Master NGN RN Pharmacology Proctored
Exam Questions 400 Latest Real Exam
Questions & Answers | 2026-2027 Edition
This comprehensive review guide contains 400 verified questions and answers for
the ATI RN Pharmacology Proctored Exam with Next Generation NCLEX (NGN) -
style questions for the 2026/2027 testing cycle . The questions cover key
pharmacology concepts including medication safety, drug interactions, adverse
effects, therapeutic monitoring, and clinical judgment scenarios, aligned with the
latest ATI and NGN test plans .
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Questions 1-80)
Question 1: A client with heart failure is prescribed digoxin. Which finding
requires immediate action?
A) Apical pulse 58 bpm
B) Serum potassium 4.0 mEq/L
C) Nausea and vomiting
D) Visual yellow halos
Correct Answer: D) Visual yellow halos
Rationale: Visual yellow halos are a classic sign of digoxin toxicity and require
immediate action . Nausea and vomiting can occur with digoxin toxicity but are
less specific. A pulse of 58 is below normal but not an immediate emergency if the
patient is asymptomatic. Potassium of 4.0 is within normal range .
,Question 2: A client on warfarin has an INR of 4.5. No bleeding is present. What
should the nurse do first?
A) Administer vitamin K
B) Hold the next dose of warfarin
C) Transfuse fresh frozen plasma
D) Notify the provider
Correct Answer: B) Hold the next dose of warfarin
Rationale: For an INR >4.0 without active bleeding, the standard practice is to
hold the next dose of warfarin. Vitamin K or fresh frozen plasma is reserved for
active bleeding or an extremely high INR (>10). The provider should be notified
after holding the dose .
Question 3: A client starting amiodarone for atrial fibrillation should be
monitored for which adverse effects? (Select all that apply.)
A) Shortness of breath and dry cough
B) Bluish-gray skin discoloration
C) Thyroid function tests abnormal
D) Heart rate 72 bpm
E) BP 130/80 mmHg
Correct Answer: A, B, C
,Rationale: Amiodarone is associated with pulmonary toxicity (shortness of breath,
cough), blue-gray skin discoloration, and thyroid dysfunction . Normal heart rate
and blood pressure do not require intervention. Amiodarone can cause both
hypothyroidism and hyperthyroidism due to its high iodine content.
Question 4: A client on warfarin has an INR of 1.2 (goal 2-3). What should the
nurse anticipate?
A) Increase the warfarin dose
B) Decrease the warfarin dose
C) Administer vitamin K
D) Hold the warfarin
Correct Answer: A) Increase the warfarin dose
Rationale: INR 1.2 is subtherapeutic. The provider will likely increase the warfarin
dose to achieve the target INR of 2-3 for most indications . Vitamin K is reserved
for supratherapeutic INR with bleeding. Decreasing or holding the dose would
worsen the subtherapeutic INR.
Question 5: Which beta-blocker is cardioselective (beta-1 selective)?
A) Propranolol
B) Metoprolol
C) Carvedilol
D) Labetalol
, Correct Answer: B) Metoprolol
Rationale: Metoprolol and atenolol are beta-1 selective (cardioselective).
Propranolol is non-selective. Carvedilol and labetalol have alpha-blocking
properties as well . Cardioselective beta-blockers are preferred in patients with
respiratory conditions like asthma.
Question 6: A client prescribed warfarin has an INR of 4.5. Which medication, if
taken concurrently, would most likely contribute to this elevated level?
A) Acetaminophen
B) Amoxicillin
C) Omeprazole
D) Vitamin K supplements
Correct Answer: C) Omeprazole
Rationale: Omeprazole (proton pump inhibitor) can increase warfarin levels by
inhibiting CYP2C19 metabolism, leading to elevated INR and bleeding risk .
Vitamin K would decrease INR, not increase it. The target INR for most indications
is 2-3; 4.5 indicates supratherapeutic levels requiring intervention .
Question 7: A nurse is administering furosemide to a client with pulmonary
edema. Which assessment finding indicates the medication is having the desired
effect?
