ATI PN PHARMACOLOGY PROCTORED EXAM
Next Generation NCLEX (NGN) Practice Test & Comprehensive Answer Key
60 High-Yield Items with Detailed Rationales
EXAM INFORMATION & INSTRUCTIONS
• Course: Practical Nursing (PN) Pharmacology Proctored Focus
• Format: Standard Multiple-Choice, Select All That Apply (SATA), and NGN Clinical Judgment Cases (Matrix Grid,
Bowtie, Drag-and-Drop)
• Total Questions: 60 Items
• Time Allowed: 90 Minutes
• Passing Threshold: Level 2 Proficiency (73.3%+) / Level 3 Proficiency (85.0%+)
• Instructions: Select the best option or combination of options for each item. Comprehensive rationales and test-
taking strategies are provided in Part II.
PART I: PRACTICE EXAMINATION QUESTIONS (1 - 60)
1. A practical nurse (PN) is preparing to administer digoxin 0.25 mg PO to a client with heart failure.
Prior to administration, the nurse obtains an apical pulse of 54/min. Which of the following actions
should the nurse take?
A. Administer the medication as prescribed.
B. Recheck the pulse in 30 minutes and give if above 50/min.
C. Hold the medication and notify the charge nurse/provider.
D. Administer the medication with a glass of orange juice.
2. A PN is monitoring a client receiving continuous intravenous heparin for deep vein thrombosis
(DVT). Which of the following laboratory values indicates a therapeutic response to heparin therapy?
A. Prothrombin time (PT) of 12 seconds
B. Activated partial thromboplastin time (aPTT) of 65 seconds
C. International normalized ratio (INR) of 3.2
D. Platelet count of 95,000/mm³
3. A nurse is reinforcing teaching with a client who has a new prescription for furosemide 40 mg PO
daily. Which of the following instructions should the nurse include? (Select All That Apply)
[ ] A. Eat foods high in potassium, such as bananas and oranges.
[ ] B. Take the medication at bedtime to maximize efficacy.
[ ] C. Change positions slowly when standing up from a sitting position.
[ ] D. Limit fluid intake to less than 1 Liter per day.
[ ] E. Report muscle weakness, cramps, or cardiac palpitations immediately.
4. A PN is preparing to administer sublingual nitroglycerin to a client experiencing acute angina.
Which of the following statements by the client demonstrates a correct understanding of
administration?
A. 'I will swallow the tablet whole with a full glass of water.'
B. 'I can take up to 3 tablets 5 minutes apart, and call 911 if pain persists after the first dose.'
, C. 'I should crush the pill and mix it with applesauce if my mouth is dry.'
D. 'I will store my tablets in a clear plastic container on my sunny windowsill.'
5. A nurse is reviewing lab results for a client taking lisinopril for hypertension. Which lab value
represents a adverse effect that requires immediate provider notification?
A. Serum sodium 138 mEq/L
B. Serum potassium 5.8 mEq/L
C. Fasting blood glucose 110 mg/dL
D. Total cholesterol 190 mg/dL
6. A PN is caring for a client who is starting therapy with levothyroxine for hypothyroidism. Which
statement by the client indicates an understanding of the treatment regimen?
A. 'I will take this medicine every night right before I go to sleep.'
B. 'I should take this medication in the morning on an empty stomach with a full glass of water.'
C. 'I will stop taking this medication as soon as my fatigue improves.'
D. 'I can take my calcium supplement at the same time as levothyroxine.'
7. [NGN CASE STUDY - ITEM 7 OF 60]
CLINICAL SCENARIO:
Client History: 68-year-old female with Type 2 Diabetes Mellitus admitted with confusion,
diaphoresis, and tremors. Blood glucose level on admission is 42 mg/dL. The provider orders 50%
Dextrose IV push, followed by rechecking blood glucose in 15 minutes.
MATRIX QUESTION: For each potential intervention, indicate whether the action is Indicated, Non-
Essential, or Contraindicated for this client.
