ATI CMS Pharmacology Proctored Exam
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: PHARMACOLOGICAL PRINCIPLES & MEDICATION SAFETY Q1 – Q12
══════════════════════════════════════
Question 1 of 60
A 78-year-old patient in a long-term care facility is prescribed digoxin 0.125 mg daily for atrial
fibrillation. Before administering the dose, the nurse reviews the morning laboratory results
and notes a serum potassium level of 3.0 mEq/L and a digoxin level of 1.8 ng/mL. The
patient's apical heart rate is 58 beats per minute.
A. Withhold the dose and notify the provider immediately ✓ CORRECT
B. Administer the digoxin with a glass of orange juice to enhance absorption
C. Recheck the apical pulse in 30 minutes and administer if the rate increases
D. Administer the dose with a potassium supplement to correct the imbalance
Correct Answer: A
Rationale: A potassium level of 3.0 mEq/L significantly increases the risk of digoxin toxicity,
and a heart rate below 60 beats per minute is a contraindication to digoxin administration; the
nurse must withhold the dose and contact the provider to address the hypokalemia and
bradycardia before continuing therapy. Administering digoxin with hypokalemia and
bradycardia could precipitate life-threatening arrhythmias including ventricular tachycardia or
complete heart block. ATI emphasizes that the "assess first" principle requires evaluating
vital signs and relevant labs before giving any cardiac glycoside.
Question 2 of 60
A 42-year-old patient admitted to the medical-surgical unit has a new prescription for warfarin
5 mg orally at 1800. The nurse reviews the patient's medication history and notes that the
patient takes omeprazole 20 mg daily for GERD and consumes large amounts of leafy green
vegetables. The patient's INR this morning is 1.1.
,A. Increase leafy green vegetable intake to boost vitamin K and prevent bleeding
B. Maintain consistent vitamin K intake and report any signs of bleeding immediately ✓
CORRECT
C. Take the warfarin with omeprazole to reduce gastric irritation
D. Stop taking omeprazole while on warfarin to prevent a dangerous drug interaction
Correct Answer: B
Rationale: Warfarin exerts its anticoagulant effect by inhibiting vitamin K-dependent clotting
factors, so maintaining consistent dietary vitamin K intake allows for stable INR monitoring
and appropriate dose adjustments; sudden increases or decreases in leafy greens can cause
subtherapeutic or supratherapeutic anticoagulation. While omeprazole may slightly increase
warfarin levels, it is not contraindicated and the patient should not stop it without provider
guidance. ATI frequently tests the principle that patients on warfarin need education about
consistent vitamin K intake and bleeding precautions rather than avoidance of all vitamin K
foods.
Question 3 of 60
A pediatric nurse is preparing to administer an intramuscular injection of ceftriaxone 250 mg
to a 6-month-old infant in the outpatient clinic. The vial concentration is 350 mg/mL. After
calculating the dose, the nurse selects the appropriate syringe and needle.
A. Confirm that the infant has received the hepatitis B vaccine series before giving
ceftriaxone
B. Assess the infant's anterior fontanelle for signs of dehydration before administering the
antibiotic
C. Verify the infant's weight and check that the calculated volume does not exceed 1 mL for a
single IM site ✓ CORRECT
D. Dilute the medication with 5 mL of normal saline to reduce the concentration and tissue
irritation
Correct Answer: C
Rationale: For infants, the maximum volume for a single intramuscular injection site is
typically 1 mL to prevent tissue damage, pain, and inadequate absorption; the calculated
volume for 250 mg from a 350 mg/mL concentration is approximately 0.71 mL, which is
within safe limits but must be verified against the infant's weight and muscle mass. The
hepatitis B vaccine series is unrelated to ceftriaxone administration, and diluting IM
medications with normal saline is not standard practice and could alter absorption. ATI
medication safety questions consistently test the nurse's responsibility to verify pediatric
dosing calculations and injection volume limits before administration.
Question 4 of 60
,A 55-year-old patient in the emergency department has a severe penicillin allergy documented
in the chart. The provider orders cefazolin 1 g IV every 8 hours for a suspected skin infection.
The nurse recognizes that cefazolin is a first-generation cephalosporin.
