ATI PHARM CMS COMPREHENSIVE EXAM 2026 | 200 QUESTIONS WITH
CORRECT SOLUTIONS | ALREADY GRADED A+ | 100% VERIFIED
Pharmacology Competencies | Key Domains: Medication Mechanisms, Adverse Effects,
Therapeutic Uses, Safe Dosage Calculations, High-Alert Medications, Interactions, Nursing
Responsibilities, Patient Education, and Clinical Decision-Making | Expert-Verified Format
& Structure | Exam-Ready
Introduction
This 2026 ATI Pharmacology CMS Exam format provides the complete structural framework
for generating comprehensive pharmacology exam content with fully validated solutions. It
reflects essential medication-safety principles, clinical application, therapeutic reasoning,
and evidence-aligned pharmacologic practice expectations for RN-level nursing. All exam
content produced using this format supports high-level critical thinking and safe medication
administration standards.
Answer Format
All correct solutions must appear in bold and green, followed by concise rationales that
reinforce pharmacologic safety, explain clinical reasoning, and clarify why alternative
responses are less accurate.
Question 1
A patient is prescribed warfarin 5 mg PO daily. Which lab value best guides dosage
adjustment?
A. PT
B. INR
C. aPTT
D. D-dimer
Answer: B. INR
Rationale: INR standardizes PT results across labs and directly reflects warfarin’s
anticoagulant effect; target is typically 2–3 for most indications. PT (A) lacks
standardization, aPTT (C) monitors heparin, D-dimer (D) assesses clot breakdown.
Question 2
The nurse is preparing to administer digoxin 0.25 mg PO. Which finding warrants
withholding the dose?
A. Heart rate 58 bpm
B. Blood pressure 138/88 mmHg
C. Serum potassium 3.8 mEq/L
D. Digoxin level 0.9 ng/mL
Answer: A. Heart rate 58 bpm
Rationale: Digoxin slows conduction; apical pulse < 60 bpm increases risk of severe
bradycardia or heart block. Hold dose and notify provider. Normal digoxin level is 0.5–2
ng/mL; 0.9 ng/mL (D) is acceptable.
Question 3
A patient receiving morphine PCA reports itching but no rash. Which medication is most
appropriate?
A. Diphenhydramine 25 mg IV
,B. Naloxone 0.4 mg IV
C. Epinephrine 0.3 mg IM
D. Albuterol 2.5 mg nebulizer
Answer: A. Diphenhydramine 25 mg IV
Rationale: Opioid-induced pruritus is histamine-mediated; antihistamine provides relief
without reversing analgesia. Naloxone (B) would reverse analgesia and is reserved for
respiratory depression.
Question 4
Which instruction is priority when teaching a patient starting metformin?
A. Take with meals to reduce GI upset
B. Stop if you develop diarrhea
C. Increase dose if glucose > 200 mg/dL
D. Use ibuprofen for joint pain
Answer: A. Take with meals to reduce GI upset
Rationale: Food decreases GI irritation and improves adherence. Diarrhea (B) is common
and usually transient; stopping metformin is not necessary unless severe or accompanied by
lactic acidosis.
Question 5
A patient on lithium carbonate 600 mg BID reports nausea, tremor, and confusion. Which
lab is most urgent?
A. TSH
B. Serum lithium level
C. BUN
D. ALT
Answer: B. Serum lithium level
Rationale: Symptoms suggest lithium toxicity; therapeutic range is 0.6–1.2 mEq/L. Early
signs include GI upset and neurologic changes; confirm level before further dosing.
Question 6
Which high-alert medication requires an independent double check before administration?
A. Metoprolol 25 mg PO
B. Insulin glargine 20 units subcutaneous
C. Acetaminophen 650 mg PO
D. Omeprazole 20 mg PO
Answer: B. Insulin glargine 20 units subcutaneous
Rationale: Insulin is a high-alert drug; double check prevents dosing errors that can cause
severe hypoglycemia or hyperglycemia. Metoprolol (A) is not high-alert at standard doses.
Question 7
A patient is prescribed phenytoin 300 mg PO at bedtime. Which statement indicates
understanding?