Actions Grid:
1. Administer 25 mL D50W IV push immediately. [Indicated / Non-Essential / Contraindicated]
2. Administer 10 units Regular Insulin subcutaneously. [Indicated / Non-Essential / Contraindicated]
3. Recheck blood glucose 15 minutes after administration. [Indicated / Non-Essential / Contraindicated]
4. Provide a complex carbohydrate and protein snack once alert. [Indicated / Non-Essential / Contraindicated]
5. Place client in high-Fowler's position and encourage oral orange juice immediately while stuporous.
[Indicated / Non-Essential / Contraindicated]
8. A PN is reinforcing discharge teaching for a client prescribed warfarin. Which of the following
statements by the client indicates a need for further instruction?
A. 'I will use a soft-bristled toothbrush to prevent bleeding.'
B. 'I should drastically increase my consumption of spinach and kale to improve my blood health.'
C. 'I will obtain regular blood tests to check my INR.'
D. 'I will report any dark, tarry stools or unexplained bruising to my doctor.'
9. A nurse is caring for a client receiving digoxin and furosemide. The client reports seeing yellow-
green halos around lights and experiencing nausea. What is the nurse's priority action?
A. Administer an antiemetic and reassess in 1 hour.
B. Check the client's serum potassium level and obtain a STAT digoxin level.
C. Encourage the client to rest in a dark, quiet room.
D. Reassure the client that visual disturbance is an expected harmless side effect.
, 10. A PN is reviewing medication orders for a group of clients. Which of the following prescriptions
should the nurse question prior to administration?
A. Metoprolol 50 mg PO daily for a client with heart rate 72/min
B. Acetaminophen 650 mg PO q6h PRN pain for a client with severe end-stage liver cirrhosis
C. Ceftriaxone 1 g IVPB daily for a client with a urinary tract infection
D. Omeprazole 20 mg PO daily before breakfast for GERD
11. A PN is administering albuterol via metered-dose inhaler (MDI) to a client with asthma. Which of
the following client responses indicates that the medication has achieved its intended therapeutic
outcome?
A. Decrease in respiratory rate from 28/min to 16/min and resolution of wheezing
B. Increase in heart rate from 70/min to 110/min
C. Client reports feeling jittery and nervous
D. Decrease in blood pressure from 130/80 mmHg to 110/70 mmHg
12. A nurse is preparing to give regular insulin and NPH insulin in a single syringe to a client with
diabetes. What is the correct order of steps for drawing up these medications?
A. Inject air into regular -> Inject air into NPH -> Draw up NPH -> Draw up regular
B. Inject air into NPH -> Inject air into regular -> Draw up regular -> Draw up NPH
C. Draw up NPH -> Draw up regular -> Inject air into both
D. Inject air into regular -> Draw up regular -> Inject air into NPH -> Draw up NPH
13. A client who has been taking prednisone 20 mg daily for rheumatoid arthritis for 6 months tells
the nurse, 'I ran out of my pills yesterday and feel fine, so I think I will stop taking them.' How should
the nurse respond?
A. 'That is fine, stopping the medication will prevent weight gain.'
B. 'You must never stop steroid medications abruptly; doing so can cause a life-threatening adrenal crisis.'
C. 'You should taper off over 2 days by taking half a pill each day.'
D. 'Steroids only work if taken continuously for 5 years minimum.'
14. A PN is administering vancomycin IVPB to a client with MRSA. Forty minutes into the infusion,
the client develops intense flushing of the neck, face, and upper chest, along with itching. Vital
signs: BP 90/58 mmHg, HR 112/min. Which action should the nurse take first?
A. Administer diphenhydramine IV push.
B. Stop the infusion immediately.
C. Slow the infusion rate by half.
D. Notify the health care provider.
15. A nurse is reinforcing teaching with a client prescribed oral iron supplements (ferrous sulfate).
Which instruction should be included?
