the warfarin dose
Answer: b) Assess the client’s INR
Rationale: Bleeding gums suggest possible warfarin toxicity. The INR (International
Normalized Ratio) should be checked first to evaluate coagulation status. An elevated
INR may require vitamin K or dose adjustment, but assessment precedes intervention.
Question 3: A nurse is teaching a client about furosemide. Which adverse effect should the nurse
emphasize?
a) Hyperkalemia
b) Hypokalemia
c) Hypernatremia
d) Hypocalcemia
Answer: b) Hypokalemia
Rationale: Furosemide, a loop diuretic, increases potassium excretion, leading to hy-
pokalemia. The nurse should educate the client to monitor for symptoms like muscle
cramps and consume potassium-rich foods, as low potassium can cause arrhythmias.
Question 4: A client is prescribed metronidazole for a bacterial infection. Which food should the
nurse instruct the client to avoid?
a) Dairy products
b) Alcohol
c) Citrus fruits
d) Leafy greens
Answer: b) Alcohol
Rationale: Metronidazole can cause a disulfiram-like reaction (nausea, flushing, tachy-
cardia) when combined with alcohol due to inhibition of aldehyde dehydrogenase. The
client should avoid alcohol during treatment and for 48 hours after.
1
,Question 5: A nurse is administering insulin lispro to a client with diabetes. When should the nurse
expect the peak effect?
a) 15–30 minutes
b) 1–2 hours
c) 4–6 hours
d) 12–24 hours
Answer: b) 1–2 hours
Rationale: Insulin lispro is a rapid-acting insulin with a peak effect at 1–2 hours. Un-
derstanding pharmacokinetics helps the nurse monitor for hypoglycemia during this time
and plan meals accordingly.
Question 6: A client receiving heparin for deep vein thrombosis develops petechiae. What should the
nurse do first?
a) Continue the infusion
b) Stop the heparin
c) Administer protamine sulfate
d) Notify the provider
Answer: d) Notify the provider
Rationale: Petechiae indicate possible heparin-induced thrombocytopenia or bleeding.
The nurse should notify the provider for further evaluation (e.g., platelet count, aPTT).
Stopping heparin or giving protamine sulfate requires a provider’s order.
Question 7: A nurse is caring for a client prescribed fluoxetine for depression. Which adverse effect
should the nurse monitor for?
a) Seizures
b) Sexual dysfunction
c) Hypertension
d) Hypoglycemia
Answer: b) Sexual dysfunction
Rationale: Fluoxetine, an SSRI, commonly causes sexual dysfunction, such as decreased
libido or erectile dysfunction. The nurse should monitor and educate the client about this
potential effect, which may impact adherence.
Question 8: A client is receiving morphine for pain. Which nursing intervention is most appropriate?
a) Monitor respiratory rate
b) Check blood glucose
c) Assess for fever
d) Measure urine specific gravity
Answer: a) Monitor respiratory rate
Rationale: Morphine, an opioid, can cause respiratory depression, a life-threatening ad-
verse effect. The nurse should monitor respiratory rate closely, holding the dose if it falls
below 12 breaths per minute and notifying the provider.
Question 9: A nurse is preparing to administer amoxicillin to a client with a penicillin allergy. What
should the nurse do?
a) Administer as prescribed
b) Verify the allergy history
c) Give a test dose
d) Switch to erythromycin
Answer: b) Verify the allergy history
2
, Rationale: Amoxicillin is a penicillin derivative, and administration to a client with a
penicillin allergy risks anaphylaxis. The nurse must confirm the allergy history and con-
sult the provider for an alternative, such as a macrolide.
Question 10: A client is prescribed atorvastatin. Which laboratory value should the nurse monitor?
a) Serum potassium
b) Liver enzymes
c) Blood urea nitrogen
d) Hemoglobin A1c
Answer: b) Liver enzymes
Rationale: Atorvastatin, a statin, can cause hepatotoxicity. Monitoring liver enzymes
(e.g., AST, ALT) is essential to detect liver damage early. Clients should report symptoms
like jaundice or abdominal pain.