Exam Questions 400 Latest Real Exam
Questions & Answers | 2026-2027 Edition
This comprehensive review guide contains 400 verified questions and answers for
the ATI RN Pharmacology Proctored Exam with Next Generation NCLEX (NGN) -
style questions for the 2026/2027 testing cycle . The questions cover key
pharmacology concepts including medication safety, drug interactions, adverse
effects, therapeutic monitoring, and clinical judgment scenarios, aligned with the
latest ATI and NGN test plans .
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Questions 1-80)
Question 1: A client with heart failure is prescribed digoxin. Which finding
requires immediate action?
A) Apical pulse 58 bpm
B) Serum potassium 4.0 mEq/L
C) Nausea and vomiting
D) Visual yellow halos
Correct Answer: D) Visual yellow halos
Rationale: Visual yellow halos are a classic sign of digoxin toxicity and require
immediate action . Nausea and vomiting can occur with digoxin toxicity but are
less specific. A pulse of 58 is below normal but not an immediate emergency if the
patient is asymptomatic. Potassium of 4.0 is within normal range .
,Question 2: A client on warfarin has an INR of 4.5. No bleeding is present. What
should the nurse do first?
A) Administer vitamin K
B) Hold the next dose of warfarin
C) Transfuse fresh frozen plasma
D) Notify the provider
Correct Answer: B) Hold the next dose of warfarin
Rationale: For an INR >4.0 without active bleeding, the standard practice is to
hold the next dose of warfarin. Vitamin K or fresh frozen plasma is reserved for
active bleeding or an extremely high INR (>10). The provider should be notified
after holding the dose .
Question 3: A client starting amiodarone for atrial fibrillation should be
monitored for which adverse effects? (Select all that apply.)
A) Shortness of breath and dry cough
B) Bluish-gray skin discoloration
C) Thyroid function tests abnormal
D) Heart rate 72 bpm
E) BP 130/80 mmHg
Correct Answer: A, B, C
,Rationale: Amiodarone is associated with pulmonary toxicity (shortness of breath,
cough), blue-gray skin discoloration, and thyroid dysfunction . Normal heart rate
and blood pressure do not require intervention. Amiodarone can cause both
hypothyroidism and hyperthyroidism due to its high iodine content.
Question 4: A client on warfarin has an INR of 1.2 (goal 2-3). What should the
nurse anticipate?
A) Increase the warfarin dose
B) Decrease the warfarin dose
C) Administer vitamin K
D) Hold the warfarin
Correct Answer: A) Increase the warfarin dose
Rationale: INR 1.2 is subtherapeutic. The provider will likely increase the warfarin
dose to achieve the target INR of 2-3 for most indications . Vitamin K is reserved
for supratherapeutic INR with bleeding. Decreasing or holding the dose would
worsen the subtherapeutic INR.
Question 5: Which beta-blocker is cardioselective (beta-1 selective)?
A) Propranolol
B) Metoprolol
C) Carvedilol
D) Labetalol
, Correct Answer: B) Metoprolol
Rationale: Metoprolol and atenolol are beta-1 selective (cardioselective).
Propranolol is non-selective. Carvedilol and labetalol have alpha-blocking
properties as well . Cardioselective beta-blockers are preferred in patients with
respiratory conditions like asthma.
Question 6: A client prescribed warfarin has an INR of 4.5. Which medication, if
taken concurrently, would most likely contribute to this elevated level?
A) Acetaminophen
B) Amoxicillin
C) Omeprazole
D) Vitamin K supplements
Correct Answer: C) Omeprazole
Rationale: Omeprazole (proton pump inhibitor) can increase warfarin levels by
inhibiting CYP2C19 metabolism, leading to elevated INR and bleeding risk .
Vitamin K would decrease INR, not increase it. The target INR for most indications
is 2-3; 4.5 indicates supratherapeutic levels requiring intervention .
Question 7: A nurse is administering furosemide to a client with pulmonary
edema. Which assessment finding indicates the medication is having the desired
effect?
