ATI Pharmacology CMS Practice Exam – Form B
(2026/2027) | NCLEX-RN Predictor | 50 Questions
with Mastery-Focused Rationales
CATEGORY 1 – Safety & Administration (18 Qs)
Q1. A nurse is preparing to administer regular insulin 5 units and NPH insulin 20 units
subcutaneously at 0730. Which action should the nurse take first?
A. Draw up the 20 units of NPH insulin into the syringe.
B. Check the client’s current blood glucose level.
C. Inject 20 units of air into the NPH insulin vial.
D. Verify the insulin doses with another nurse.
ATI Mastery Rationale
Correct Answer: B
Nursing Principle: Safe Insulin Administration – Assessment Priority for High-Alert
Medications
Step-by-Step Analysis:
● Key Cue: Scheduled insulin (high-alert) dose about to be given.
● Primary Concern: Risk of hypoglycemia if blood glucose (BG) is already low.
, ● Why B is Correct: Current BG must be known before drawing up or verifying
doses; it determines whether the dose is safe, should be held, or needs
adjustment.
Why the Others are Incorrect:
● A & C: Preparation steps, but assessment always precedes action.
● D: Double-check is mandatory after assessment and before administration, not
first.
NCLEX Tip: When an assessment action (vital sign, lab value) is listed alongside
preparation or verification steps, choose assessment first—the nursing process
demands data before intervention.
Q2. A pediatric client weighs 22 kg. The order reads: cefazolin 500 mg IV q8h. The
therapeutic dosage range is 25–50 mg/kg/day. What is the maximum safe daily dose
for this child?
A. 550 mg
B. 1,100 mg
C. 1,200 mg
D. 1,500 mg
Correct Answer: B
Nursing Principle: Pediatric Dosage Calculation – Maximum Therapeutic Limit
Analysis:
● Key Cue: Need maximum safe daily dose, not per-dose.
● Math: 22 kg × 50 mg/kg/day = 1,100 mg/day.
● Why B is Correct: Matches the upper limit of the safe range.
,Distractor Breakdown:
● A: Uses 25 mg/kg (minimum), not maximum.
● C & D: Exceed safe upper limit.
NCLEX Tip: Always read whether the question asks for per day, per dose, or per kg;
misreading the time frame is a classic ATI trap.
Q3. A nurse is mixing NPH and regular insulin in the same syringe. Which sequence is
correct?
A. Air into NPH → air into regular → draw up regular → draw up NPH
B. Air into regular → air into NPH → draw up NPH → draw up regular
C. Draw up NPH first to avoid contamination
D. Draw up regular first, then add NPH
Correct Answer: A
Nursing Principle: Insulin Mixing Sequence – “Clear Before Cloudy” to Prevent
Contamination
Analysis:
● Key Cue: Mixing two insulin types in one syringe.
● Primary Concern: Prevent cloudy (NPH) from entering clear (regular) vial.
● Why A is Correct:
1. Air into NPH first (pressurizes).
2. Air into regular (prevents vacuum).
3. Draw regular (clear) first.
4. Draw NPH (cloudy) last.
Why Others are Incorrect:
, ● B: Inserts air into regular first → risk of NPH contamination when inserting
needle.
● C: Drawing NPH first contaminates needle with cloudy insulin before entering
regular vial.
● D: Correct order but omits air-injection steps, risking vial collapse or inaccurate
withdrawal.
NCLEX Tip: Memorize the mnemonic: “Air into Cloudy, Air into Clear, Draw Clear, Draw
Cloudy” to guarantee contamination-free mixing.
Q4. A nurse is preparing to give morphine 2 mg IV q2h PRN for pain. The vial contains
morphine 10 mg/mL. How many mL should the nurse administer?
A. 0.2 mL
B. 0.4 mL
C. 0.8 mL
D. 1.0 mL
Correct Answer: A
Nursing Principle: High-Alert Medication Dosage Calculation – IV Opioids
Analysis:
● Key Cue: Concentrated opioid; small volume.
● Math: 2 mg ÷ 10 mg/mL = 0.2 mL.
● Why A is Correct: Accurate dose; always double-check small volumes.
Distractor Breakdown:
● B–D: Decimal errors; 10× or 5× overdose.