Question 11: A client is prescribed midazolam for procedural sedation. Which finding indicates the
client is ready for discharge?
a) Blood pressure 90/60 mmHg
b) Capnography at baseline
c) Heart rate 50 bpm
d) Oxygen saturation 85%
Answer: b) Capnography at baseline
Rationale: Midazolam can cause respiratory depression. A return to baseline capnog-
raphy (end-tidal CO2) indicates stable respiratory status, a key criterion for discharge
post-sedation.
Question 12: A client is prescribed metformin. Which client statement indicates a need for further
teaching?
a) “I’ll take it with breakfast.”
b) “I’ll monitor for signs of lactic acidosis.”
c) “I’ll stop it before a CT scan with contrast.”
d) “I’ll take it even if I’m vomiting.”
Answer: d) “I’ll take it even if I’m vomiting.”
Rationale: Metformin should be held if the client is vomiting due to the risk of lactic aci-
dosis, especially in dehydrated states. The other statements reflect correct understanding
of metformin use.
Question 13: A nurse is caring for a client receiving gentamicin. Which adverse effect should the nurse
monitor for?
a) Ototoxicity
b) Hypokalemia
c) Hyperglycemia
d) Bradycardia
Answer: a) Ototoxicity
Rationale: Gentamicin, an aminoglycoside, can cause ototoxicity, leading to hearing loss
or tinnitus. The nurse should monitor for auditory changes and ensure trough levels are
checked to minimize toxicity.
Question 14: A client is prescribed lisinopril. Which drug interaction should the nurse be aware of?
a) Potassium supplements
b) Calcium supplements
3
NCLEX-Style Questions with Rationales & A+ Verified
Solutions
Pharmacology Questions
Question 1: A nurse is preparing to administer digoxin 0.125 mg PO to a client with heart failure.
Which assessment should the nurse prioritize before administration?
a) Blood glucose level
b) Apical pulse rate
c) Respiratory rate
d) Urine output
Answer: b) Apical pulse rate
Rationale: Digoxin slows heart rate and increases contractility. Checking the apical pulse
for 1 minute is critical to ensure it is above 60 bpm, as bradycardia is a potential adverse
effect. Holding the dose and notifying the provider is necessary if the pulse is too low.
Question 2: A client receiving warfarin reports bleeding gums. Which action should the nurse take
first?
a) Administer vitamin K
b) Assess the client’s INR
c) Encourage oral hygiene
d) Stop the warfarin dose
Answer: b) Assess the client’s INR
Rationale: Bleeding gums suggest possible warfarin toxicity. The INR (International
Normalized Ratio) should be checked first to evaluate coagulation status. An elevated
INR may require vitamin K or dose adjustment, but assessment precedes intervention.
Question 3: A nurse is teaching a client about furosemide. Which adverse effect should the nurse
emphasize?
a) Hyperkalemia
b) Hypokalemia
c) Hypernatremia
d) Hypocalcemia
Answer: b) Hypokalemia
Rationale: Furosemide, a loop diuretic, increases potassium excretion, leading to hy-
pokalemia. The nurse should educate the client to monitor for symptoms like muscle
cramps and consume potassium-rich foods, as low potassium can cause arrhythmias.
Question 4: A client is prescribed metronidazole for a bacterial infection. Which food should the
nurse instruct the client to avoid?
a) Dairy products
b) Alcohol
c) Citrus fruits
d) Leafy greens
Answer: b) Alcohol
Rationale: Metronidazole can cause a disulfiram-like reaction (nausea, flushing, tachy-
cardia) when combined with alcohol due to inhibition of aldehyde dehydrogenase. The
client should avoid alcohol during treatment and for 48 hours after.
1
,Question 5: A nurse is administering insulin lispro to a client with diabetes. When should the nurse
expect the peak effect?
a) 15–30 minutes
b) 1–2 hours
c) 4–6 hours
d) 12–24 hours
Answer: b) 1–2 hours
Rationale: Insulin lispro is a rapid-acting insulin with a peak effect at 1–2 hours. Un-
derstanding pharmacokinetics helps the nurse monitor for hypoglycemia during this time
and plan meals accordingly.
