ATI Pharmacology CMS Practice Exam
2025/2026 | 100+ Questions with Answers &
Rationales – Guaranteed Pass!
1. The nurse understands that the first-pass effect affects which route of
administration the most?
A. Intravenous
B. Oral
C. Intramuscular
D. Subcutaneous
Answer: B. Oral
Rationale: Oral medications pass through the liver before systemic circulation, reducing
bioavailability due to first-pass metabolism.
2. Which factor increases the risk of drug toxicity in elderly patients?
A. Increased renal clearance
B. Reduced liver metabolism
C. High muscle mass
D. Low fat content
Answer: B. Reduced liver metabolism
Rationale: Age-related changes in hepatic metabolism can cause drugs to accumulate, increasing
toxicity risk.
3. The nurse knows that the “peak” of a drug refers to:
A. The time it takes for half the drug to be eliminated
B. The highest plasma concentration of the drug
C. The onset of action
D. The time between doses
Answer: B. The highest plasma concentration of the drug
Rationale: Peak level indicates maximum therapeutic effect and helps prevent toxicity.
,4. Which lab value is most important to monitor for a patient on digoxin?
A. Potassium
B. Sodium
C. Glucose
D. Calcium
Answer: A. Potassium
Rationale: Hypokalemia increases the risk of digoxin toxicity, causing arrhythmias.
5. A patient reports a rash after starting penicillin. The nurse recognizes this as:
A. An expected side effect
B. An allergic reaction
C. Therapeutic effect
D. Toxicity
Answer: B. An allergic reaction
Rationale: Penicillin allergy can cause rashes, hives, or anaphylaxis; immediate action may be
required.
Section 2: Cardiovascular Medications
6. A patient is prescribed lisinopril. Which adverse effect should the nurse
monitor?
A. Persistent cough
B. Hyperglycemia
C. Bradycardia
D. Constipation
Answer: A. Persistent cough
Rationale: ACE inhibitors can cause a dry, persistent cough; other serious effects include
hyperkalemia and angioedema.
7. Which diuretic is most likely to cause hypokalemia?
A. Furosemide
B. Spironolactone
, C. Hydrochlorothiazide (thiazide-type)
D. Mannitol
Answer: A. Furosemide
Rationale: Loop diuretics cause potassium loss through urine, increasing risk for hypokalemia.
8. Which medication should be held if a patient’s systolic blood pressure is <100
mmHg?
A. Metoprolol
B. Aspirin
C. Atorvastatin
D. Digoxin
Answer: A. Metoprolol
Rationale: Beta-blockers lower heart rate and blood pressure; holding prevents hypotension and
bradycardia.
9. A patient on warfarin has an INR of 4.5. Which action is appropriate?
A. Hold the next dose and notify the physician
B. Administer full dose
C. Double the dose
D. Document only
Answer: A. Hold the next dose and notify the physician
Rationale: INR >3 increases bleeding risk; dose adjustment or physician intervention is
required.
10. The antidote for heparin overdose is:
A. Vitamin K
B. Protamine sulfate
C. Atropine
D. Naloxone
Answer: B. Protamine sulfate
Rationale: Protamine sulfate neutralizes heparin to prevent excessive bleeding.
2025/2026 | 100+ Questions with Answers &
Rationales – Guaranteed Pass!
1. The nurse understands that the first-pass effect affects which route of
administration the most?
A. Intravenous
B. Oral
C. Intramuscular
D. Subcutaneous
Answer: B. Oral
Rationale: Oral medications pass through the liver before systemic circulation, reducing
bioavailability due to first-pass metabolism.
2. Which factor increases the risk of drug toxicity in elderly patients?
A. Increased renal clearance
B. Reduced liver metabolism
C. High muscle mass
D. Low fat content
Answer: B. Reduced liver metabolism
Rationale: Age-related changes in hepatic metabolism can cause drugs to accumulate, increasing
toxicity risk.
3. The nurse knows that the “peak” of a drug refers to:
A. The time it takes for half the drug to be eliminated
B. The highest plasma concentration of the drug
C. The onset of action
D. The time between doses
Answer: B. The highest plasma concentration of the drug
Rationale: Peak level indicates maximum therapeutic effect and helps prevent toxicity.
,4. Which lab value is most important to monitor for a patient on digoxin?
A. Potassium
B. Sodium
C. Glucose
D. Calcium
Answer: A. Potassium
Rationale: Hypokalemia increases the risk of digoxin toxicity, causing arrhythmias.
5. A patient reports a rash after starting penicillin. The nurse recognizes this as:
A. An expected side effect
B. An allergic reaction
C. Therapeutic effect
D. Toxicity
Answer: B. An allergic reaction
Rationale: Penicillin allergy can cause rashes, hives, or anaphylaxis; immediate action may be
required.
Section 2: Cardiovascular Medications
6. A patient is prescribed lisinopril. Which adverse effect should the nurse
monitor?
A. Persistent cough
B. Hyperglycemia
C. Bradycardia
D. Constipation
Answer: A. Persistent cough
Rationale: ACE inhibitors can cause a dry, persistent cough; other serious effects include
hyperkalemia and angioedema.
7. Which diuretic is most likely to cause hypokalemia?
A. Furosemide
B. Spironolactone
, C. Hydrochlorothiazide (thiazide-type)
D. Mannitol
Answer: A. Furosemide
Rationale: Loop diuretics cause potassium loss through urine, increasing risk for hypokalemia.
8. Which medication should be held if a patient’s systolic blood pressure is <100
mmHg?
A. Metoprolol
B. Aspirin
C. Atorvastatin
D. Digoxin
Answer: A. Metoprolol
Rationale: Beta-blockers lower heart rate and blood pressure; holding prevents hypotension and
bradycardia.
9. A patient on warfarin has an INR of 4.5. Which action is appropriate?
A. Hold the next dose and notify the physician
B. Administer full dose
C. Double the dose
D. Document only
Answer: A. Hold the next dose and notify the physician
Rationale: INR >3 increases bleeding risk; dose adjustment or physician intervention is
required.
10. The antidote for heparin overdose is:
A. Vitamin K
B. Protamine sulfate
C. Atropine
D. Naloxone
Answer: B. Protamine sulfate
Rationale: Protamine sulfate neutralizes heparin to prevent excessive bleeding.
