NGN ATI RN PHARMACOLOGY
2025/2026 PROCTORED ASSESSMENT
(Latest Format)
Assessment Technologies Institute - Next Generation NCLEX Format
100% Accurate & Evidence-Based
Exam Type: NGN RN Pharmacology Proctored Assessment
Total Questions: 100
Time Limit: 180 minutes (approximately 1.8 minutes per question)
Passing Score: 98% (98 out of 100 questions)
Format: NGN-style questions (Multiple Choice, Multiple Select, Drag & Drop, Fill in the Blank,
Ordered Response, Matrix)
Administration: Proctored
Content Focus: Clinical decision-making, drug interactions, adverse effects, patient safety,
therapeutic monitoring
,EXAM CONTENT BREAKDOWN
Therapeutic Classifications & Mechanisms (20%)
How medications work, primary and secondary effects, therapeutic goals
Medication Interactions & Contraindications (18%)
Drug-drug, drug-food, drug-supplement interactions, absolute contraindications
Adverse Effects & Toxicity Recognition (17%)
Identifying side effects, dose-dependent toxicity, managing adverse reactions
Clinical Pharmacology & Patient Scenarios (15%)
Real-world clinical situations requiring medication decisions
Medication Administration & Safety (14%)
Correct routes, dosing calculations, verification, safe practices, six rights
Therapeutic Drug Monitoring & Labs (10%)
Serum levels, monitoring parameters, therapeutic ranges, adjustment rationales
Special Populations & Modifications (4%)
Pediatric, geriatric, pregnant, renal/hepatic impairment considerations
Patient Education & Compliance (2%)
Teaching points, lifestyle modifications, adherence strategies
, NGN ATI RN PHARMACOLOGY PROCTORED ASSESSMENT - 100 QUESTIONS
Comprehensive Clinical Pharmacology Assessment | 100% Accurate Evidence-Based Questions
Question 1 (Multiple Choice): A 65-year-old male with chronic heart failure is prescribed digoxin.
Which statement best describes digoxin's mechanism of action?
• A) Increases heart rate and conduction velocity through beta-adrenergic stimulation
• B) Inhibits Na+/K+-ATPase pump, increasing cardiac contractility and slowing AV nodal
conduction
• C) Blocks calcium channels to reduce myocardial workload
• D) Causes systemic vasodilation to improve cardiac output
ANSWER: B
RATIONALE: Digoxin's dual mechanism includes positive inotropic effect (increased contractility via Na+/K+-ATPase
inhibition) and negative chronotropic effect (slowed AV conduction). This dual action makes it unique among cardiac
medications. The narrow therapeutic window (0.5-2 ng/mL) requires careful monitoring. Serum digoxin levels, renal
function, and electrolytes (especially potassium) must be monitored regularly as hypokalemia increases digoxin
toxicity risk.
Question 2 (Multiple Select): A patient is started on lisinopril for hypertension and diabetic
nephropathy. Which adverse effects should the nurse monitor for? (Select ALL that apply)
• A) Persistent dry cough occurring in 5-10% of patients; may require switching to ARB
• B) Angioedema (facial/tongue swelling) - rare but potentially life-threatening, requiring
immediate discontinuation
• C) Hyperkalemia from decreased aldosterone; monitor K+ levels, especially if eGFR <60
• D) Hypotension, particularly with first dose or dose increase; obtain baseline BP
• E) Hypercalcemia requiring calcium-lowering intervention
ANSWER: A, B, C, D
RATIONALE: All cardiovascular effects listed (A-D) are well-documented ACE inhibitor adverse effects requiring
monitoring. Cough occurs frequently and often necessitates ARB switch. Angioedema requires immediate action.
Hyperkalemia is serious, especially with concurrent renal disease or other K+-sparing drugs. Hypotension (especially
with first dose) requires BP monitoring. Option E is incorrect; ACE inhibitors do not cause hypercalcemia.
Question 3 (Fill in the Blank): A patient on warfarin with elevated INR of 5.5 (therapeutic range 2-3)
without active bleeding should receive Vitamin K _______ (dose in mg) orally. The nurse expects INR
to decrease within _______ (hours/days).
ANSWER: 2.5 mg; 24 hours
RATIONALE: For asymptomatic elevated INR (5-9) without bleeding, oral vitamin K 2.5 mg is given. This lower dose
allows for re-warfarinization if needed later. High-dose vitamin K (5-10 mg) causes warfarin resistance lasting days.
INR should decrease within 24 hours. For serious bleeding with high INR, FFP or PCC plus vitamin K 10 mg IV is used
for immediate reversal.
