1
RN ATI Pharmacology Proctored Exam 2025 (V1 & V2)
160 Verified Questions and Answers with NGN-Style Rationales
1.
A 68-year-old patient with a history of chronic heart failure is admitted to the medical unit with
shortness of breath and lower extremity edema. The provider prescribes digoxin 0.125 mg
PO daily. The patient’s apical heart rate is 56 bpm, blood pressure is 110/72 mmHg, and
potassium level is 3.7 mEq/L.
C
Which of the following actions should the nurse take before administering the medication?
A. Hold the dose and notify the provider
B. Administer the dose as prescribed
LE
C. Check the patient’s blood glucose level
ST
D. Provide supplemental potassium
Answer: A. Hold the dose and notify the provider
BE
Rationale: Digoxin slows cardiac conduction and increases myocardial contractility.
Bradycardia (<60 bpm in adults) is a sign of potential digoxin toxicity and requires the nurse
to withhold the medication and notify the provider. Checking blood glucose or providing
potassium is not indicated unless abnormalities are present, and potassium 3.7 mEq/L is within
the normal range.
2.
, 2
A 55-year-old patient is newly prescribed warfarin after a diagnosis of deep vein thrombosis
(DVT). During discharge teaching, the patient states, “I eat spinach and kale salads almost
every day.”
Which lab value is most important to monitor to ensure safe anticoagulation?
A. Hemoglobin A1C
B. Sodium (Na⁺)
C. International Normalized Ratio (INR)
D. Potassium (K⁺)
Answer: C. International Normalized Ratio (INR)
C
Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors. Leafy green
LE
vegetables like spinach are high in vitamin K, which can reduce warfarin’s effectiveness and
lower INR, increasing the risk of clot formation. Monitoring INR ensures the patient remains in
ST
the therapeutic range (2–3 for DVT).
BE
3.
A 72-year-old patient with congestive heart failure is receiving furosemide 40 mg IV push for
fluid overload. Morning labs reveal:
Potassium: 2.9 mEq/L
Sodium: 139 mEq/L
Blood Pressure: 134/82 mmHg
, 3
Which finding requires immediate intervention?
A. Potassium 2.9 mEq/L
B. Sodium 139 mEq/L
C. Blood pressure 134/82 mmHg
D. Mild thirst
Answer: A. Potassium 2.9 mEq/L
Rationale: Furosemide, a loop diuretic, can cause significant potassium loss. A potassium
level of 2.9 mEq/L is critically low and can lead to life-threatening arrhythmias. This is the
priority over mild changes in blood pressure or sodium because cardiac stability is at risk.
C
4.
LE
ST
A 63-year-old patient is prescribed gentamicin for a severe urinary tract infection. After three
days of therapy, the patient reports decreased urine output and ringing in the ears (tinnitus).
BE
Which complication should the nurse suspect?
A. Hepatotoxicity
B. Nephrotoxicity
C. Constipation
D. Bradycardia
Answer: B. Nephrotoxicity
Rationale: Aminoglycosides like gentamicin can accumulate in the kidneys and inner ear,
causing nephrotoxicity and ototoxicity. Decreased urine output and tinnitus indicate toxicity,
, 4
and the nurse should notify the provider immediately and monitor BUN, creatinine, and urine
output.
5.
A 60-year-old patient receiving vancomycin 1 g IV develops sudden flushing of the face, neck,
and upper chest 10 minutes into the infusion.
Which nursing action is most appropriate?
A. Stop the medication permanently
C
B. Slow the infusion rate
LE
C. Administer diphenhydramine and continue at the same rate
D. Notify the healthcare provider for a new order
ST
Answer: B. Slow the infusion rate
Rationale: This patient is experiencing Red Man Syndrome, a histamine reaction caused by
BE
rapid vancomycin infusion. Slowing the infusion typically resolves symptoms. It is not an
allergic reaction, so the medication is not permanently discontinued unless the patient develops
severe hypotension or angioedema.
6.
A patient is starting phenytoin for seizure control. The nurse provides medication teaching.
Which patient statement indicates correct understanding?
