ATI PN Pharmacology Level 3 Proctored Exam
Prep Document 2026/2027 | Practical Nursing
Pharmacology
Section 1: Cardiovascular & Hematologic Medications
1. A patient prescribed digoxin should be monitored for which early sign of
toxicity?
A. Tachycardia
B. Bradycardia
C. Hypertension
D. Hyperkalemia
Answer: B. Bradycardia
Rationale: Digoxin toxicity can cause various cardiac arrhythmias, with
bradycardia being an early sign. Digoxin slows the heart rate and can cause heart
block. Toxicity also presents with nausea, vomiting, and visual disturbances (halos,
yellow-green vision). Digoxin levels should be monitored (therapeutic range 0.8–
2.0 ng/mL).
2. Which finding indicates toxicity of digoxin?
A. Clear vision
B. Yellow halos
C. BP 120/80
D. HR 72
Answer: B. Yellow halos
Rationale: Visual disturbances including yellow-green halos around lights are
classic signs of digoxin toxicity.
,3. A nurse is administering digoxin. Which finding indicates therapeutic effect?
A. Increased edema
B. Decreased urine output
C. Improved cardiac output
D. Tachycardia
Answer: C. Improved cardiac output
Rationale: Digoxin increases myocardial contractility, improving cardiac output.
4. A patient on warfarin has an INR of 5.0. Which action should the nurse take?
A. Administer the next dose as scheduled
B. Hold the dose and notify the provider
C. Increase the dose
D. Administer vitamin K immediately
Answer: B. Hold the dose and notify the provider
Rationale: An INR of 5.0 indicates a high bleeding risk. The dose should be held,
and the provider should be notified. Vitamin K is the antidote for warfarin, but it is
not typically administered unless there is active bleeding or the INR is significantly
higher. The INR should be monitored regularly to maintain a therapeutic range of
2.0–3.0.
5. A nurse is caring for a client on warfarin. Which lab value is priority?
A. aPTT
B. INR
C. WBC
D. Platelets
Answer: B. INR
Rationale: INR monitors warfarin effectiveness and bleeding risk.
6. Which antidote reverses heparin?
, A. Vitamin K
B. Naloxone
C. Protamine sulfate
D. Atropine
Answer: C. Protamine sulfate
Rationale: Protamine sulfate neutralizes heparin by binding to it and forming a
stable complex.
7. Heparin is administered to prevent thrombus formation. Which lab value
should be monitored?
A. INR
B. aPTT
C. Platelet count
D. Both B and C
Answer: D. Both B and C
Rationale: Heparin therapy is monitored using aPTT (activated partial
thromboplastin time) to maintain a therapeutic level 1.5–2.5 times the normal
value. Platelet counts should also be monitored for heparin-induced
thrombocytopenia (HIT). Protamine sulfate is the antidote.
8. Which finding indicates a patient is experiencing heparin-induced
thrombocytopenia (HIT)?
A. Increased platelet count
B. Decreased platelet count
C. Prolonged INR
D. Elevated potassium
Answer: B. Decreased platelet count
Rationale: HIT is characterized by a sudden drop in platelet count (often by more
than 50%) occurring 5–10 days after heparin exposure. HIT is a prothrombotic
state that can lead to thromboembolism. Heparin should be discontinued
Prep Document 2026/2027 | Practical Nursing
Pharmacology
Section 1: Cardiovascular & Hematologic Medications
1. A patient prescribed digoxin should be monitored for which early sign of
toxicity?
A. Tachycardia
B. Bradycardia
C. Hypertension
D. Hyperkalemia
Answer: B. Bradycardia
Rationale: Digoxin toxicity can cause various cardiac arrhythmias, with
bradycardia being an early sign. Digoxin slows the heart rate and can cause heart
block. Toxicity also presents with nausea, vomiting, and visual disturbances (halos,
yellow-green vision). Digoxin levels should be monitored (therapeutic range 0.8–
2.0 ng/mL).
2. Which finding indicates toxicity of digoxin?
A. Clear vision
B. Yellow halos
C. BP 120/80
D. HR 72
Answer: B. Yellow halos
Rationale: Visual disturbances including yellow-green halos around lights are
classic signs of digoxin toxicity.
,3. A nurse is administering digoxin. Which finding indicates therapeutic effect?
A. Increased edema
B. Decreased urine output
C. Improved cardiac output
D. Tachycardia
Answer: C. Improved cardiac output
Rationale: Digoxin increases myocardial contractility, improving cardiac output.
4. A patient on warfarin has an INR of 5.0. Which action should the nurse take?
A. Administer the next dose as scheduled
B. Hold the dose and notify the provider
C. Increase the dose
D. Administer vitamin K immediately
Answer: B. Hold the dose and notify the provider
Rationale: An INR of 5.0 indicates a high bleeding risk. The dose should be held,
and the provider should be notified. Vitamin K is the antidote for warfarin, but it is
not typically administered unless there is active bleeding or the INR is significantly
higher. The INR should be monitored regularly to maintain a therapeutic range of
2.0–3.0.
5. A nurse is caring for a client on warfarin. Which lab value is priority?
A. aPTT
B. INR
C. WBC
D. Platelets
Answer: B. INR
Rationale: INR monitors warfarin effectiveness and bleeding risk.
6. Which antidote reverses heparin?
, A. Vitamin K
B. Naloxone
C. Protamine sulfate
D. Atropine
Answer: C. Protamine sulfate
Rationale: Protamine sulfate neutralizes heparin by binding to it and forming a
stable complex.
7. Heparin is administered to prevent thrombus formation. Which lab value
should be monitored?
A. INR
B. aPTT
C. Platelet count
D. Both B and C
Answer: D. Both B and C
Rationale: Heparin therapy is monitored using aPTT (activated partial
thromboplastin time) to maintain a therapeutic level 1.5–2.5 times the normal
value. Platelet counts should also be monitored for heparin-induced
thrombocytopenia (HIT). Protamine sulfate is the antidote.
8. Which finding indicates a patient is experiencing heparin-induced
thrombocytopenia (HIT)?
A. Increased platelet count
B. Decreased platelet count
C. Prolonged INR
D. Elevated potassium
Answer: B. Decreased platelet count
Rationale: HIT is characterized by a sudden drop in platelet count (often by more
than 50%) occurring 5–10 days after heparin exposure. HIT is a prothrombotic
state that can lead to thromboembolism. Heparin should be discontinued