A. “I will take it with milk to protect my stomach.”
B. “I will never stop this medicine suddenly.”
C. “I will brush my gums daily to prevent swelling.”
D. “I will avoid grapefruit juice completely.”
Answer: B. “I will never stop this medicine suddenly.”
Rationale: Abrupt discontinuation can precipitate status epilepticus. Milk (A) interferes with
absorption; phenytoin can cause gingival hyperplasia (C) but brushing gums is not
preventive; grapefruit (D) is not a major interaction.
,Question 8
Which nursing action is appropriate before administering gentamicin 80 mg IV?
A. Obtain peak level 30 minutes after infusion
B. Obtain trough level immediately before next dose
C. Monitor blood pressure every 15 minutes
D. Administer rapidly over 5 minutes
Answer: B. Obtain trough level immediately before next dose
Rationale: Trough levels guide dosing and prevent nephrotoxicity/ototoxicity; monitor
creatinine (A) but trough guides dosing. Gentamicin is given over 30–60 min.
Question 9
A patient receiving heparin infusion has aPTT 90 seconds (control 30). Which action is
correct?
A. Stop infusion and call provider
B. Continue current rate
C. Administer protamine sulfate
D. Increase rate
Answer: A. Stop infusion and call provider
Rationale: aPTT > 3 times control increases bleeding risk; stop infusion and await further
orders. Protamine (C) is reserved for life-threatening bleeding.
Question 10
Which teaching is priority for a patient starting prednisone 40 mg daily?
A. Take at bedtime to minimize insomnia
B. Stop abruptly after 5 days
C. Report black tarry stools immediately
D. Avoid all fruits
Answer: C. Report black tarry stools immediately
Rationale: Corticosteroids increase GI bleeding risk; early recognition prevents
complications. Never stop abruptly (B); taper after > 5–7 days to prevent adrenal
insufficiency.
Question 11
A patient is prescribed clopidogrel 75 mg daily. Which over-the-counter medication should
be avoided?
A. Acetaminophen
B. Aspirin
C. Calcium carbonate
D. Vitamin C
Answer: B. Aspirin
Rationale: Dual antiplatelet therapy increases bleeding risk; advise against aspirin-
containing OTC products unless prescribed.
Question 12
Which lab value best reflects adequate heparin anticoagulation during dialysis?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
Answer: B. aPTT
, Rationale: aPTT monitors unfractionated heparin; target 1.5–2.5 times baseline. PT/INR (A)
monitors warfarin; platelets (C) detect HIT.
Question 13
A patient on atorvastatin reports new-onset muscle pain and dark urine. Which lab is
priority?
A. ALT
B. Creatine kinase
C. LDH
D. Alkaline phosphatase
Answer: B. Creatine kinase
Rationale: Dark urine and muscle pain suggest rhabdomyolysis; CK > 10 times ULN requires
statin discontinuation. ALT (A) monitors hepatotoxicity.
Question 14
Which instruction is essential for a patient starting sildenafil?
A. Take with nitrates for chest pain
B. Avoid grapefruit juice
C. Take on empty stomach for faster onset
D. Double dose if ineffective
Answer: C. Take on empty stomach for faster onset
Rationale: High-fat meals delay absorption. Nitrates (A) are contraindicated due to severe
hypotension risk.
Question 15
Which medication requires a negative pregnancy test before initiation in women of
childbearing age?
A. Lisinopril
B. Isotretinoin
C. Metformin
D. Sertraline
Answer: B. Isotretinoin
Rationale: Isotretinoin is highly teratogenic; iPLEDGE program mandates two negative
pregnancy tests before dispensing.
Question 16
A patient is prescribed spironolactone 25 mg BID. Which finding requires immediate
intervention?
A. Serum potassium 5.8 mEq/L
B. Blood pressure 130/80 mmHg
C. Heart rate 76 bpm
D. Mild gynecomastia
Answer: A. Serum potassium 5.8 mEq/L
Rationale: Spironolactone is potassium-sparing; levels > 5.5 mEq/L increase arrhythmia
risk. Hold dose and notify provider.
Question 17
Which route is preferred for naloxone in an outpatient opioid overdose?
A. IV
B. IM
CORRECT SOLUTIONS | ALREADY GRADED A+ | 100% VERIFIED
Pharmacology Competencies | Key Domains: Medication Mechanisms, Adverse Effects,
Therapeutic Uses, Safe Dosage Calculations, High-Alert Medications, Interactions, Nursing
Responsibilities, Patient Education, and Clinical Decision-Making | Expert-Verified Format
& Structure | Exam-Ready
Introduction
This 2026 ATI Pharmacology CMS Exam format provides the complete structural framework
for generating comprehensive pharmacology exam content with fully validated solutions. It
reflects essential medication-safety principles, clinical application, therapeutic reasoning,
and evidence-aligned pharmacologic practice expectations for RN-level nursing. All exam
content produced using this format supports high-level critical thinking and safe medication
administration standards.
Answer Format
All correct solutions must appear in bold and green, followed by concise rationales that
reinforce pharmacologic safety, explain clinical reasoning, and clarify why alternative
responses are less accurate.
Question 1
A patient is prescribed warfarin 5 mg PO daily. Which lab value best guides dosage
adjustment?
A. PT
B. INR
C. aPTT
D. D-dimer
Answer: B. INR
Rationale: INR standardizes PT results across labs and directly reflects warfarin’s
anticoagulant effect; target is typically 2–3 for most indications. PT (A) lacks
standardization, aPTT (C) monitors heparin, D-dimer (D) assesses clot breakdown.
Question 2
The nurse is preparing to administer digoxin 0.25 mg PO. Which finding warrants
withholding the dose?
A. Heart rate 58 bpm
B. Blood pressure 138/88 mmHg
C. Serum potassium 3.8 mEq/L
D. Digoxin level 0.9 ng/mL
Answer: A. Heart rate 58 bpm
Rationale: Digoxin slows conduction; apical pulse < 60 bpm increases risk of severe
bradycardia or heart block. Hold dose and notify provider. Normal digoxin level is 0.5–2
ng/mL; 0.9 ng/mL (D) is acceptable.
Question 3
A patient receiving morphine PCA reports itching but no rash. Which medication is most
appropriate?
A. Diphenhydramine 25 mg IV
,B. Naloxone 0.4 mg IV
C. Epinephrine 0.3 mg IM
D. Albuterol 2.5 mg nebulizer
Answer: A. Diphenhydramine 25 mg IV
Rationale: Opioid-induced pruritus is histamine-mediated; antihistamine provides relief
without reversing analgesia. Naloxone (B) would reverse analgesia and is reserved for
respiratory depression.
Question 4
Which instruction is priority when teaching a patient starting metformin?
A. Take with meals to reduce GI upset
B. Stop if you develop diarrhea
C. Increase dose if glucose > 200 mg/dL
D. Use ibuprofen for joint pain
Answer: A. Take with meals to reduce GI upset
Rationale: Food decreases GI irritation and improves adherence. Diarrhea (B) is common
and usually transient; stopping metformin is not necessary unless severe or accompanied by
lactic acidosis.
Question 5
A patient on lithium carbonate 600 mg BID reports nausea, tremor, and confusion. Which
lab is most urgent?
A. TSH
B. Serum lithium level
C. BUN
D. ALT
Answer: B. Serum lithium level
Rationale: Symptoms suggest lithium toxicity; therapeutic range is 0.6–1.2 mEq/L. Early
signs include GI upset and neurologic changes; confirm level before further dosing.
Question 6
Which high-alert medication requires an independent double check before administration?
A. Metoprolol 25 mg PO
B. Insulin glargine 20 units subcutaneous
C. Acetaminophen 650 mg PO
D. Omeprazole 20 mg PO
Answer: B. Insulin glargine 20 units subcutaneous
Rationale: Insulin is a high-alert drug; double check prevents dosing errors that can cause
severe hypoglycemia or hyperglycemia. Metoprolol (A) is not high-alert at standard doses.
Question 7
A patient is prescribed phenytoin 300 mg PO at bedtime. Which statement indicates
understanding?
A. “I will take it with milk to protect my stomach.”
B. “I will never stop this medicine suddenly.”
C. “I will brush my gums daily to prevent swelling.”
D. “I will avoid grapefruit juice completely.”
Answer: B. “I will never stop this medicine suddenly.”
Rationale: Abrupt discontinuation can precipitate status epilepticus. Milk (A) interferes with
absorption; phenytoin can cause gingival hyperplasia (C) but brushing gums is not
preventive; grapefruit (D) is not a major interaction.
,Question 8
Which nursing action is appropriate before administering gentamicin 80 mg IV?
A. Obtain peak level 30 minutes after infusion
B. Obtain trough level immediately before next dose
C. Monitor blood pressure every 15 minutes
D. Administer rapidly over 5 minutes
Answer: B. Obtain trough level immediately before next dose
Rationale: Trough levels guide dosing and prevent nephrotoxicity/ototoxicity; monitor
creatinine (A) but trough guides dosing. Gentamicin is given over 30–60 min.
Question 9
A patient receiving heparin infusion has aPTT 90 seconds (control 30). Which action is
correct?
A. Stop infusion and call provider
B. Continue current rate
C. Administer protamine sulfate
D. Increase rate
Answer: A. Stop infusion and call provider
Rationale: aPTT > 3 times control increases bleeding risk; stop infusion and await further
orders. Protamine (C) is reserved for life-threatening bleeding.
Question 10
Which teaching is priority for a patient starting prednisone 40 mg daily?
A. Take at bedtime to minimize insomnia
B. Stop abruptly after 5 days
C. Report black tarry stools immediately
D. Avoid all fruits
Answer: C. Report black tarry stools immediately
Rationale: Corticosteroids increase GI bleeding risk; early recognition prevents
complications. Never stop abruptly (B); taper after > 5–7 days to prevent adrenal
insufficiency.
Question 11
A patient is prescribed clopidogrel 75 mg daily. Which over-the-counter medication should
be avoided?
A. Acetaminophen
B. Aspirin
C. Calcium carbonate
D. Vitamin C
Answer: B. Aspirin
Rationale: Dual antiplatelet therapy increases bleeding risk; advise against aspirin-
containing OTC products unless prescribed.
Question 12
Which lab value best reflects adequate heparin anticoagulation during dialysis?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
Answer: B. aPTT
, Rationale: aPTT monitors unfractionated heparin; target 1.5–2.5 times baseline. PT/INR (A)
monitors warfarin; platelets (C) detect HIT.
Question 13
A patient on atorvastatin reports new-onset muscle pain and dark urine. Which lab is
priority?
A. ALT
B. Creatine kinase
C. LDH
D. Alkaline phosphatase
Answer: B. Creatine kinase
Rationale: Dark urine and muscle pain suggest rhabdomyolysis; CK > 10 times ULN requires
statin discontinuation. ALT (A) monitors hepatotoxicity.
Question 14
Which instruction is essential for a patient starting sildenafil?
A. Take with nitrates for chest pain
B. Avoid grapefruit juice
C. Take on empty stomach for faster onset
D. Double dose if ineffective
Answer: C. Take on empty stomach for faster onset
Rationale: High-fat meals delay absorption. Nitrates (A) are contraindicated due to severe
hypotension risk.
Question 15
Which medication requires a negative pregnancy test before initiation in women of
childbearing age?
A. Lisinopril
B. Isotretinoin
C. Metformin
D. Sertraline
Answer: B. Isotretinoin
Rationale: Isotretinoin is highly teratogenic; iPLEDGE program mandates two negative
pregnancy tests before dispensing.
Question 16
A patient is prescribed spironolactone 25 mg BID. Which finding requires immediate
intervention?
A. Serum potassium 5.8 mEq/L
B. Blood pressure 130/80 mmHg
C. Heart rate 76 bpm
D. Mild gynecomastia
Answer: A. Serum potassium 5.8 mEq/L
Rationale: Spironolactone is potassium-sparing; levels > 5.5 mEq/L increase arrhythmia
risk. Hold dose and notify provider.
Question 17
Which route is preferred for naloxone in an outpatient opioid overdose?
A. IV
B. IM
