ATI Pharmacology 2026/2027 – Comprehensive
Exam Review & Practice Test
Question 1
A nurse is preparing to administer digoxin 0.25 mg PO daily to an adult client with
heart failure. Which assessment finding requires the nurse to withhold the medication
and notify the healthcare provider?
A. Blood pressure of 108/68 mmHg
B. Apical pulse rate of 52 beats/min
C. Respiratory rate of 18 breaths/min
D. Serum potassium level of 4.6 mEq/L
Correct Answer: B
Rationale: Digoxin exerts a negative chronotropic effect by slowing atrioventricular
node conduction. The nurse must auscultate the apical pulse for 60 full seconds prior
to administration; a heart rate below 60 beats/min in an adult warrants withholding
the medication to prevent profound bradycardia, heart block, or fatal arrhythmias.
Question 2
A nurse is caring for a client receiving a continuous intravenous heparin infusion for
a pulmonary embolism. The client's activated partial thromboplastin time (aPTT) is
110 seconds. What is the priority nursing action?
A. Increase the infusion rate by 100 units/hour.
B. Stop the heparin infusion and notify the provider.
,C. Administer oral phytonadione (vitamin K) immediately.
D. Maintain the current infusion rate and recheck in 24 hours.
Correct Answer: B
Rationale: The therapeutic aPTT target during heparin therapy is 1.5 to 2.5 times the
control value (approximately 60 to 80 seconds). An aPTT of 110 seconds indicates
excessive anticoagulation and a critical risk for severe internal hemorrhage. The
nurse must stop the infusion and alert the primary provider.
Question 3
A client diagnosed with atrial fibrillation is initiated on warfarin therapy while
continuing IV heparin. What is the pharmacological rationale for this dual
anticoagulant therapy?
A. Heparin prevents the immediate allergic breakdown of oral warfarin.
B. Warfarin requires 3 to 5 days to reach therapeutic INR levels due to clotting factor
half-lives.
C. Heparin directly stimulates the hepatic synthesis of vitamin K-dependent factors.
D. Dual therapy prevents the development of drug-induced immune
thrombocytopenia.
Correct Answer: B
Rationale: Warfarin inhibits the synthesis of vitamin K-dependent clotting factors,
requiring 3 to 5 days to deplete existing circulating factors and achieve a therapeutic
International Normalized Ratio (INR 2.0–3.0). Heparin provides immediate
anticoagulation during this bridging period until oral warfarin achieves adequate,
stable therapeutic levels.
,Question 4
A client with chronic hypertension begins taking lisinopril. Which adverse effect
should the nurse instruct the client to report immediately as a potential life-
threatening emergency?
A. Dry, hacking, non-productive cough
B. Dizziness upon standing from a sitting position
C. Swelling of the lips, tongue, face, or throat
D. Mild metallic taste following morning administration
Correct Answer: C
Rationale: Angioedema is a life-threatening adverse effect of angiotensin-converting
enzyme (ACE) inhibitors caused by localized bradykinin accumulation. Rapid
submucosal swelling of the tongue, glottis, and pharynx can cause fatal upper airway
obstruction. Clients must immediately seek emergency medical intervention and
discontinue the drug permanently.
Question 5
A nurse is reviewing the medication administration record for a client prescribed
carvedilol for heart failure. Which underlying condition is a contraindication to beta-
blocker therapy?
A. Essential hypertension
B. Severe bronchial asthma
C. Chronic stable angina
D. Primary hyperparathyroidism
, Correct Answer: B
Rationale: Non-selective beta-adrenergic antagonists block beta-2 receptors located
on bronchial smooth muscle, triggering severe bronchoconstriction and life-
threatening bronchospasms in clients with reactive airway diseases, such as asthma
or severe COPD. Beta-blockers are contraindicated in clients with active, severe
bronchospastic pulmonary disease.
Question 6
A nurse is reinforcing education with a client who is prescribed sublingual
nitroglycerin tablets for acute angina pectoris. Which instruction is correct?
A. "Swallow the tablet immediately with a full glass of warm water."
B. "Take one tablet every 5 minutes up to 3 doses; call 911 if chest pain persists after
the first dose."
C. "Chew the tablet thoroughly and spit out residual fragments after 1 minute."
D. "Store the tablets in a clear plastic container on your kitchen counter."
Correct Answer: B
Rationale: Sublingual nitroglycerin dissolves under the tongue for rapid
transmucosal absorption into systemic circulation. Clients must take one tablet at
onset of chest pain; if unresolved after 5 minutes, they must call 911 and take up to
two additional doses at 5-minute intervals while awaiting emergency services.
