ATI Pharmacology Proctored 2025”2026 ACTUAL Retake EXAM
150 QUESTIONS AND CORRECT ANSWERS WITH RATIONALES
GUARANTEE OVER 85% PASSMARK
1. A 62-year-old patient with chronic heart failure is prescribed furosemide. They report
muscle cramps and feeling weak. Which electrolyte imbalance is most likely responsible for
these symptoms, and what is the mechanism behind it?
A. Hyperkalemia
B. Hypokalemia ☑
C. Hypernatremia
D. Hypocalcemia
Rationale: Furosemide is a loop diuretic that inhibits the Na⁺/K⁺/2Cl⁻ symporter in the thick
ascending loop of Henle, causing increased urinary excretion of sodium, chloride, and
potassium. Hypokalemia occurs because potassium is lost in the urine, leading to muscle
cramps, weakness, and potentially arrhythmias. Monitoring potassium levels and
supplementing if necessary is crucial in patients on loop diuretics.
2. A patient with type 2 diabetes is started on metformin. They are concerned about possible
adverse effects and the risk of lactic acidosis. Which patient scenario increases their risk for
this complication?
A. Well-controlled diabetes with no comorbidities
B. Patient with chronic kidney disease stage 4 ☑
C. Healthy patient on a low-carbohydrate diet
D. Patient using insulin concurrently
Rationale: Metformin decreases hepatic gluconeogenesis and improves insulin sensitivity.
While generally safe, it can increase the risk of lactic acidosis, particularly in patients with
conditions that impair lactate clearance such as chronic kidney disease, liver disease, or severe
hypoxia. Monitoring renal function before and during therapy is essential.
3. A 55-year-old patient with hypertension is prescribed lisinopril. After several weeks, they
develop a persistent dry cough. What is the most likely cause, and what alternative can be
prescribed?
A. Allergic reaction; prescribe calcium channel blocker
B. Fluid retention; prescribe diuretic
,C. Bradykinin accumulation due to ACE inhibition; prescribe an ARB ☑
D. Sympathetic overactivity; prescribe beta-blocker
Rationale: ACE inhibitors inhibit angiotensin-converting enzyme, which also breaks down
bradykinin. Accumulation of bradykinin can cause a persistent dry cough in some patients.
Switching to an angiotensin receptor blocker (ARB), which blocks angiotensin II receptors
without affecting bradykinin, can relieve the cough while maintaining antihypertensive
benefits.
4. A patient with atrial fibrillation is prescribed warfarin. They are advised about foods that
can affect their therapy. Which vitamin and dietary source should the patient monitor, and
why?
A. Vitamin A; liver
B. Vitamin K; green leafy vegetables ☑
C. Vitamin D; fortified milk
D. Vitamin E; nuts
Rationale: Warfarin inhibits vitamin K–dependent clotting factor synthesis (II, VII, IX, X). High
intake of vitamin K can reduce warfarin’s anticoagulant effect, increasing the risk of clot
formation. Patients should maintain consistent vitamin K intake and avoid sudden large
increases in foods such as spinach, kale, and broccoli.
5. A patient with chronic pain is prescribed morphine. After several days, they report nausea,
constipation, and drowsiness. What is the primary mechanism behind the constipation, and
how can it be managed?
A. CNS depression; reduce dose
B. Renal accumulation; hydrate
C. Reduced gastrointestinal motility due to mu-opioid receptor activation; prescribe a stool
softener or laxative ☑
D. Electrolyte imbalance; supplement potassium
Rationale: Morphine binds to mu-opioid receptors in the CNS for analgesia but also in the
gastrointestinal tract, reducing peristalsis and slowing bowel transit. Constipation is a common
side effect. Management includes dietary fiber, increased fluid intake, and using stool softeners
or osmotic laxatives.
6. A 45-year-old patient is prescribed levothyroxine for hypothyroidism. What is the most
appropriate time and method of administration to ensure optimal absorption, and why?
A. With meals to reduce GI upset
,B. On an empty stomach in the morning, 30–60 minutes before breakfast ☑
C. At bedtime with a snack
D. Twice daily with water
Rationale: Levothyroxine is best absorbed in an acidic environment, ideally taken on an empty
stomach in the morning. Food, especially high-fiber or calcium-containing meals, can reduce
absorption. Consistent timing and monitoring of TSH levels are necessary to ensure therapeutic
efficacy.
7. A patient with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium.
Which effect does this drug have on the airways, and what is its mechanism of action?
A. Bronchoconstriction by M2 receptor activation
B. Bronchodilation by blocking M3 muscarinic receptors ☑
C. Anti-inflammatory effect by inhibiting leukotrienes
D. Beta-2 receptor agonism
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA) that inhibits M3 receptors
on airway smooth muscle. This prevents acetylcholine-mediated bronchoconstriction, leading
to bronchodilation and improved airflow in patients with COPD. It does not have systemic beta-
2 effects, reducing cardiovascular risks.
8. A patient with asthma is prescribed prednisone for an acute exacerbation. They ask why
this medication must be tapered instead of stopped abruptly. Explain the rationale.
A. Abrupt cessation causes rapid bronchodilation
B. Abrupt cessation can lead to adrenal insufficiency due to HPA axis suppression ☑
C. Stopping abruptly decreases inflammation immediately
D. Tapering is only to reduce GI upset
Rationale: Chronic corticosteroid therapy suppresses the hypothalamic-pituitary-adrenal (HPA)
axis. Abrupt cessation can result in adrenal insufficiency, leading to hypotension, fatigue, and
electrolyte imbalance. Gradual tapering allows endogenous cortisol production to resume
safely.
9. A 50-year-old patient with type 2 diabetes is prescribed glipizide. They develop symptoms
of hypoglycemia, including shakiness and sweating. What is the mechanism of glipizide, and
why can it cause hypoglycemia?
A. Delays carbohydrate absorption; causes delayed hypoglycemia
B. Stimulates pancreatic beta cells to release insulin; can lower blood glucose excessively ☑
, C. Increases insulin sensitivity in peripheral tissues; no risk of hypoglycemia
D. Reduces renal glucose reabsorption; low risk of hypoglycemia
Rationale: Glipizide is a sulfonylurea that binds to sulfonylurea receptors on pancreatic beta
cells, closing potassium channels, depolarizing the cell membrane, and stimulating insulin
release. Excess insulin can cause hypoglycemia, especially if meals are skipped or excessive
doses are taken. Patients should be educated about hypoglycemia recognition and
management.
10. A patient with hypertension is prescribed hydrochlorothiazide. During follow-up, the
nurse notes elevated uric acid levels and mild hyperglycemia. Explain why these metabolic
changes occur.
A. Renal failure
B. Increased sympathetic activity
C. Thiazide-induced electrolyte changes lead to increased uric acid reabsorption and altered
glucose tolerance ☑
D. Excessive dietary intake
Rationale: Hydrochlorothiazide increases sodium and water excretion but can also increase uric
acid reabsorption in the proximal tubule, leading to hyperuricemia and risk of gout. Thiazides
may impair insulin release or glucose uptake, causing mild hyperglycemia. Monitoring
electrolytes, uric acid, and blood glucose is recommended.
11. A 68-year-old patient with chronic atrial fibrillation is prescribed dabigatran. They ask
how this drug works compared to warfarin and what monitoring is required. What is the
mechanism of action and monitoring requirement?
A. Vitamin K antagonist; requires frequent INR checks
B. Direct thrombin inhibitor; no routine coagulation monitoring required ☑
C. Factor Xa inhibitor; requires anti-Xa levels
D. Platelet aggregation inhibitor; monitor bleeding time
Rationale: Dabigatran directly inhibits thrombin (factor IIa), preventing conversion of fibrinogen
to fibrin. Unlike warfarin, it does not require routine INR monitoring and has fewer food
interactions. Understanding mechanism and monitoring helps reduce risk of bleeding while
maintaining efficacy.