Question 6: A client receiving heparin for deep vein thrombosis develops petechiae. What should the
nurse do first?
a) Continue the infusion
b) Stop the heparin
c) Administer protamine sulfate
d) Notify the provider
Answer: d) Notify the provider
Rationale: Petechiae indicate possible heparin-induced thrombocytopenia or bleeding.
The nurse should notify the provider for further evaluation (e.g., platelet count, aPTT).
Stopping heparin or giving protamine sulfate requires a provider’s order.
Question 7: A nurse is caring for a client prescribed fluoxetine for depression. Which adverse effect
should the nurse monitor for?
a) Seizures
b) Sexual dysfunction
c) Hypertension
d) Hypoglycemia
Answer: b) Sexual dysfunction
Rationale: Fluoxetine, an SSRI, commonly causes sexual dysfunction, such as decreased
libido or erectile dysfunction. The nurse should monitor and educate the client about this
potential effect, which may impact adherence.
Question 8: A client is receiving morphine for pain. Which nursing intervention is most appropriate?
a) Monitor respiratory rate
b) Check blood glucose
c) Assess for fever
d) Measure urine specific gravity
Answer: a) Monitor respiratory rate
Rationale: Morphine, an opioid, can cause respiratory depression, a life-threatening ad-
verse effect. The nurse should monitor respiratory rate closely, holding the dose if it falls
below 12 breaths per minute and notifying the provider.
Question 9: A nurse is preparing to administer amoxicillin to a client with a penicillin allergy. What
should the nurse do?
a) Administer as prescribed
b) Verify the allergy history
c) Give a test dose
d) Switch to erythromycin
Answer: b) Verify the allergy history
2
, Rationale: Amoxicillin is a penicillin derivative, and administration to a client with a
penicillin allergy risks anaphylaxis. The nurse must confirm the allergy history and con-
sult the provider for an alternative, such as a macrolide.
Question 10: A client is prescribed atorvastatin. Which laboratory value should the nurse monitor?
a) Serum potassium
b) Liver enzymes
c) Blood urea nitrogen
d) Hemoglobin A1c
Answer: b) Liver enzymes
Rationale: Atorvastatin, a statin, can cause hepatotoxicity. Monitoring liver enzymes
(e.g., AST, ALT) is essential to detect liver damage early. Clients should report symptoms
like jaundice or abdominal pain.
Question 11: A client is prescribed midazolam for procedural sedation. Which finding indicates the
client is ready for discharge?
a) Blood pressure 90/60 mmHg
b) Capnography at baseline
c) Heart rate 50 bpm
d) Oxygen saturation 85%
Answer: b) Capnography at baseline
Rationale: Midazolam can cause respiratory depression. A return to baseline capnog-
raphy (end-tidal CO2) indicates stable respiratory status, a key criterion for discharge
post-sedation.
Question 12: A client is prescribed metformin. Which client statement indicates a need for further
teaching?
a) “I’ll take it with breakfast.”
b) “I’ll monitor for signs of lactic acidosis.”
c) “I’ll stop it before a CT scan with contrast.”
d) “I’ll take it even if I’m vomiting.”
Answer: d) “I’ll take it even if I’m vomiting.”
Rationale: Metformin should be held if the client is vomiting due to the risk of lactic aci-
dosis, especially in dehydrated states. The other statements reflect correct understanding
of metformin use.
Question 13: A nurse is caring for a client receiving gentamicin. Which adverse effect should the nurse
monitor for?
a) Ototoxicity
b) Hypokalemia
c) Hyperglycemia
d) Bradycardia
Answer: a) Ototoxicity
Rationale: Gentamicin, an aminoglycoside, can cause ototoxicity, leading to hearing loss
or tinnitus. The nurse should monitor for auditory changes and ensure trough levels are
checked to minimize toxicity.
Question 14: A client is prescribed lisinopril. Which drug interaction should the nurse be aware of?
a) Potassium supplements
b) Calcium supplements
3