A. Take the medication with milk to prevent gastric upset.
B. Take the medication with orange juice to enhance absorption.
C. Expect stools to become light clay-colored.
D. Crush the extended-release tablet if difficult to swallow.
16. [NGN CASE STUDY - ITEM 16 OF 60]
BOWTIE QUESTION:
Next Generation NCLEX (NGN) Practice Test & Comprehensive Answer Key
60 High-Yield Items with Detailed Rationales
EXAM INFORMATION & INSTRUCTIONS
• Course: Practical Nursing (PN) Pharmacology Proctored Focus
• Format: Standard Multiple-Choice, Select All That Apply (SATA), and NGN Clinical Judgment Cases (Matrix Grid,
Bowtie, Drag-and-Drop)
• Total Questions: 60 Items
• Time Allowed: 90 Minutes
• Passing Threshold: Level 2 Proficiency (73.3%+) / Level 3 Proficiency (85.0%+)
• Instructions: Select the best option or combination of options for each item. Comprehensive rationales and test-
taking strategies are provided in Part II.
PART I: PRACTICE EXAMINATION QUESTIONS (1 - 60)
1. A practical nurse (PN) is preparing to administer digoxin 0.25 mg PO to a client with heart failure.
Prior to administration, the nurse obtains an apical pulse of 54/min. Which of the following actions
should the nurse take?
A. Administer the medication as prescribed.
B. Recheck the pulse in 30 minutes and give if above 50/min.
C. Hold the medication and notify the charge nurse/provider.
D. Administer the medication with a glass of orange juice.
2. A PN is monitoring a client receiving continuous intravenous heparin for deep vein thrombosis
(DVT). Which of the following laboratory values indicates a therapeutic response to heparin therapy?
A. Prothrombin time (PT) of 12 seconds
B. Activated partial thromboplastin time (aPTT) of 65 seconds
C. International normalized ratio (INR) of 3.2
D. Platelet count of 95,000/mm³
3. A nurse is reinforcing teaching with a client who has a new prescription for furosemide 40 mg PO
daily. Which of the following instructions should the nurse include? (Select All That Apply)
[ ] A. Eat foods high in potassium, such as bananas and oranges.
[ ] B. Take the medication at bedtime to maximize efficacy.
[ ] C. Change positions slowly when standing up from a sitting position.
[ ] D. Limit fluid intake to less than 1 Liter per day.
[ ] E. Report muscle weakness, cramps, or cardiac palpitations immediately.
4. A PN is preparing to administer sublingual nitroglycerin to a client experiencing acute angina.
Which of the following statements by the client demonstrates a correct understanding of
administration?
A. 'I will swallow the tablet whole with a full glass of water.'
B. 'I can take up to 3 tablets 5 minutes apart, and call 911 if pain persists after the first dose.'
, C. 'I should crush the pill and mix it with applesauce if my mouth is dry.'
D. 'I will store my tablets in a clear plastic container on my sunny windowsill.'
5. A nurse is reviewing lab results for a client taking lisinopril for hypertension. Which lab value
represents a adverse effect that requires immediate provider notification?
A. Serum sodium 138 mEq/L
B. Serum potassium 5.8 mEq/L
C. Fasting blood glucose 110 mg/dL
D. Total cholesterol 190 mg/dL
6. A PN is caring for a client who is starting therapy with levothyroxine for hypothyroidism. Which
statement by the client indicates an understanding of the treatment regimen?
A. 'I will take this medicine every night right before I go to sleep.'
B. 'I should take this medication in the morning on an empty stomach with a full glass of water.'
C. 'I will stop taking this medication as soon as my fatigue improves.'
D. 'I can take my calcium supplement at the same time as levothyroxine.'
7. [NGN CASE STUDY - ITEM 7 OF 60]
CLINICAL SCENARIO:
Client History: 68-year-old female with Type 2 Diabetes Mellitus admitted with confusion,
diaphoresis, and tremors. Blood glucose level on admission is 42 mg/dL. The provider orders 50%
Dextrose IV push, followed by rechecking blood glucose in 15 minutes.
MATRIX QUESTION: For each potential intervention, indicate whether the action is Indicated, Non-
Essential, or Contraindicated for this client.