A. “I will stop taking this medication if I feel drowsy.”
RN ATI Pharmacology Proctored Exam 2025 (V1 & V2)
160 Verified Questions and Answers with NGN-Style Rationales
1.
A 68-year-old patient with a history of chronic heart failure is admitted to the medical unit with
shortness of breath and lower extremity edema. The provider prescribes digoxin 0.125 mg
PO daily. The patient’s apical heart rate is 56 bpm, blood pressure is 110/72 mmHg, and
potassium level is 3.7 mEq/L.
C
Which of the following actions should the nurse take before administering the medication?
A. Hold the dose and notify the provider
B. Administer the dose as prescribed
LE
C. Check the patient’s blood glucose level
ST
D. Provide supplemental potassium
Answer: A. Hold the dose and notify the provider
BE
Rationale: Digoxin slows cardiac conduction and increases myocardial contractility.
Bradycardia (<60 bpm in adults) is a sign of potential digoxin toxicity and requires the nurse
to withhold the medication and notify the provider. Checking blood glucose or providing
potassium is not indicated unless abnormalities are present, and potassium 3.7 mEq/L is within
the normal range.
2.
, 2
A 55-year-old patient is newly prescribed warfarin after a diagnosis of deep vein thrombosis
(DVT). During discharge teaching, the patient states, “I eat spinach and kale salads almost
every day.”
Which lab value is most important to monitor to ensure safe anticoagulation?
A. Hemoglobin A1C
B. Sodium (Na⁺)
C. International Normalized Ratio (INR)
D. Potassium (K⁺)
Answer: C. International Normalized Ratio (INR)
C
Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors. Leafy green
LE
vegetables like spinach are high in vitamin K, which can reduce warfarin’s effectiveness and
lower INR, increasing the risk of clot formation. Monitoring INR ensures the patient remains in
ST
the therapeutic range (2–3 for DVT).
BE
3.
A 72-year-old patient with congestive heart failure is receiving furosemide 40 mg IV push for
fluid overload. Morning labs reveal:
Potassium: 2.9 mEq/L
Sodium: 139 mEq/L
Blood Pressure: 134/82 mmHg
, 3
Which finding requires immediate intervention?
A. Potassium 2.9 mEq/L
B. Sodium 139 mEq/L
C. Blood pressure 134/82 mmHg
D. Mild thirst
Answer: A. Potassium 2.9 mEq/L
Rationale: Furosemide, a loop diuretic, can cause significant potassium loss. A potassium
level of 2.9 mEq/L is critically low and can lead to life-threatening arrhythmias. This is the
priority over mild changes in blood pressure or sodium because cardiac stability is at risk.
C
4.
LE
ST
A 63-year-old patient is prescribed gentamicin for a severe urinary tract infection. After three
days of therapy, the patient reports decreased urine output and ringing in the ears (tinnitus).
BE
Which complication should the nurse suspect?
A. Hepatotoxicity
B. Nephrotoxicity
C. Constipation
D. Bradycardia
Answer: B. Nephrotoxicity
Rationale: Aminoglycosides like gentamicin can accumulate in the kidneys and inner ear,
causing nephrotoxicity and ototoxicity. Decreased urine output and tinnitus indicate toxicity,
, 4
and the nurse should notify the provider immediately and monitor BUN, creatinine, and urine
output.
5.
A 60-year-old patient receiving vancomycin 1 g IV develops sudden flushing of the face, neck,
and upper chest 10 minutes into the infusion.
Which nursing action is most appropriate?
A. Stop the medication permanently
C
B. Slow the infusion rate
LE
C. Administer diphenhydramine and continue at the same rate
D. Notify the healthcare provider for a new order
ST
Answer: B. Slow the infusion rate
Rationale: This patient is experiencing Red Man Syndrome, a histamine reaction caused by
BE
rapid vancomycin infusion. Slowing the infusion typically resolves symptoms. It is not an
allergic reaction, so the medication is not permanently discontinued unless the patient develops
severe hypotension or angioedema.
6.
A patient is starting phenytoin for seizure control. The nurse provides medication teaching.
Which patient statement indicates correct understanding?
A. “I will stop taking this medication if I feel drowsy.”
