ATI Pharmacology Proctored exam
2025/2026 questions and
answers(LATEST 2025 /2026UPDATE)
1. A nurse is preparing to administer digoxin to a client with heart failure. Which
finding requires the nurse to withhold the medication and notify the provider?
A) Apical pulse 58/min
B) Potassium level 4.0 mEq/L
C) Blood pressure 118/76 mm Hg
D) Respiratory rate 18/min
Correct answer: A
Rationale: The apical pulse should be taken for 1 full minute before administering
digoxin. The medication is withheld if the pulse is <60/min in an adult (or <70 in an
infant/child) due to the risk of bradycardia and digoxin toxicity. Potassium of 4.0 is
normal.
2. A client receiving warfarin has an INR of 4.5. Which action should the nurse take
first?
A) Administer vitamin K
B) Hold the next dose of warfarin
C) Assess for signs of bleeding
D) Notify the provider
Correct answer: C
Rationale: Therapeutic INR for most conditions is 2.0-3.0. An INR of 4.5 increases
bleeding risk. The first action is to assess the client for overt or occult bleeding (e.g.,
bruising, hematuria, black stools). Then hold the dose, notify the provider, and prepare
vitamin K if ordered.
,3. A nurse provides teaching for a client starting sertraline for depression. Which
statement by the client indicates understanding?
A) "I will feel better within 24 hours."
B) "I can stop taking it once my mood improves."
C) "I should avoid taking St. John's wort with this medication."
D) "I will take it in the morning on an empty stomach."
Correct answer: C
Rationale: Sertraline (SSRI) plus St. John's wort increases risk of serotonin syndrome
(agitation, confusion, fever, tremors). SSRIs take 4-6 weeks for full effect, should not be
stopped abruptly, and can be taken with food to reduce GI upset.
4. A client with type 2 diabetes reports weight loss and fruity breath. Their
metformin is due. What should the nurse do?
A) Administer metformin as ordered
B) Hold metformin and check blood glucose
C) Give metformin with a snack
D) Increase the metformin dose
Correct answer: B
Rationale: Fruity breath suggests diabetic ketoacidosis (DKA). Metformin is
contraindicated during acute metabolic acidosis. The nurse should hold the dose, check
blood glucose, and assess for hyperglycemia and ketones.
5. A nurse administers enoxaparin subcutaneously. Which technique is correct?
, A) Expel the air bubble before injection
B) Massage the site after injection
C) Insert the needle at a 90-degree angle into an abdominal fold
D) Aspirate before depressing the plunger
Correct answer: C
Rationale: Enoxaparin (low molecular weight heparin) is given subcutaneously into the
abdomen at 90 degrees (if using a 5/8" needle). The air bubble should not be expelled
(it ensures full dose delivery). Do not massage (risk of bruising). Aspiration is not
required.
6. A client takes phenelzine (MAOI). Which food choice indicates a need fo r further
teaching?
A) Fresh apple slices
B) Broiled chicken breast
C) Aged cheddar cheese
D) White rice
Correct answer: C
Rationale: MAOIs require a low-tyramine diet to prevent hypertensive crisis. Aged
cheese (cheddar, blue, Swiss) is high in tyramine. Safe foods: fresh fruits/vegetables,
fresh meats, rice.
7. A nurse receives an order for IV vancomycin. Which finding requires immediate
action?
A) Infusion rate of 10 mg/min
B) Red rash on the upper torso and neck
, C) Serum creatinine 0.9 mg/dL
D) Complaints of mild headache
Correct answer: B
Rationale: A red rash on the upper torso/neck (“Red Man Syndrome”) is a histamine
reaction caused by too-rapid infusion. The nurse should slow the infusion rate (over at
least 60 minutes). Creatinine of 0.9 is normal.
8. A client on spironolactone (potassium-sparing diuretic) has a potassium level of
5.8 mEq/L. Which intervention is priority?
A) Encourage potassium-rich foods
B) Administer furosemide as ordered
C) Hold the spironolactone
D) Give oral potassium supplement
Correct answer: C
Rationale: Normal potassium 3.5-5.0. 5.8 is hyperkalemia. Spironolactone should be
held immediately. Furosemide (loop diuretic) may be given to excrete potassium, but
holding the offending drug is first. Potassium foods/supplements are dangerous.