Question 4 (Ordered Response): A patient uses multiple inhalers for asthma. Place these in correct
use order: 1) Fluticasone (ICS), 2) Albuterol (SABA), 3) Wait 5 minutes between doses. Correct
sequence:
ANSWER: Albuterol → Wait 5 minutes → Fluticasone
2025/2026 PROCTORED ASSESSMENT
(Latest Format)
Assessment Technologies Institute - Next Generation NCLEX Format
100% Accurate & Evidence-Based
Exam Type: NGN RN Pharmacology Proctored Assessment
Total Questions: 100
Time Limit: 180 minutes (approximately 1.8 minutes per question)
Passing Score: 98% (98 out of 100 questions)
Format: NGN-style questions (Multiple Choice, Multiple Select, Drag & Drop, Fill in the Blank,
Ordered Response, Matrix)
Administration: Proctored
Content Focus: Clinical decision-making, drug interactions, adverse effects, patient safety,
therapeutic monitoring
,EXAM CONTENT BREAKDOWN
Therapeutic Classifications & Mechanisms (20%)
How medications work, primary and secondary effects, therapeutic goals
Medication Interactions & Contraindications (18%)
Drug-drug, drug-food, drug-supplement interactions, absolute contraindications
Adverse Effects & Toxicity Recognition (17%)
Identifying side effects, dose-dependent toxicity, managing adverse reactions
Clinical Pharmacology & Patient Scenarios (15%)
Real-world clinical situations requiring medication decisions
Medication Administration & Safety (14%)
Correct routes, dosing calculations, verification, safe practices, six rights
Therapeutic Drug Monitoring & Labs (10%)
Serum levels, monitoring parameters, therapeutic ranges, adjustment rationales
Special Populations & Modifications (4%)
Pediatric, geriatric, pregnant, renal/hepatic impairment considerations
Patient Education & Compliance (2%)
Teaching points, lifestyle modifications, adherence strategies
, NGN ATI RN PHARMACOLOGY PROCTORED ASSESSMENT - 100 QUESTIONS
Comprehensive Clinical Pharmacology Assessment | 100% Accurate Evidence-Based Questions
Question 1 (Multiple Choice): A 65-year-old male with chronic heart failure is prescribed digoxin.
Which statement best describes digoxin's mechanism of action?
• A) Increases heart rate and conduction velocity through beta-adrenergic stimulation
• B) Inhibits Na+/K+-ATPase pump, increasing cardiac contractility and slowing AV nodal
conduction
• C) Blocks calcium channels to reduce myocardial workload
• D) Causes systemic vasodilation to improve cardiac output
ANSWER: B
RATIONALE: Digoxin's dual mechanism includes positive inotropic effect (increased contractility via Na+/K+-ATPase
inhibition) and negative chronotropic effect (slowed AV conduction). This dual action makes it unique among cardiac
medications. The narrow therapeutic window (0.5-2 ng/mL) requires careful monitoring. Serum digoxin levels, renal
function, and electrolytes (especially potassium) must be monitored regularly as hypokalemia increases digoxin
toxicity risk.
Question 2 (Multiple Select): A patient is started on lisinopril for hypertension and diabetic
nephropathy. Which adverse effects should the nurse monitor for? (Select ALL that apply)
• A) Persistent dry cough occurring in 5-10% of patients; may require switching to ARB
• B) Angioedema (facial/tongue swelling) - rare but potentially life-threatening, requiring
immediate discontinuation
• C) Hyperkalemia from decreased aldosterone; monitor K+ levels, especially if eGFR <60
• D) Hypotension, particularly with first dose or dose increase; obtain baseline BP
• E) Hypercalcemia requiring calcium-lowering intervention
ANSWER: A, B, C, D
RATIONALE: All cardiovascular effects listed (A-D) are well-documented ACE inhibitor adverse effects requiring
monitoring. Cough occurs frequently and often necessitates ARB switch. Angioedema requires immediate action.
Hyperkalemia is serious, especially with concurrent renal disease or other K+-sparing drugs. Hypotension (especially
with first dose) requires BP monitoring. Option E is incorrect; ACE inhibitors do not cause hypercalcemia.
Question 3 (Fill in the Blank): A patient on warfarin with elevated INR of 5.5 (therapeutic range 2-3)
without active bleeding should receive Vitamin K _______ (dose in mg) orally. The nurse expects INR
to decrease within _______ (hours/days).
ANSWER: 2.5 mg; 24 hours
RATIONALE: For asymptomatic elevated INR (5-9) without bleeding, oral vitamin K 2.5 mg is given. This lower dose
allows for re-warfarinization if needed later. High-dose vitamin K (5-10 mg) causes warfarin resistance lasting days.
INR should decrease within 24 hours. For serious bleeding with high INR, FFP or PCC plus vitamin K 10 mg IV is used
for immediate reversal.
Question 4 (Ordered Response): A patient uses multiple inhalers for asthma. Place these in correct
use order: 1) Fluticasone (ICS), 2) Albuterol (SABA), 3) Wait 5 minutes between doses. Correct
sequence:
ANSWER: Albuterol → Wait 5 minutes → Fluticasone