A. Administer the cefazolin slowly over 30 minutes while monitoring for a reaction
B. Give diphenhydramine 25 mg IV before administering the cefazolin as a premedication
C. Administer the cefazolin and observe the patient for 2 hours after the infusion
D. Clarify the order with the provider because cephalosporins share a beta-lactam ring with
penicillin ✓ CORRECT
Correct Answer: D
Rationale: First-generation cephalosporins such as cefazolin share a beta-lactam ring
structure with penicillin and carry a significant cross-reactivity risk, particularly in patients
with documented IgE-mediated penicillin allergies; the nurse must clarify the order with the
provider to discuss alternative antibiotics such as vancomycin or clindamycin. Administering
the medication without addressing the allergy risk could result in anaphylaxis, and
premedicating with diphenhydramine does not prevent IgE-mediated reactions. ATI
pharmacology exams frequently test cross-reactivity between drug classes and the nurse's
duty to question orders that pose serious safety risks.
Question 5 of 60
A nurse is caring for a 68-year-old patient with chronic kidney disease stage 3 who is
prescribed metformin 1000 mg twice daily for type 2 diabetes. The patient's serum creatinine
is 2.1 mg/dL and the eGFR is 28 mL/min/1.73m².
A. Hold the dose and contact the provider to discuss renal dosing adjustments ✓ CORRECT
B. Administer the metformin with food to reduce gastrointestinal upset
C. Administer the dose and monitor the patient's blood glucose every 2 hours
D. Switch the patient to insulin therapy without consulting the provider
Correct Answer: A
Rationale: Metformin is contraindicated in patients with an eGFR below 30 mL/min/1.73m²
because impaired renal clearance significantly increases the risk of lactic acidosis, a
potentially fatal adverse effect; the nurse must hold the dose and notify the provider to
discuss discontinuation or alternative therapy. Administering metformin with severe renal
impairment violates medication safety protocols, and nurses cannot independently switch
patients to insulin without a provider order. ATI pharmacology questions often test renal
contraindications for metformin and emphasize that lactic acidosis risk increases
dramatically when eGFR falls below 30.
Question 6 of 60
, A nurse is administering morning medications to a patient on the cardiac unit. The patient
has prescriptions for furosemide 40 mg IV, potassium chloride 20 mEq orally, and digoxin
0.25 mg orally. The nurse reviews the laboratory results and notes a serum potassium of 3.2
mEq/L and a serum magnesium of 1.4 mg/dL.
A. Administer all three medications as ordered since the potassium is within acceptable
range
B. Hold the digoxin, administer the furosemide and potassium, and notify the provider ✓
CORRECT
C. Administer the digoxin first, then give the furosemide and potassium 2 hours later
D. Administer the furosemide and potassium but hold the digoxin due to the low potassium
Correct Answer: B
Rationale: A potassium level of 3.2 mEq/L and magnesium of 1.4 mg/dL both increase the
risk of digoxin toxicity because hypokalemia and hypomagnesemia potentiate digoxin's
inhibitory effect on the Na-K-ATPase pump; the nurse must hold the digoxin, administer the
furosemide and potassium as ordered, and notify the provider to reassess the digoxin dose.
Administering digoxin with these electrolyte imbalances could precipitate fatal cardiac
arrhythmias including ventricular fibrillation. ATI emphasizes that the nurse must always
check potassium and magnesium levels before administering digoxin, as these are the most
common precipitating factors for toxicity.
Question 7 of 60
A 35-year-old patient in the outpatient clinic is starting a new prescription for phenytoin 300
mg daily for seizure control. The nurse is providing medication education. Which statement
by the patient indicates a need for further teaching?
A. "I will take my medication at the same time every day to maintain a steady blood level"
B. "I should use a soft toothbrush and floss gently to prevent gum problems"
C. "I can stop taking this medication once my seizures are under control for 6 months" ✓
CORRECT
D. "I will notify my dentist that I am taking phenytoin before any dental work"
Correct Answer: C
Rationale: Phenytoin requires long-term adherence and should never be discontinued abruptly
because sudden withdrawal can precipitate status epilepticus, a life-threatening emergency;
the patient must understand that discontinuation requires gradual tapering under provider
supervision. Using a soft toothbrush and notifying dental providers are appropriate because
phenytoin commonly causes gingival hyperplasia. ATI pharmacology exams frequently test
patient education for anticonvulsants and emphasize that abrupt discontinuation is one of
the most dangerous errors patients can make.
Question 8 of 60
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: PHARMACOLOGICAL PRINCIPLES & MEDICATION SAFETY Q1 – Q12
══════════════════════════════════════
Question 1 of 60
A 78-year-old patient in a long-term care facility is prescribed digoxin 0.125 mg daily for atrial
fibrillation. Before administering the dose, the nurse reviews the morning laboratory results
and notes a serum potassium level of 3.0 mEq/L and a digoxin level of 1.8 ng/mL. The
patient's apical heart rate is 58 beats per minute.
A. Withhold the dose and notify the provider immediately ✓ CORRECT
B. Administer the digoxin with a glass of orange juice to enhance absorption
C. Recheck the apical pulse in 30 minutes and administer if the rate increases
D. Administer the dose with a potassium supplement to correct the imbalance
Correct Answer: A
Rationale: A potassium level of 3.0 mEq/L significantly increases the risk of digoxin toxicity,
and a heart rate below 60 beats per minute is a contraindication to digoxin administration; the
nurse must withhold the dose and contact the provider to address the hypokalemia and
bradycardia before continuing therapy. Administering digoxin with hypokalemia and
bradycardia could precipitate life-threatening arrhythmias including ventricular tachycardia or
complete heart block. ATI emphasizes that the "assess first" principle requires evaluating
vital signs and relevant labs before giving any cardiac glycoside.
Question 2 of 60
A 42-year-old patient admitted to the medical-surgical unit has a new prescription for warfarin
5 mg orally at 1800. The nurse reviews the patient's medication history and notes that the
patient takes omeprazole 20 mg daily for GERD and consumes large amounts of leafy green
vegetables. The patient's INR this morning is 1.1.
,A. Increase leafy green vegetable intake to boost vitamin K and prevent bleeding
B. Maintain consistent vitamin K intake and report any signs of bleeding immediately ✓
CORRECT
C. Take the warfarin with omeprazole to reduce gastric irritation
D. Stop taking omeprazole while on warfarin to prevent a dangerous drug interaction
Correct Answer: B
Rationale: Warfarin exerts its anticoagulant effect by inhibiting vitamin K-dependent clotting
factors, so maintaining consistent dietary vitamin K intake allows for stable INR monitoring
and appropriate dose adjustments; sudden increases or decreases in leafy greens can cause
subtherapeutic or supratherapeutic anticoagulation. While omeprazole may slightly increase
warfarin levels, it is not contraindicated and the patient should not stop it without provider
guidance. ATI frequently tests the principle that patients on warfarin need education about
consistent vitamin K intake and bleeding precautions rather than avoidance of all vitamin K
foods.
Question 3 of 60
A pediatric nurse is preparing to administer an intramuscular injection of ceftriaxone 250 mg
to a 6-month-old infant in the outpatient clinic. The vial concentration is 350 mg/mL. After
calculating the dose, the nurse selects the appropriate syringe and needle.
A. Confirm that the infant has received the hepatitis B vaccine series before giving
ceftriaxone
B. Assess the infant's anterior fontanelle for signs of dehydration before administering the
antibiotic
C. Verify the infant's weight and check that the calculated volume does not exceed 1 mL for a
single IM site ✓ CORRECT
D. Dilute the medication with 5 mL of normal saline to reduce the concentration and tissue
irritation
Correct Answer: C
Rationale: For infants, the maximum volume for a single intramuscular injection site is
typically 1 mL to prevent tissue damage, pain, and inadequate absorption; the calculated
volume for 250 mg from a 350 mg/mL concentration is approximately 0.71 mL, which is
within safe limits but must be verified against the infant's weight and muscle mass. The
hepatitis B vaccine series is unrelated to ceftriaxone administration, and diluting IM
medications with normal saline is not standard practice and could alter absorption. ATI
medication safety questions consistently test the nurse's responsibility to verify pediatric
dosing calculations and injection volume limits before administration.
Question 4 of 60
,A 55-year-old patient in the emergency department has a severe penicillin allergy documented
in the chart. The provider orders cefazolin 1 g IV every 8 hours for a suspected skin infection.
The nurse recognizes that cefazolin is a first-generation cephalosporin.
A. Administer the cefazolin slowly over 30 minutes while monitoring for a reaction
B. Give diphenhydramine 25 mg IV before administering the cefazolin as a premedication
C. Administer the cefazolin and observe the patient for 2 hours after the infusion
D. Clarify the order with the provider because cephalosporins share a beta-lactam ring with
penicillin ✓ CORRECT
Correct Answer: D
Rationale: First-generation cephalosporins such as cefazolin share a beta-lactam ring
structure with penicillin and carry a significant cross-reactivity risk, particularly in patients
with documented IgE-mediated penicillin allergies; the nurse must clarify the order with the
provider to discuss alternative antibiotics such as vancomycin or clindamycin. Administering
the medication without addressing the allergy risk could result in anaphylaxis, and
premedicating with diphenhydramine does not prevent IgE-mediated reactions. ATI
pharmacology exams frequently test cross-reactivity between drug classes and the nurse's
duty to question orders that pose serious safety risks.
Question 5 of 60
A nurse is caring for a 68-year-old patient with chronic kidney disease stage 3 who is
prescribed metformin 1000 mg twice daily for type 2 diabetes. The patient's serum creatinine
is 2.1 mg/dL and the eGFR is 28 mL/min/1.73m².
A. Hold the dose and contact the provider to discuss renal dosing adjustments ✓ CORRECT
B. Administer the metformin with food to reduce gastrointestinal upset
C. Administer the dose and monitor the patient's blood glucose every 2 hours
D. Switch the patient to insulin therapy without consulting the provider
Correct Answer: A
Rationale: Metformin is contraindicated in patients with an eGFR below 30 mL/min/1.73m²
because impaired renal clearance significantly increases the risk of lactic acidosis, a
potentially fatal adverse effect; the nurse must hold the dose and notify the provider to
discuss discontinuation or alternative therapy. Administering metformin with severe renal
impairment violates medication safety protocols, and nurses cannot independently switch
patients to insulin without a provider order. ATI pharmacology questions often test renal
contraindications for metformin and emphasize that lactic acidosis risk increases
dramatically when eGFR falls below 30.
Question 6 of 60
, A nurse is administering morning medications to a patient on the cardiac unit. The patient
has prescriptions for furosemide 40 mg IV, potassium chloride 20 mEq orally, and digoxin
0.25 mg orally. The nurse reviews the laboratory results and notes a serum potassium of 3.2
mEq/L and a serum magnesium of 1.4 mg/dL.
A. Administer all three medications as ordered since the potassium is within acceptable
range
B. Hold the digoxin, administer the furosemide and potassium, and notify the provider ✓
CORRECT
C. Administer the digoxin first, then give the furosemide and potassium 2 hours later
D. Administer the furosemide and potassium but hold the digoxin due to the low potassium
Correct Answer: B
Rationale: A potassium level of 3.2 mEq/L and magnesium of 1.4 mg/dL both increase the
risk of digoxin toxicity because hypokalemia and hypomagnesemia potentiate digoxin's
inhibitory effect on the Na-K-ATPase pump; the nurse must hold the digoxin, administer the
furosemide and potassium as ordered, and notify the provider to reassess the digoxin dose.
Administering digoxin with these electrolyte imbalances could precipitate fatal cardiac
arrhythmias including ventricular fibrillation. ATI emphasizes that the nurse must always
check potassium and magnesium levels before administering digoxin, as these are the most
common precipitating factors for toxicity.
Question 7 of 60
A 35-year-old patient in the outpatient clinic is starting a new prescription for phenytoin 300
mg daily for seizure control. The nurse is providing medication education. Which statement
by the patient indicates a need for further teaching?
A. "I will take my medication at the same time every day to maintain a steady blood level"
B. "I should use a soft toothbrush and floss gently to prevent gum problems"
C. "I can stop taking this medication once my seizures are under control for 6 months" ✓
CORRECT
D. "I will notify my dentist that I am taking phenytoin before any dental work"
Correct Answer: C
Rationale: Phenytoin requires long-term adherence and should never be discontinued abruptly
because sudden withdrawal can precipitate status epilepticus, a life-threatening emergency;
the patient must understand that discontinuation requires gradual tapering under provider
supervision. Using a soft toothbrush and notifying dental providers are appropriate because
phenytoin commonly causes gingival hyperplasia. ATI pharmacology exams frequently test
patient education for anticonvulsants and emphasize that abrupt discontinuation is one of
the most dangerous errors patients can make.
Question 8 of 60