Question 7
A client receiving intravenous amiodarone for recurrent ventricular tachycardia
Exam Review & Practice Test
Question 1
A nurse is preparing to administer digoxin 0.25 mg PO daily to an adult client with
heart failure. Which assessment finding requires the nurse to withhold the medication
and notify the healthcare provider?
A. Blood pressure of 108/68 mmHg
B. Apical pulse rate of 52 beats/min
C. Respiratory rate of 18 breaths/min
D. Serum potassium level of 4.6 mEq/L
Correct Answer: B
Rationale: Digoxin exerts a negative chronotropic effect by slowing atrioventricular
node conduction. The nurse must auscultate the apical pulse for 60 full seconds prior
to administration; a heart rate below 60 beats/min in an adult warrants withholding
the medication to prevent profound bradycardia, heart block, or fatal arrhythmias.
Question 2
A nurse is caring for a client receiving a continuous intravenous heparin infusion for
a pulmonary embolism. The client's activated partial thromboplastin time (aPTT) is
110 seconds. What is the priority nursing action?
A. Increase the infusion rate by 100 units/hour.
B. Stop the heparin infusion and notify the provider.
,C. Administer oral phytonadione (vitamin K) immediately.
D. Maintain the current infusion rate and recheck in 24 hours.
Correct Answer: B
Rationale: The therapeutic aPTT target during heparin therapy is 1.5 to 2.5 times the
control value (approximately 60 to 80 seconds). An aPTT of 110 seconds indicates
excessive anticoagulation and a critical risk for severe internal hemorrhage. The
nurse must stop the infusion and alert the primary provider.
Question 3
A client diagnosed with atrial fibrillation is initiated on warfarin therapy while
continuing IV heparin. What is the pharmacological rationale for this dual
anticoagulant therapy?
A. Heparin prevents the immediate allergic breakdown of oral warfarin.
B. Warfarin requires 3 to 5 days to reach therapeutic INR levels due to clotting factor
half-lives.
C. Heparin directly stimulates the hepatic synthesis of vitamin K-dependent factors.
D. Dual therapy prevents the development of drug-induced immune
thrombocytopenia.
Correct Answer: B
Rationale: Warfarin inhibits the synthesis of vitamin K-dependent clotting factors,
requiring 3 to 5 days to deplete existing circulating factors and achieve a therapeutic
International Normalized Ratio (INR 2.0–3.0). Heparin provides immediate
anticoagulation during this bridging period until oral warfarin achieves adequate,
stable therapeutic levels.
,Question 4
A client with chronic hypertension begins taking lisinopril. Which adverse effect
should the nurse instruct the client to report immediately as a potential life-
threatening emergency?
A. Dry, hacking, non-productive cough
B. Dizziness upon standing from a sitting position
C. Swelling of the lips, tongue, face, or throat
D. Mild metallic taste following morning administration
Correct Answer: C
Rationale: Angioedema is a life-threatening adverse effect of angiotensin-converting
enzyme (ACE) inhibitors caused by localized bradykinin accumulation. Rapid
submucosal swelling of the tongue, glottis, and pharynx can cause fatal upper airway
obstruction. Clients must immediately seek emergency medical intervention and
discontinue the drug permanently.
Question 5
A nurse is reviewing the medication administration record for a client prescribed
carvedilol for heart failure. Which underlying condition is a contraindication to beta-
blocker therapy?
A. Essential hypertension
B. Severe bronchial asthma
C. Chronic stable angina
D. Primary hyperparathyroidism
, Correct Answer: B
Rationale: Non-selective beta-adrenergic antagonists block beta-2 receptors located
on bronchial smooth muscle, triggering severe bronchoconstriction and life-
threatening bronchospasms in clients with reactive airway diseases, such as asthma
or severe COPD. Beta-blockers are contraindicated in clients with active, severe
bronchospastic pulmonary disease.
Question 6
A nurse is reinforcing education with a client who is prescribed sublingual
nitroglycerin tablets for acute angina pectoris. Which instruction is correct?
A. "Swallow the tablet immediately with a full glass of warm water."
B. "Take one tablet every 5 minutes up to 3 doses; call 911 if chest pain persists after
the first dose."
C. "Chew the tablet thoroughly and spit out residual fragments after 1 minute."
D. "Store the tablets in a clear plastic container on your kitchen counter."
Correct Answer: B
Rationale: Sublingual nitroglycerin dissolves under the tongue for rapid
transmucosal absorption into systemic circulation. Clients must take one tablet at
onset of chest pain; if unresolved after 5 minutes, they must call 911 and take up to
two additional doses at 5-minute intervals while awaiting emergency services.
Question 7
A client receiving intravenous amiodarone for recurrent ventricular tachycardia