150 QUESTIONS AND CORRECT ANSWERS WITH RATIONALES
GUARANTEE OVER 85% PASSMARK
1. A 62-year-old patient with chronic heart failure is prescribed furosemide. They report
muscle cramps and feeling weak. Which electrolyte imbalance is most likely responsible for
these symptoms, and what is the mechanism behind it?
A. Hyperkalemia
B. Hypokalemia ☑
C. Hypernatremia
D. Hypocalcemia
Rationale: Furosemide is a loop diuretic that inhibits the Na⁺/K⁺/2Cl⁻ symporter in the thick
ascending loop of Henle, causing increased urinary excretion of sodium, chloride, and
potassium. Hypokalemia occurs because potassium is lost in the urine, leading to muscle
cramps, weakness, and potentially arrhythmias. Monitoring potassium levels and
supplementing if necessary is crucial in patients on loop diuretics.
2. A patient with type 2 diabetes is started on metformin. They are concerned about possible
adverse effects and the risk of lactic acidosis. Which patient scenario increases their risk for
this complication?
A. Well-controlled diabetes with no comorbidities
B. Patient with chronic kidney disease stage 4 ☑
C. Healthy patient on a low-carbohydrate diet
D. Patient using insulin concurrently
Rationale: Metformin decreases hepatic gluconeogenesis and improves insulin sensitivity.
While generally safe, it can increase the risk of lactic acidosis, particularly in patients with
conditions that impair lactate clearance such as chronic kidney disease, liver disease, or severe
hypoxia. Monitoring renal function before and during therapy is essential.
3. A 55-year-old patient with hypertension is prescribed lisinopril. After several weeks, they
develop a persistent dry cough. What is the most likely cause, and what alternative can be
prescribed?
A. Allergic reaction; prescribe calcium channel blocker
B. Fluid retention; prescribe diuretic
,C. Bradykinin accumulation due to ACE inhibition; prescribe an ARB ☑
D. Sympathetic overactivity; prescribe beta-blocker
Rationale: ACE inhibitors inhibit angiotensin-converting enzyme, which also breaks down
bradykinin. Accumulation of bradykinin can cause a persistent dry cough in some patients.
Switching to an angiotensin receptor blocker (ARB), which blocks angiotensin II receptors
without affecting bradykinin, can relieve the cough while maintaining antihypertensive
benefits.
4. A patient with atrial fibrillation is prescribed warfarin. They are advised about foods that
can affect their therapy. Which vitamin and dietary source should the patient monitor, and
why?
A. Vitamin A; liver
B. Vitamin K; green leafy vegetables ☑
C. Vitamin D; fortified milk
D. Vitamin E; nuts
Rationale: Warfarin inhibits vitamin K–dependent clotting factor synthesis (II, VII, IX, X). High
intake of vitamin K can reduce warfarin’s anticoagulant effect, increasing the risk of clot
formation. Patients should maintain consistent vitamin K intake and avoid sudden large
increases in foods such as spinach, kale, and broccoli.
5. A patient with chronic pain is prescribed morphine. After several days, they report nausea,
constipation, and drowsiness. What is the primary mechanism behind the constipation, and
how can it be managed?
A. CNS depression; reduce dose
B. Renal accumulation; hydrate
C. Reduced gastrointestinal motility due to mu-opioid receptor activation; prescribe a stool
softener or laxative ☑
D. Electrolyte imbalance; supplement potassium
Rationale: Morphine binds to mu-opioid receptors in the CNS for analgesia but also in the
gastrointestinal tract, reducing peristalsis and slowing bowel transit. Constipation is a common
side effect. Management includes dietary fiber, increased fluid intake, and using stool softeners
or osmotic laxatives.
6. A 45-year-old patient is prescribed levothyroxine for hypothyroidism. What is the most
appropriate time and method of administration to ensure optimal absorption, and why?
A. With meals to reduce GI upset
,B. On an empty stomach in the morning, 30–60 minutes before breakfast ☑
C. At bedtime with a snack
D. Twice daily with water
Rationale: Levothyroxine is best absorbed in an acidic environment, ideally taken on an empty
stomach in the morning. Food, especially high-fiber or calcium-containing meals, can reduce
absorption. Consistent timing and monitoring of TSH levels are necessary to ensure therapeutic
efficacy.
7. A patient with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium.
Which effect does this drug have on the airways, and what is its mechanism of action?
A. Bronchoconstriction by M2 receptor activation
B. Bronchodilation by blocking M3 muscarinic receptors ☑
C. Anti-inflammatory effect by inhibiting leukotrienes
D. Beta-2 receptor agonism
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA) that inhibits M3 receptors
on airway smooth muscle. This prevents acetylcholine-mediated bronchoconstriction, leading
to bronchodilation and improved airflow in patients with COPD. It does not have systemic beta-
2 effects, reducing cardiovascular risks.
8. A patient with asthma is prescribed prednisone for an acute exacerbation. They ask why
this medication must be tapered instead of stopped abruptly. Explain the rationale.
A. Abrupt cessation causes rapid bronchodilation
B. Abrupt cessation can lead to adrenal insufficiency due to HPA axis suppression ☑
C. Stopping abruptly decreases inflammation immediately
D. Tapering is only to reduce GI upset
Rationale: Chronic corticosteroid therapy suppresses the hypothalamic-pituitary-adrenal (HPA)
axis. Abrupt cessation can result in adrenal insufficiency, leading to hypotension, fatigue, and
electrolyte imbalance. Gradual tapering allows endogenous cortisol production to resume
safely.
9. A 50-year-old patient with type 2 diabetes is prescribed glipizide. They develop symptoms
of hypoglycemia, including shakiness and sweating. What is the mechanism of glipizide, and
why can it cause hypoglycemia?
A. Delays carbohydrate absorption; causes delayed hypoglycemia
B. Stimulates pancreatic beta cells to release insulin; can lower blood glucose excessively ☑
, C. Increases insulin sensitivity in peripheral tissues; no risk of hypoglycemia
D. Reduces renal glucose reabsorption; low risk of hypoglycemia
Rationale: Glipizide is a sulfonylurea that binds to sulfonylurea receptors on pancreatic beta
cells, closing potassium channels, depolarizing the cell membrane, and stimulating insulin
release. Excess insulin can cause hypoglycemia, especially if meals are skipped or excessive
doses are taken. Patients should be educated about hypoglycemia recognition and
management.
10. A patient with hypertension is prescribed hydrochlorothiazide. During follow-up, the
nurse notes elevated uric acid levels and mild hyperglycemia. Explain why these metabolic
changes occur.
A. Renal failure
B. Increased sympathetic activity
C. Thiazide-induced electrolyte changes lead to increased uric acid reabsorption and altered
glucose tolerance ☑
D. Excessive dietary intake
Rationale: Hydrochlorothiazide increases sodium and water excretion but can also increase uric
acid reabsorption in the proximal tubule, leading to hyperuricemia and risk of gout. Thiazides
may impair insulin release or glucose uptake, causing mild hyperglycemia. Monitoring
electrolytes, uric acid, and blood glucose is recommended.
11. A 68-year-old patient with chronic atrial fibrillation is prescribed dabigatran. They ask
how this drug works compared to warfarin and what monitoring is required. What is the
mechanism of action and monitoring requirement?
A. Vitamin K antagonist; requires frequent INR checks
B. Direct thrombin inhibitor; no routine coagulation monitoring required ☑
C. Factor Xa inhibitor; requires anti-Xa levels
D. Platelet aggregation inhibitor; monitor bleeding time
Rationale: Dabigatran directly inhibits thrombin (factor IIa), preventing conversion of fibrinogen
to fibrin. Unlike warfarin, it does not require routine INR monitoring and has fewer food
interactions. Understanding mechanism and monitoring helps reduce risk of bleeding while
maintaining efficacy.
