ATI RN PHARMACOLOGY 2023 PROCTORED
EXAM WITH NGN: COMPREHENSIVE STUDY
GUIDE
SECTION I: PHARMACOLOGY PRINCIPLES, SAFETY, MEDICATION ADMINISTRATION AND
DOSAGE CALCULATIONS (10 QUESTIONS)
1. A nurse is preparing to administer a medication that undergoes extensive firstpass
metabolism. Which route of administration will result in the highest bioavailability of this
medication?
☐ A. Oral
☐ B. Sublingual
☐ C. Rectal (suppository)
☑ D. Intravenous
Rationale: Intravenous (IV) administration bypasses the gastrointestinal tract and liver,
avoiding firstpass metabolism. This results in 100% bioavailability. Sublingual routes also
bypass firstpass metabolism but absorption can be variable. Oral medications undergo
,significant firstpass metabolism, greatly reducing bioavailability. Rectal absorption is
partial and unpredictable.
2. A nurse is reviewing a client's medication list. The client is prescribed warfarin. Which
laboratory value should the nurse monitor to evaluate the therapeutic effect of this
medication?
☐ A. Activated partial thromboplastin time (aPTT)
☐ B. Platelet count
☑ C. International normalized ratio (INR)
☐ D. Fibrinogen level
Rationale: Warfarin inhibits vitamin Kdependent clotting factors and its therapeutic effect
is monitored by INR. The target INR for most indications is 2.0–3.0. aPTT is used to monitor
heparin therapy. Platelets and fibrinogen are not used to evaluate warfarin's therapeutic
effect.
3. A nurse is administering medications to an older adult client. Which agerelated
physiological change places this client at greatest risk for medication toxicity?
☐ A. Increased gastric motility
☐ B. Increased hepatic blood flow
☐ C. Increased glomerular filtration rate
☑ D. Decreased renal excretion
Rationale: With aging, renal function declines, resulting in decreased glomerular filtration
rate, tubular secretion, and renal blood flow. This leads to decreased excretion of many
medications, increasing the risk for drug accumulation and toxicity. Hepatic changes also
occur but renal excretion is the most significant factor for many drugs.
,4. A nurse is preparing to administer vancomycin intravenously to a client. To minimize the
risk of red man syndrome, the nurse should administer the medication by which of the
following methods?
☐ A. Rapid IV bolus over 1 minute
☐ B. IV push over 5 minutes
☑ C. Slow IV infusion over 60 to 90 minutes
☐ D. Intermittent infusion over 15 minutes
Rationale: Red man syndrome (flushing, rash, hypotension, pruritus) is associated with
rapid infusion of vancomycin. To prevent this reaction, vancomycin should be infused
slowly over at least 60–90 minutes, depending on dose. Rapid administration increases
histamine release.
5. A client has been prescribed digoxin. Which assessment finding would be the priority for
the nurse to report to the healthcare provider?
☐ A. Heart rate of 62 beats/min
☐ B. Serum potassium of 3.2 mEq/L
☐ C. Blood pressure of 130/78 mmHg
☑ D. Anorexia and newonset visual halos
Rationale: Hypokalemia (3.2 mEq/L) significantly increases the risk of digoxin toxicity.
While anorexia, nausea, visual disturbances (halos, blurred vision) are classic signs of
digoxin toxicity and also priority, hypokalemia predisposes the client to toxicity and can be
lifethreatening. Both are critical, however, potassium of 3.2 requires immediate
intervention to prevent dysrhythmias. Visual halos with anorexia are early signs of toxicity
but correcting potassium is essential.
, 6. A nurse is calculating an IV infusion rate. The provider orders 1,000 mL of 0.9% sodium
chloride to infuse over 8 hours. The drop factor is 15 gtt/mL. What is the correct flow rate in
gtt/min? (Round to the nearest whole number.)
☐ A. 21 gtt/min
☑ B. 31 gtt/min
☐ C. 42 gtt/min
☐ D. 63 gtt/min
Rationale: Formula: (Volume (mL) × Drop factor (gtt/mL)) ÷ Time (min) = gtt/min. 1000 mL ×
15 gtt/mL = 15,000. 8 hours × 60 = 480 minutes. 15,000 ÷ 480 = 31.25 → 31 gtt/min.
7. A nurse receives a new prescription for gentamicin. Which assessment is most
important prior to administering the first dose?
☐ A. Liver function tests
☐ B. Serum calcium level
☑ C. Serum creatinine and BUN
☐ D. Hemoglobin and hematocrit
Rationale: Gentamicin is an aminoglycoside that is nephrotoxic and ototoxic. Baseline
renal function (BUN, creatinine) must be assessed prior to administration. Dosage
adjustments are often required for clients with renal impairment. Peak and trough levels
are also monitored.
8. The nurse is preparing to administer morphine sulfate to a client. Which of the following
is the priority assessment before administration?