(2026/2027) | NCLEX-RN Predictor | 50 Questions
with Mastery-Focused Rationales
CATEGORY 1 – Safety & Administration (18 Qs)
Q1. A nurse is preparing to administer regular insulin 5 units and NPH insulin 20 units
subcutaneously at 0730. Which action should the nurse take first?
A. Draw up the 20 units of NPH insulin into the syringe.
B. Check the client’s current blood glucose level.
C. Inject 20 units of air into the NPH insulin vial.
D. Verify the insulin doses with another nurse.
ATI Mastery Rationale
Correct Answer: B
Nursing Principle: Safe Insulin Administration – Assessment Priority for High-Alert
Medications
Step-by-Step Analysis:
● Key Cue: Scheduled insulin (high-alert) dose about to be given.
● Primary Concern: Risk of hypoglycemia if blood glucose (BG) is already low.
, ● Why B is Correct: Current BG must be known before drawing up or verifying
doses; it determines whether the dose is safe, should be held, or needs
adjustment.
Why the Others are Incorrect:
● A & C: Preparation steps, but assessment always precedes action.
● D: Double-check is mandatory after assessment and before administration, not
first.
NCLEX Tip: When an assessment action (vital sign, lab value) is listed alongside
preparation or verification steps, choose assessment first—the nursing process
demands data before intervention.
Q2. A pediatric client weighs 22 kg. The order reads: cefazolin 500 mg IV q8h. The
therapeutic dosage range is 25–50 mg/kg/day. What is the maximum safe daily dose
for this child?
A. 550 mg
B. 1,100 mg
C. 1,200 mg
D. 1,500 mg
Correct Answer: B
Nursing Principle: Pediatric Dosage Calculation – Maximum Therapeutic Limit
Analysis:
● Key Cue: Need maximum safe daily dose, not per-dose.
● Math: 22 kg × 50 mg/kg/day = 1,100 mg/day.
● Why B is Correct: Matches the upper limit of the safe range.
,Distractor Breakdown:
● A: Uses 25 mg/kg (minimum), not maximum.
● C & D: Exceed safe upper limit.
NCLEX Tip: Always read whether the question asks for per day, per dose, or per kg;
misreading the time frame is a classic ATI trap.
Q3. A nurse is mixing NPH and regular insulin in the same syringe. Which sequence is
correct?
A. Air into NPH → air into regular → draw up regular → draw up NPH
B. Air into regular → air into NPH → draw up NPH → draw up regular
C. Draw up NPH first to avoid contamination
D. Draw up regular first, then add NPH
Correct Answer: A
Nursing Principle: Insulin Mixing Sequence – “Clear Before Cloudy” to Prevent
Contamination
Analysis:
● Key Cue: Mixing two insulin types in one syringe.
● Primary Concern: Prevent cloudy (NPH) from entering clear (regular) vial.
● Why A is Correct:
1. Air into NPH first (pressurizes).
2. Air into regular (prevents vacuum).
3. Draw regular (clear) first.
4. Draw NPH (cloudy) last.
Why Others are Incorrect:
, ● B: Inserts air into regular first → risk of NPH contamination when inserting
needle.
● C: Drawing NPH first contaminates needle with cloudy insulin before entering
regular vial.
● D: Correct order but omits air-injection steps, risking vial collapse or inaccurate
withdrawal.
NCLEX Tip: Memorize the mnemonic: “Air into Cloudy, Air into Clear, Draw Clear, Draw
Cloudy” to guarantee contamination-free mixing.
Q4. A nurse is preparing to give morphine 2 mg IV q2h PRN for pain. The vial contains
morphine 10 mg/mL. How many mL should the nurse administer?
A. 0.2 mL
B. 0.4 mL
C. 0.8 mL
D. 1.0 mL
Correct Answer: A
Nursing Principle: High-Alert Medication Dosage Calculation – IV Opioids
Analysis:
● Key Cue: Concentrated opioid; small volume.
● Math: 2 mg ÷ 10 mg/mL = 0.2 mL.
● Why A is Correct: Accurate dose; always double-check small volumes.
Distractor Breakdown:
● B–D: Decimal errors; 10× or 5× overdose.