Actions Grid:
1. Administer 25 mL D50W IV push immediately. [Indicated / Non-Essential / Contraindicated]
2. Administer 10 units Regular Insulin subcutaneously. [Indicated / Non-Essential / Contraindicated]
3. Recheck blood glucose 15 minutes after administration. [Indicated / Non-Essential / Contraindicated]
4. Provide a complex carbohydrate and protein snack once alert. [Indicated / Non-Essential / Contraindicated]
5. Place client in high-Fowler's position and encourage oral orange juice immediately while stuporous.
[Indicated / Non-Essential / Contraindicated]
8. A PN is reinforcing discharge teaching for a client prescribed warfarin. Which of the following
statements by the client indicates a need for further instruction?
A. 'I will use a soft-bristled toothbrush to prevent bleeding.'
B. 'I should drastically increase my consumption of spinach and kale to improve my blood health.'
C. 'I will obtain regular blood tests to check my INR.'
D. 'I will report any dark, tarry stools or unexplained bruising to my doctor.'
9. A nurse is caring for a client receiving digoxin and furosemide. The client reports seeing yellow-
green halos around lights and experiencing nausea. What is the nurse's priority action?
A. Administer an antiemetic and reassess in 1 hour.
B. Check the client's serum potassium level and obtain a STAT digoxin level.
C. Encourage the client to rest in a dark, quiet room.
D. Reassure the client that visual disturbance is an expected harmless side effect.
, 10. A PN is reviewing medication orders for a group of clients. Which of the following prescriptions
should the nurse question prior to administration?
A. Metoprolol 50 mg PO daily for a client with heart rate 72/min
B. Acetaminophen 650 mg PO q6h PRN pain for a client with severe end-stage liver cirrhosis
C. Ceftriaxone 1 g IVPB daily for a client with a urinary tract infection
D. Omeprazole 20 mg PO daily before breakfast for GERD
11. A PN is administering albuterol via metered-dose inhaler (MDI) to a client with asthma. Which of
the following client responses indicates that the medication has achieved its intended therapeutic
outcome?
A. Decrease in respiratory rate from 28/min to 16/min and resolution of wheezing
B. Increase in heart rate from 70/min to 110/min
C. Client reports feeling jittery and nervous
D. Decrease in blood pressure from 130/80 mmHg to 110/70 mmHg
12. A nurse is preparing to give regular insulin and NPH insulin in a single syringe to a client with
diabetes. What is the correct order of steps for drawing up these medications?
A. Inject air into regular -> Inject air into NPH -> Draw up NPH -> Draw up regular
B. Inject air into NPH -> Inject air into regular -> Draw up regular -> Draw up NPH
C. Draw up NPH -> Draw up regular -> Inject air into both
D. Inject air into regular -> Draw up regular -> Inject air into NPH -> Draw up NPH
13. A client who has been taking prednisone 20 mg daily for rheumatoid arthritis for 6 months tells
the nurse, 'I ran out of my pills yesterday and feel fine, so I think I will stop taking them.' How should
the nurse respond?
A. 'That is fine, stopping the medication will prevent weight gain.'
B. 'You must never stop steroid medications abruptly; doing so can cause a life-threatening adrenal crisis.'
C. 'You should taper off over 2 days by taking half a pill each day.'
D. 'Steroids only work if taken continuously for 5 years minimum.'
14. A PN is administering vancomycin IVPB to a client with MRSA. Forty minutes into the infusion,
the client develops intense flushing of the neck, face, and upper chest, along with itching. Vital
signs: BP 90/58 mmHg, HR 112/min. Which action should the nurse take first?
A. Administer diphenhydramine IV push.
B. Stop the infusion immediately.
C. Slow the infusion rate by half.
D. Notify the health care provider.
15. A nurse is reinforcing teaching with a client prescribed oral iron supplements (ferrous sulfate).
Which instruction should be included?
A. Take the medication with milk to prevent gastric upset.
B. Take the medication with orange juice to enhance absorption.
C. Expect stools to become light clay-colored.
D. Crush the extended-release tablet if difficult to swallow.
16. [NGN CASE STUDY - ITEM 16 OF 60]
BOWTIE QUESTION:
