RN PHARMACOLOGY
ATI RN Pharmacology Proctored Exam 2023–2026
| NGN 140 Questions & Answers |
MOST TESTED QUESTIONS DISCUSSED.90% PASS
GUARANTEED NO RETAKE
Question 1
A nurse is preparing to administer IV phenytoin to a client with status
epilepticus. Which of the following actions should the nurse take?
• Flush the IV line with dextrose 5% before administration.
• Administer the medication at a rate of 50 mg/min.
• Use a filtered infusion set.
• Dilute the medication with normal saline.
Answer:
Dilute the medication with normal saline.
Rationale:
• Dilute the medication with normal saline: Phenytoin is incompatible
with dextrose solutions, which can cause precipitation. It should be
diluted only with 0.9% sodium chloride (normal saline).
• Flush the IV line with dextrose 5% before administration: Incorrect –
dextrose will cause precipitation. Flush with normal saline before and
after.
• Administer the medication at a rate of 50 mg/min: Incorrect – the
maximum rate is 50 mg/min for fosphenytoin, but for phenytoin the rate
should not exceed 25–50 mg/min; however, slower is safer (usually 25
mg/min) to avoid hypotension and arrhythmias. But the critical error is
the diluent.
• Use a filtered infusion set: Not required; in fact, a 0.22 micron filter
should be avoided because phenytoin may precipitate in the filter.
, RN PHARMACOLOGY
Question 2
A nurse is administering IV vancomycin to a client with methicillin-
resistant Staphylococcus aureus (MRSA). The client reports itching and flushing
of the neck and face 10 minutes after the infusion starts. Which of the following
actions should the nurse take first?
• Stop the infusion.
• Administer diphenhydramine.
• Slow the infusion rate.
• Notify the provider.
Answer:
Slow the infusion rate.
Rationale:
• Slow the infusion rate: The client is experiencing “Red Man Syndrome,”
a histamine-mediated reaction caused by too rapid an infusion. Slowing
the rate (over ≥60 minutes) usually resolves symptoms.
• Stop the infusion: Not necessary unless severe hypotension or
respiratory distress occurs.
• Administer diphenhydramine: This may help but is not the first action;
rate adjustment comes first.
• Notify the provider: Can be done after slowing the infusion if symptoms
persist.
Question 3
A nurse is teaching a client who has a new prescription for nitroglycerin
transdermal patch for stable angina. Which of the following statements by the
client indicates understanding?
• “I will remove the patch at bedtime and apply a new one in the morning.”
• “I can still have a glass of wine with dinner while using this patch.”
• “I will apply the patch to the same spot every day.”
• “If I get a headache, I should stop using the patch.”
Answer:
“I will remove the patch at bedtime and apply a new one in the morning.”
Rationale:
, RN PHARMACOLOGY
• Remove at bedtime, apply new in morning: Nitroglycerin patches
require a daily 10–12 hour nitrate-free interval to prevent tolerance.
Removing at night is standard.
• “I can still have a glass of wine”: Incorrect – alcohol increases the risk
of hypotension and dizziness.
• “Apply to the same spot every day”: Incorrect – rotate sites to avoid
skin irritation.
• “If I get a headache, I should stop”: Incorrect – headaches are common
initially; treat with analgesics. Stopping can worsen angina.
Question 4
A nurse is reviewing the medication list of a client who will
start MAOI (phenelzine) for depression. Which of the following over-the-
counter medications should the nurse instruct the client to avoid?
• Diphenhydramine
• Ibuprofen
• Pseudoephedrine
• Acetaminophen
Answer:
Pseudoephedrine
Rationale:
• Pseudoephedrine: MAOIs can cause severe hypertension when
combined with sympathomimetics (pseudoephedrine, phenylephrine).
Clients should avoid decongestants.
• Diphenhydramine: Generally safe but may increase anticholinergic
effects.
• Ibuprofen & Acetaminophen: No significant interaction with MAOIs.
Question 5
A nurse is preparing to administer enoxaparin subcutaneously to a client after
hip replacement surgery. Which of the following actions should the nurse take?
• Expel the air bubble from the prefilled syringe before injection.
• Insert the needle at a 90° angle into a skin fold.
, RN PHARMACOLOGY
• Massage the injection site after administration.
• Aspirate before injecting to check for blood return.
Answer:
Insert the needle at a 90° angle into a skin fold.
Rationale:
• Insert at 90° into skin fold: Enoxaparin is given subcutaneously into the
abdomen, pinching a skin fold, using a 90° angle (or 45° for thin clients).
• Expel the air bubble: Do not expel – the air bubble ensures full dose
delivery.
• Massage the site: Do not massage – it can cause bruising or hematoma.
• Aspirate before injecting: Not recommended for subcutaneous
heparin/enoxaparin; aspiration may cause tissue damage.
Question 6
A nurse is caring for a client who is receiving a continuous heparin infusion. The
client’s aPTT is 120 seconds, and the baseline was 30 seconds. Which of the
following actions should the nurse take?
• Increase the heparin infusion rate.
• Decrease the heparin infusion rate.
• Stop the heparin infusion and notify the provider.
• Continue the infusion as ordered.
Answer:
Stop the heparin infusion and notify the provider.
Rationale:
• Stop and notify: Therapeutic aPTT for heparin is typically 1.5–2.5 times
normal (45–75 seconds). An aPTT of 120 seconds indicates a high risk of
bleeding. The infusion should be stopped and the provider notified
immediately.
• Increase/decrease: Both are inappropriate; the infusion must be held.
• Continue as ordered: Unsafe given supratherapeutic level.
Question 7
ATI RN Pharmacology Proctored Exam 2023–2026
| NGN 140 Questions & Answers |
MOST TESTED QUESTIONS DISCUSSED.90% PASS
GUARANTEED NO RETAKE
Question 1
A nurse is preparing to administer IV phenytoin to a client with status
epilepticus. Which of the following actions should the nurse take?
• Flush the IV line with dextrose 5% before administration.
• Administer the medication at a rate of 50 mg/min.
• Use a filtered infusion set.
• Dilute the medication with normal saline.
Answer:
Dilute the medication with normal saline.
Rationale:
• Dilute the medication with normal saline: Phenytoin is incompatible
with dextrose solutions, which can cause precipitation. It should be
diluted only with 0.9% sodium chloride (normal saline).
• Flush the IV line with dextrose 5% before administration: Incorrect –
dextrose will cause precipitation. Flush with normal saline before and
after.
• Administer the medication at a rate of 50 mg/min: Incorrect – the
maximum rate is 50 mg/min for fosphenytoin, but for phenytoin the rate
should not exceed 25–50 mg/min; however, slower is safer (usually 25
mg/min) to avoid hypotension and arrhythmias. But the critical error is
the diluent.
• Use a filtered infusion set: Not required; in fact, a 0.22 micron filter
should be avoided because phenytoin may precipitate in the filter.
, RN PHARMACOLOGY
Question 2
A nurse is administering IV vancomycin to a client with methicillin-
resistant Staphylococcus aureus (MRSA). The client reports itching and flushing
of the neck and face 10 minutes after the infusion starts. Which of the following
actions should the nurse take first?
• Stop the infusion.
• Administer diphenhydramine.
• Slow the infusion rate.
• Notify the provider.
Answer:
Slow the infusion rate.
Rationale:
• Slow the infusion rate: The client is experiencing “Red Man Syndrome,”
a histamine-mediated reaction caused by too rapid an infusion. Slowing
the rate (over ≥60 minutes) usually resolves symptoms.
• Stop the infusion: Not necessary unless severe hypotension or
respiratory distress occurs.
• Administer diphenhydramine: This may help but is not the first action;
rate adjustment comes first.
• Notify the provider: Can be done after slowing the infusion if symptoms
persist.
Question 3
A nurse is teaching a client who has a new prescription for nitroglycerin
transdermal patch for stable angina. Which of the following statements by the
client indicates understanding?
• “I will remove the patch at bedtime and apply a new one in the morning.”
• “I can still have a glass of wine with dinner while using this patch.”
• “I will apply the patch to the same spot every day.”
• “If I get a headache, I should stop using the patch.”
Answer:
“I will remove the patch at bedtime and apply a new one in the morning.”
Rationale:
, RN PHARMACOLOGY
• Remove at bedtime, apply new in morning: Nitroglycerin patches
require a daily 10–12 hour nitrate-free interval to prevent tolerance.
Removing at night is standard.
• “I can still have a glass of wine”: Incorrect – alcohol increases the risk
of hypotension and dizziness.
• “Apply to the same spot every day”: Incorrect – rotate sites to avoid
skin irritation.
• “If I get a headache, I should stop”: Incorrect – headaches are common
initially; treat with analgesics. Stopping can worsen angina.
Question 4
A nurse is reviewing the medication list of a client who will
start MAOI (phenelzine) for depression. Which of the following over-the-
counter medications should the nurse instruct the client to avoid?
• Diphenhydramine
• Ibuprofen
• Pseudoephedrine
• Acetaminophen
Answer:
Pseudoephedrine
Rationale:
• Pseudoephedrine: MAOIs can cause severe hypertension when
combined with sympathomimetics (pseudoephedrine, phenylephrine).
Clients should avoid decongestants.
• Diphenhydramine: Generally safe but may increase anticholinergic
effects.
• Ibuprofen & Acetaminophen: No significant interaction with MAOIs.
Question 5
A nurse is preparing to administer enoxaparin subcutaneously to a client after
hip replacement surgery. Which of the following actions should the nurse take?
• Expel the air bubble from the prefilled syringe before injection.
• Insert the needle at a 90° angle into a skin fold.
, RN PHARMACOLOGY
• Massage the injection site after administration.
• Aspirate before injecting to check for blood return.
Answer:
Insert the needle at a 90° angle into a skin fold.
Rationale:
• Insert at 90° into skin fold: Enoxaparin is given subcutaneously into the
abdomen, pinching a skin fold, using a 90° angle (or 45° for thin clients).
• Expel the air bubble: Do not expel – the air bubble ensures full dose
delivery.
• Massage the site: Do not massage – it can cause bruising or hematoma.
• Aspirate before injecting: Not recommended for subcutaneous
heparin/enoxaparin; aspiration may cause tissue damage.
Question 6
A nurse is caring for a client who is receiving a continuous heparin infusion. The
client’s aPTT is 120 seconds, and the baseline was 30 seconds. Which of the
following actions should the nurse take?
• Increase the heparin infusion rate.
• Decrease the heparin infusion rate.
• Stop the heparin infusion and notify the provider.
• Continue the infusion as ordered.
Answer:
Stop the heparin infusion and notify the provider.
Rationale:
• Stop and notify: Therapeutic aPTT for heparin is typically 1.5–2.5 times
normal (45–75 seconds). An aPTT of 120 seconds indicates a high risk of
bleeding. The infusion should be stopped and the provider notified
immediately.
• Increase/decrease: Both are inappropriate; the infusion must be held.
• Continue as ordered: Unsafe given supratherapeutic level.
Question 7
