ATI Pharmacology Proctored
Exam | 2025/2026 Verified
Questions & Expert-Level
Rationales
Question 1
A nurse is preparing to administer gentamicin 5 mg/kg IV every 24 hours to a 70 kg adult client
with normal renal function. The correct dose is: A. 250 mg B. 350 mg C. 450 mg D. 500 mg
B. 350 mg
Rationale: Dosage calculation: 5 mg/kg × 70 kg = 350 mg. Gentamicin's aminoglycoside class
risks ototoxicity and nephrotoxicity; 2025 FDA guidelines recommend once-daily dosing for
adults with CrCl >60 mL/min, with trough levels <1 mcg/mL to ensure safety. Monitor renal
function and audiometry in prolonged use.
Question 2
A client with penicillin allergy is prescribed azithromycin for community-acquired pneumonia.
Which adverse effect should the nurse monitor most closely? A. Nephrotoxicity B. QT
prolongation C. Hepatotoxicity D. Thrombocytopenia
B. QT prolongation
Rationale: Azithromycin's macrolide structure can prolong QT interval, risking torsades de
pointes, especially in clients with cardiac history. 2025 AHA guidelines contraindicate in long
QT syndrome; monitor ECG and potassium, advising avoidance of QT-prolonging drugs like
antiarrhythmics.
Question 3
A 65-year-old client with CrCl 30 mL/min is prescribed metformin 500 mg PO BID for type 2
diabetes. The nurse should: A. Administer as ordered B. Hold and notify provider C. Reduce to
250 mg daily D. Switch to extended-release
B. Hold and notify provider
,Rationale: Metformin's biguanide class risks lactic acidosis in renal impairment (CrCl <45
mL/min per ADA 2025); contraindication for CrCl <30 mL/min. Safety requires immediate
discontinuation and alternative like SGLT2 inhibitors, with monitoring for acidosis symptoms.
Question 4
A nurse is administering warfarin 5 mg PO daily to a client with atrial fibrillation. The target
INR is: A. 1.5-2.0 B. 2.0-3.0 C. 3.0-4.0 D. 4.0-5.0
B. 2.0-3.0
Rationale: Warfarin's vitamin K antagonism targets INR 2.0-3.0 for AF stroke prevention (AHA
2025). Below increases thrombosis; above risks bleed. Safety includes weekly monitoring,
vitamin K consistency, and reversal with vitamin K for supratherapeutic.
Question 5
A client receiving cisplatin 75 mg/m2 IV for ovarian cancer has a creatinine clearance of 50
mL/min. The nurse should anticipate: A. Full dose B. Dose reduction to 50-75% C.
Discontinuation D. Switch to carboplatin
B. Dose reduction to 50-75%
Rationale: Cisplatin's platinum nephrotoxicity requires adjustment for CrCl 50-60 mL/min per
NCCN 2025; hydration and mannitol protect kidneys. Safety includes pre/post hydration and
magnesium supplementation for hypomagnesemia.
Question 6
A nurse is monitoring a client on lithium 900 mg PO daily for bipolar disorder. The therapeutic
serum level is: A. 0.2-0.5 mEq/L B. 0.6-1.2 mEq/L C. 1.5-2.0 mEq/L D. >2.0 mEq/L
B. 0.6-1.2 mEq/L
Rationale: Lithium's mood stabilization targets 0.6-1.2 mEq/L (APA 2025); <0.6
subtherapeutic, >1.2 toxicity (tremor, confusion). Safety includes renal/thyroid monitoring and
low-sodium diet avoidance.
Question 7
A client with sulfa allergy is prescribed trimethoprim-sulfamethoxazole for UTI. The nurse
should: A. Administer with caution B. Notify provider for alternative C. Give with probenecid
D. Monitor urine output only
B. Notify provider for alternative
, Rationale: Cross-reactivity ~3% with sulfonamides risks Stevens-Johnson syndrome (FDA
2025). Safety requires nitrofurantoin or fosfomycin substitution, with allergy verification.
Question 8
A nurse is calculating a dose of enoxaparin 1 mg/kg subcutaneous BID for a 80 kg client with
DVT. The dose is: A. 40 mg B. 80 mg C. 120 mg D. 160 mg
B. 80 mg
Rationale: 1 mg/kg × 80 kg = 80 mg BID; LMWH's anti-Xa activity. ASH 2025 recommends
anti-Xa levels if obese, with subcutaneous technique using 90-degree angle for safety.
Question 9
A client on amiodarone 200 mg PO daily for atrial fibrillation should be monitored for: A.
Hypothyroidism B. Pulmonary fibrosis C. Hyperkalemia D. Anemia
B. Pulmonary fibrosis
Rationale: Amiodarone's iodine content causes interstitial pneumonitis (5-15% risk per AHA
2025); baseline PFTs and annual CXR. Safety includes discontinuation if dyspnea occurs.
Question 10
A 50-year-old client with CrCl 25 mL/min is prescribed gabapentin 300 mg PO TID for
neuropathy. The nurse should anticipate: A. Full dose B. Reduce to 100 mg TID C. Switch to
IV D. Discontinue
B. Reduce to 100 mg TID
Rationale: Gabapentin's renal excretion requires 25-50% reduction for CrCl 15-30 mL/min
(FDA 2025); toxicity risks sedation/seizures. Safety includes titration and myoclonus
monitoring.
Question 11
A nurse is administering verapamil 120 mg PO daily to a client with hypertension.
Contraindication includes: A. Heart rate 80 bpm B. Second-degree AV block C. BP 140/90 mm
Hg D. Age 55 years
B. Second-degree AV block
Rationale: Verapamil's calcium channel blockade slows AV conduction, worsening block (AHA
2025). Safety requires ECG pre-treatment and PR interval monitoring.
Exam | 2025/2026 Verified
Questions & Expert-Level
Rationales
Question 1
A nurse is preparing to administer gentamicin 5 mg/kg IV every 24 hours to a 70 kg adult client
with normal renal function. The correct dose is: A. 250 mg B. 350 mg C. 450 mg D. 500 mg
B. 350 mg
Rationale: Dosage calculation: 5 mg/kg × 70 kg = 350 mg. Gentamicin's aminoglycoside class
risks ototoxicity and nephrotoxicity; 2025 FDA guidelines recommend once-daily dosing for
adults with CrCl >60 mL/min, with trough levels <1 mcg/mL to ensure safety. Monitor renal
function and audiometry in prolonged use.
Question 2
A client with penicillin allergy is prescribed azithromycin for community-acquired pneumonia.
Which adverse effect should the nurse monitor most closely? A. Nephrotoxicity B. QT
prolongation C. Hepatotoxicity D. Thrombocytopenia
B. QT prolongation
Rationale: Azithromycin's macrolide structure can prolong QT interval, risking torsades de
pointes, especially in clients with cardiac history. 2025 AHA guidelines contraindicate in long
QT syndrome; monitor ECG and potassium, advising avoidance of QT-prolonging drugs like
antiarrhythmics.
Question 3
A 65-year-old client with CrCl 30 mL/min is prescribed metformin 500 mg PO BID for type 2
diabetes. The nurse should: A. Administer as ordered B. Hold and notify provider C. Reduce to
250 mg daily D. Switch to extended-release
B. Hold and notify provider
,Rationale: Metformin's biguanide class risks lactic acidosis in renal impairment (CrCl <45
mL/min per ADA 2025); contraindication for CrCl <30 mL/min. Safety requires immediate
discontinuation and alternative like SGLT2 inhibitors, with monitoring for acidosis symptoms.
Question 4
A nurse is administering warfarin 5 mg PO daily to a client with atrial fibrillation. The target
INR is: A. 1.5-2.0 B. 2.0-3.0 C. 3.0-4.0 D. 4.0-5.0
B. 2.0-3.0
Rationale: Warfarin's vitamin K antagonism targets INR 2.0-3.0 for AF stroke prevention (AHA
2025). Below increases thrombosis; above risks bleed. Safety includes weekly monitoring,
vitamin K consistency, and reversal with vitamin K for supratherapeutic.
Question 5
A client receiving cisplatin 75 mg/m2 IV for ovarian cancer has a creatinine clearance of 50
mL/min. The nurse should anticipate: A. Full dose B. Dose reduction to 50-75% C.
Discontinuation D. Switch to carboplatin
B. Dose reduction to 50-75%
Rationale: Cisplatin's platinum nephrotoxicity requires adjustment for CrCl 50-60 mL/min per
NCCN 2025; hydration and mannitol protect kidneys. Safety includes pre/post hydration and
magnesium supplementation for hypomagnesemia.
Question 6
A nurse is monitoring a client on lithium 900 mg PO daily for bipolar disorder. The therapeutic
serum level is: A. 0.2-0.5 mEq/L B. 0.6-1.2 mEq/L C. 1.5-2.0 mEq/L D. >2.0 mEq/L
B. 0.6-1.2 mEq/L
Rationale: Lithium's mood stabilization targets 0.6-1.2 mEq/L (APA 2025); <0.6
subtherapeutic, >1.2 toxicity (tremor, confusion). Safety includes renal/thyroid monitoring and
low-sodium diet avoidance.
Question 7
A client with sulfa allergy is prescribed trimethoprim-sulfamethoxazole for UTI. The nurse
should: A. Administer with caution B. Notify provider for alternative C. Give with probenecid
D. Monitor urine output only
B. Notify provider for alternative
, Rationale: Cross-reactivity ~3% with sulfonamides risks Stevens-Johnson syndrome (FDA
2025). Safety requires nitrofurantoin or fosfomycin substitution, with allergy verification.
Question 8
A nurse is calculating a dose of enoxaparin 1 mg/kg subcutaneous BID for a 80 kg client with
DVT. The dose is: A. 40 mg B. 80 mg C. 120 mg D. 160 mg
B. 80 mg
Rationale: 1 mg/kg × 80 kg = 80 mg BID; LMWH's anti-Xa activity. ASH 2025 recommends
anti-Xa levels if obese, with subcutaneous technique using 90-degree angle for safety.
Question 9
A client on amiodarone 200 mg PO daily for atrial fibrillation should be monitored for: A.
Hypothyroidism B. Pulmonary fibrosis C. Hyperkalemia D. Anemia
B. Pulmonary fibrosis
Rationale: Amiodarone's iodine content causes interstitial pneumonitis (5-15% risk per AHA
2025); baseline PFTs and annual CXR. Safety includes discontinuation if dyspnea occurs.
Question 10
A 50-year-old client with CrCl 25 mL/min is prescribed gabapentin 300 mg PO TID for
neuropathy. The nurse should anticipate: A. Full dose B. Reduce to 100 mg TID C. Switch to
IV D. Discontinue
B. Reduce to 100 mg TID
Rationale: Gabapentin's renal excretion requires 25-50% reduction for CrCl 15-30 mL/min
(FDA 2025); toxicity risks sedation/seizures. Safety includes titration and myoclonus
monitoring.
Question 11
A nurse is administering verapamil 120 mg PO daily to a client with hypertension.
Contraindication includes: A. Heart rate 80 bpm B. Second-degree AV block C. BP 140/90 mm
Hg D. Age 55 years
B. Second-degree AV block
Rationale: Verapamil's calcium channel blockade slows AV conduction, worsening block (AHA
2025). Safety requires ECG pre-treatment and PR interval monitoring.