EXAM WITH NGN: COMPREHENSIVE STUDY
GUIDE
SECTION I: PHARMACOLOGY PRINCIPLES, SAFETY, MEDICATION ADMINISTRATION AND
DOSAGE CALCULATIONS (10 QUESTIONS)
1. A nurse is preparing to administer a medication that undergoes extensive firstpass
metabolism. Which route of administration will result in the highest bioavailability of this
medication?
☐ A. Oral
☐ B. Sublingual
☐ C. Rectal (suppository)
☑ D. Intravenous
Rationale: Intravenous (IV) administration bypasses the gastrointestinal tract and liver,
avoiding firstpass metabolism. This results in 100% bioavailability. Sublingual routes also
bypass firstpass metabolism but absorption can be variable. Oral medications undergo
,significant firstpass metabolism, greatly reducing bioavailability. Rectal absorption is
partial and unpredictable.
2. A nurse is reviewing a client's medication list. The client is prescribed warfarin. Which
laboratory value should the nurse monitor to evaluate the therapeutic effect of this
medication?
☐ A. Activated partial thromboplastin time (aPTT)
☐ B. Platelet count
☑ C. International normalized ratio (INR)
☐ D. Fibrinogen level
Rationale: Warfarin inhibits vitamin Kdependent clotting factors and its therapeutic effect
is monitored by INR. The target INR for most indications is 2.0–3.0. aPTT is used to monitor
heparin therapy. Platelets and fibrinogen are not used to evaluate warfarin's therapeutic
effect.
3. A nurse is administering medications to an older adult client. Which agerelated
physiological change places this client at greatest risk for medication toxicity?
☐ A. Increased gastric motility
☐ B. Increased hepatic blood flow
☐ C. Increased glomerular filtration rate
☑ D. Decreased renal excretion
Rationale: With aging, renal function declines, resulting in decreased glomerular filtration
rate, tubular secretion, and renal blood flow. This leads to decreased excretion of many
medications, increasing the risk for drug accumulation and toxicity. Hepatic changes also
occur but renal excretion is the most significant factor for many drugs.
,4. A nurse is preparing to administer vancomycin intravenously to a client. To minimize the
risk of red man syndrome, the nurse should administer the medication by which of the
following methods?
☐ A. Rapid IV bolus over 1 minute
☐ B. IV push over 5 minutes
☑ C. Slow IV infusion over 60 to 90 minutes
☐ D. Intermittent infusion over 15 minutes
Rationale: Red man syndrome (flushing, rash, hypotension, pruritus) is associated with
rapid infusion of vancomycin. To prevent this reaction, vancomycin should be infused
slowly over at least 60–90 minutes, depending on dose. Rapid administration increases
histamine release.
5. A client has been prescribed digoxin. Which assessment finding would be the priority for
the nurse to report to the healthcare provider?
☐ A. Heart rate of 62 beats/min
☐ B. Serum potassium of 3.2 mEq/L
☐ C. Blood pressure of 130/78 mmHg
☑ D. Anorexia and newonset visual halos
Rationale: Hypokalemia (3.2 mEq/L) significantly increases the risk of digoxin toxicity.
While anorexia, nausea, visual disturbances (halos, blurred vision) are classic signs of
digoxin toxicity and also priority, hypokalemia predisposes the client to toxicity and can be
lifethreatening. Both are critical, however, potassium of 3.2 requires immediate
intervention to prevent dysrhythmias. Visual halos with anorexia are early signs of toxicity
but correcting potassium is essential.
, 6. A nurse is calculating an IV infusion rate. The provider orders 1,000 mL of 0.9% sodium
chloride to infuse over 8 hours. The drop factor is 15 gtt/mL. What is the correct flow rate in
gtt/min? (Round to the nearest whole number.)
☐ A. 21 gtt/min
☑ B. 31 gtt/min
☐ C. 42 gtt/min
☐ D. 63 gtt/min
Rationale: Formula: (Volume (mL) × Drop factor (gtt/mL)) ÷ Time (min) = gtt/min. 1000 mL ×
15 gtt/mL = 15,000. 8 hours × 60 = 480 minutes. 15,000 ÷ 480 = 31.25 → 31 gtt/min.
7. A nurse receives a new prescription for gentamicin. Which assessment is most
important prior to administering the first dose?
☐ A. Liver function tests
☐ B. Serum calcium level
☑ C. Serum creatinine and BUN
☐ D. Hemoglobin and hematocrit
Rationale: Gentamicin is an aminoglycoside that is nephrotoxic and ototoxic. Baseline
renal function (BUN, creatinine) must be assessed prior to administration. Dosage
adjustments are often required for clients with renal impairment. Peak and trough levels
are also monitored.
8. The nurse is preparing to administer morphine sulfate to a client. Which of the following
is the priority assessment before administration?
