Solutions manual for ATI Pharm CMS Comprehensive Exam 2026
(2025_2026)
1. A patient is prescribed furosemide for heart failure. Which electrolyte imbalance should the
nurse monitor for?
Answer: Hypokalemia
Rationale: Furosemide is a loop diuretic that increases potassium excretion in urine, risking
hypokalemia.
2. A patient taking lisinopril reports a persistent dry cough. What is the best nursing action?
Answer: Notify the provider; consider switching to an ARB.
Rationale: ACE inhibitors like lisinopril can cause a persistent cough due to bradykinin
accumulation.
3. A patient is prescribed warfarin. Which lab test should the nurse monitor?
Answer: INR (International Normalized Ratio)
Rationale: INR measures the effectiveness of warfarin in preventing clot formation.
4. Metformin is prescribed for type 2 diabetes. Which is a key contraindication?
Answer: Renal impairment
Rationale: Metformin can accumulate in patients with kidney dysfunction, increasing the risk of
lactic acidosis.
5. A patient taking digoxin has nausea, vomiting, and vision changes. What is the likely cause?
Answer: Digoxin toxicity
Rationale: Digoxin has a narrow therapeutic window; GI and visual symptoms are early signs
of toxicity.
6. Which medication is used to reverse heparin anticoagulation?
Answer: Protamine sulfate
Rationale: Protamine binds heparin and neutralizes its anticoagulant effect.
7. A patient taking albuterol reports tremors and palpitations. What is the likely cause?
Answer: Beta-2 agonist side effects
Rationale: Albuterol stimulates beta-2 receptors, causing tremors and tachycardia.
8. Atorvastatin is prescribed. Which lab should be monitored regularly?
Answer: Liver function tests (AST/ALT)
Rationale: Statins can cause hepatotoxicity; periodic liver monitoring is recommended.
,9. Which antibiotic requires peak and trough levels monitoring?
Answer: Vancomycin
Rationale: To ensure therapeutic levels and avoid nephrotoxicity or ototoxicity.
10. Morphine is given IV. What is the priority nursing assessment?
Answer: Respiratory rate
Rationale: Opioids can cause respiratory depression, which is the most dangerous side effect.
11. A patient taking prednisone for long-term therapy should be monitored for:
Answer: Hyperglycemia
Rationale: Corticosteroids increase blood glucose levels.
12. Insulin lispro is a:
Answer: Rapid-acting insulin
Rationale: Lispro acts within 15 minutes and is used around mealtimes.
13. Which drug class is first-line for hypertension in African American adults without CKD or
diabetes?
Answer: Thiazide diuretics or calcium channel blockers
Rationale: Evidence shows better efficacy in this population.
14. A patient on clopidogrel reports unusual bruising. What is the concern?
Answer: Increased bleeding risk
Rationale: Clopidogrel inhibits platelet aggregation, increasing bleeding tendency.
15. Omeprazole is prescribed for GERD. How does it work?
Answer: Proton pump inhibitor; reduces gastric acid secretion
Rationale: PPIs block the H+/K+ ATPase enzyme in gastric parietal cells.
16. Levofloxacin is contraindicated in patients with:
Answer: Tendon disorders
Rationale: Fluoroquinolones increase the risk of tendonitis and tendon rupture.
17. A patient taking lithium should avoid:
Answer: Excessive sodium restriction
Rationale: Sodium levels affect lithium excretion; low sodium can cause toxicity.
18. Atenolol is prescribed. What is a major contraindication?
Answer: Asthma
Rationale: Beta-blockers can cause bronchoconstriction in patients with reactive airway
disease.
19. Ceftriaxone is administered IM. What is an important nursing consideration?
Answer: Rotate injection sites
Rationale: IM injections can cause local tissue irritation; rotating sites reduces discomfort.
, 20. Dextromethorphan is used for:
Answer: Cough suppression
Rationale: It acts on the CNS to suppress the cough reflex.
21. A patient on spironolactone should be monitored for:
Answer: Hyperkalemia
Rationale: Spironolactone is a potassium-sparing diuretic.
22. Which medication is an antidote for acetaminophen overdose?
Answer: N-acetylcysteine
Rationale: NAC replenishes glutathione to prevent liver damage.
23. Ciprofloxacin teaching should include:
Answer: Avoid sun exposure
Rationale: Fluoroquinolones can cause photosensitivity.
24. A patient taking phenytoin reports gum swelling. What is the likely cause?
Answer: Gingival hyperplasia
Rationale: Phenytoin can cause overgrowth of gum tissue with long-term use.
25. Hydrochlorothiazide may cause:
Answer: Hypokalemia
Rationale: Thiazide diuretics increase urinary potassium excretion.
26. Amiodarone is prescribed for atrial fibrillation. What should be monitored?
Answer: Thyroid and liver function
Rationale: Amiodarone can cause hypo/hyperthyroidism and hepatotoxicity.
27. A patient taking tetracycline should avoid:
Answer: Dairy products
Rationale: Calcium binds tetracycline, reducing absorption.
28. Enalapril is an ACE inhibitor. What is a serious adverse effect?
Answer: Angioedema
Rationale: ACE inhibitors can cause rapid swelling of face, lips, or tongue.
29. Metoprolol is prescribed. What is a key nursing assessment before administration?
Answer: Heart rate
Rationale: Beta-blockers can cause bradycardia.
30. Ranitidine (H2 blocker) decreases:
Answer: Gastric acid secretion
Rationale: H2 receptor antagonists reduce acid production in the stomach.
(2025_2026)
1. A patient is prescribed furosemide for heart failure. Which electrolyte imbalance should the
nurse monitor for?
Answer: Hypokalemia
Rationale: Furosemide is a loop diuretic that increases potassium excretion in urine, risking
hypokalemia.
2. A patient taking lisinopril reports a persistent dry cough. What is the best nursing action?
Answer: Notify the provider; consider switching to an ARB.
Rationale: ACE inhibitors like lisinopril can cause a persistent cough due to bradykinin
accumulation.
3. A patient is prescribed warfarin. Which lab test should the nurse monitor?
Answer: INR (International Normalized Ratio)
Rationale: INR measures the effectiveness of warfarin in preventing clot formation.
4. Metformin is prescribed for type 2 diabetes. Which is a key contraindication?
Answer: Renal impairment
Rationale: Metformin can accumulate in patients with kidney dysfunction, increasing the risk of
lactic acidosis.
5. A patient taking digoxin has nausea, vomiting, and vision changes. What is the likely cause?
Answer: Digoxin toxicity
Rationale: Digoxin has a narrow therapeutic window; GI and visual symptoms are early signs
of toxicity.
6. Which medication is used to reverse heparin anticoagulation?
Answer: Protamine sulfate
Rationale: Protamine binds heparin and neutralizes its anticoagulant effect.
7. A patient taking albuterol reports tremors and palpitations. What is the likely cause?
Answer: Beta-2 agonist side effects
Rationale: Albuterol stimulates beta-2 receptors, causing tremors and tachycardia.
8. Atorvastatin is prescribed. Which lab should be monitored regularly?
Answer: Liver function tests (AST/ALT)
Rationale: Statins can cause hepatotoxicity; periodic liver monitoring is recommended.
,9. Which antibiotic requires peak and trough levels monitoring?
Answer: Vancomycin
Rationale: To ensure therapeutic levels and avoid nephrotoxicity or ototoxicity.
10. Morphine is given IV. What is the priority nursing assessment?
Answer: Respiratory rate
Rationale: Opioids can cause respiratory depression, which is the most dangerous side effect.
11. A patient taking prednisone for long-term therapy should be monitored for:
Answer: Hyperglycemia
Rationale: Corticosteroids increase blood glucose levels.
12. Insulin lispro is a:
Answer: Rapid-acting insulin
Rationale: Lispro acts within 15 minutes and is used around mealtimes.
13. Which drug class is first-line for hypertension in African American adults without CKD or
diabetes?
Answer: Thiazide diuretics or calcium channel blockers
Rationale: Evidence shows better efficacy in this population.
14. A patient on clopidogrel reports unusual bruising. What is the concern?
Answer: Increased bleeding risk
Rationale: Clopidogrel inhibits platelet aggregation, increasing bleeding tendency.
15. Omeprazole is prescribed for GERD. How does it work?
Answer: Proton pump inhibitor; reduces gastric acid secretion
Rationale: PPIs block the H+/K+ ATPase enzyme in gastric parietal cells.
16. Levofloxacin is contraindicated in patients with:
Answer: Tendon disorders
Rationale: Fluoroquinolones increase the risk of tendonitis and tendon rupture.
17. A patient taking lithium should avoid:
Answer: Excessive sodium restriction
Rationale: Sodium levels affect lithium excretion; low sodium can cause toxicity.
18. Atenolol is prescribed. What is a major contraindication?
Answer: Asthma
Rationale: Beta-blockers can cause bronchoconstriction in patients with reactive airway
disease.
19. Ceftriaxone is administered IM. What is an important nursing consideration?
Answer: Rotate injection sites
Rationale: IM injections can cause local tissue irritation; rotating sites reduces discomfort.
, 20. Dextromethorphan is used for:
Answer: Cough suppression
Rationale: It acts on the CNS to suppress the cough reflex.
21. A patient on spironolactone should be monitored for:
Answer: Hyperkalemia
Rationale: Spironolactone is a potassium-sparing diuretic.
22. Which medication is an antidote for acetaminophen overdose?
Answer: N-acetylcysteine
Rationale: NAC replenishes glutathione to prevent liver damage.
23. Ciprofloxacin teaching should include:
Answer: Avoid sun exposure
Rationale: Fluoroquinolones can cause photosensitivity.
24. A patient taking phenytoin reports gum swelling. What is the likely cause?
Answer: Gingival hyperplasia
Rationale: Phenytoin can cause overgrowth of gum tissue with long-term use.
25. Hydrochlorothiazide may cause:
Answer: Hypokalemia
Rationale: Thiazide diuretics increase urinary potassium excretion.
26. Amiodarone is prescribed for atrial fibrillation. What should be monitored?
Answer: Thyroid and liver function
Rationale: Amiodarone can cause hypo/hyperthyroidism and hepatotoxicity.
27. A patient taking tetracycline should avoid:
Answer: Dairy products
Rationale: Calcium binds tetracycline, reducing absorption.
28. Enalapril is an ACE inhibitor. What is a serious adverse effect?
Answer: Angioedema
Rationale: ACE inhibitors can cause rapid swelling of face, lips, or tongue.
29. Metoprolol is prescribed. What is a key nursing assessment before administration?
Answer: Heart rate
Rationale: Beta-blockers can cause bradycardia.
30. Ranitidine (H2 blocker) decreases:
Answer: Gastric acid secretion
Rationale: H2 receptor antagonists reduce acid production in the stomach.