9. A nurse teaches a client about nitroglycerin sublingual tablets. Which statement
is correct?
A) "Take one tablet every 15 minutes for up to 3 doses."
B) "Swallow the tablet with a full glass of water."
C) "Store the bottle in the refrigerator."
D) "Expect a mild burning sensation under the tongue."
2025/2026 questions and
answers(LATEST 2025 /2026UPDATE)
1. A nurse is preparing to administer digoxin to a client with heart failure. Which
finding requires the nurse to withhold the medication and notify the provider?
A) Apical pulse 58/min
B) Potassium level 4.0 mEq/L
C) Blood pressure 118/76 mm Hg
D) Respiratory rate 18/min
Correct answer: A
Rationale: The apical pulse should be taken for 1 full minute before administering
digoxin. The medication is withheld if the pulse is <60/min in an adult (or <70 in an
infant/child) due to the risk of bradycardia and digoxin toxicity. Potassium of 4.0 is
normal.
2. A client receiving warfarin has an INR of 4.5. Which action should the nurse take
first?
A) Administer vitamin K
B) Hold the next dose of warfarin
C) Assess for signs of bleeding
D) Notify the provider
Correct answer: C
Rationale: Therapeutic INR for most conditions is 2.0-3.0. An INR of 4.5 increases
bleeding risk. The first action is to assess the client for overt or occult bleeding (e.g.,
bruising, hematuria, black stools). Then hold the dose, notify the provider, and prepare
vitamin K if ordered.
,3. A nurse provides teaching for a client starting sertraline for depression. Which
statement by the client indicates understanding?
A) "I will feel better within 24 hours."
B) "I can stop taking it once my mood improves."
C) "I should avoid taking St. John's wort with this medication."
D) "I will take it in the morning on an empty stomach."
Correct answer: C
Rationale: Sertraline (SSRI) plus St. John's wort increases risk of serotonin syndrome
(agitation, confusion, fever, tremors). SSRIs take 4-6 weeks for full effect, should not be
stopped abruptly, and can be taken with food to reduce GI upset.
4. A client with type 2 diabetes reports weight loss and fruity breath. Their
metformin is due. What should the nurse do?
A) Administer metformin as ordered
B) Hold metformin and check blood glucose
C) Give metformin with a snack
D) Increase the metformin dose
Correct answer: B
Rationale: Fruity breath suggests diabetic ketoacidosis (DKA). Metformin is
contraindicated during acute metabolic acidosis. The nurse should hold the dose, check
blood glucose, and assess for hyperglycemia and ketones.
5. A nurse administers enoxaparin subcutaneously. Which technique is correct?
, A) Expel the air bubble before injection
B) Massage the site after injection
C) Insert the needle at a 90-degree angle into an abdominal fold
D) Aspirate before depressing the plunger
Correct answer: C
Rationale: Enoxaparin (low molecular weight heparin) is given subcutaneously into the
abdomen at 90 degrees (if using a 5/8" needle). The air bubble should not be expelled
(it ensures full dose delivery). Do not massage (risk of bruising). Aspiration is not
required.
6. A client takes phenelzine (MAOI). Which food choice indicates a need fo r further
teaching?
A) Fresh apple slices
B) Broiled chicken breast
C) Aged cheddar cheese
D) White rice
Correct answer: C
Rationale: MAOIs require a low-tyramine diet to prevent hypertensive crisis. Aged
cheese (cheddar, blue, Swiss) is high in tyramine. Safe foods: fresh fruits/vegetables,
fresh meats, rice.
7. A nurse receives an order for IV vancomycin. Which finding requires immediate
action?
A) Infusion rate of 10 mg/min
B) Red rash on the upper torso and neck
, C) Serum creatinine 0.9 mg/dL
D) Complaints of mild headache
Correct answer: B
Rationale: A red rash on the upper torso/neck (“Red Man Syndrome”) is a histamine
reaction caused by too-rapid infusion. The nurse should slow the infusion rate (over at
least 60 minutes). Creatinine of 0.9 is normal.
8. A client on spironolactone (potassium-sparing diuretic) has a potassium level of
5.8 mEq/L. Which intervention is priority?
A) Encourage potassium-rich foods
B) Administer furosemide as ordered
C) Hold the spironolactone
D) Give oral potassium supplement
Correct answer: C
Rationale: Normal potassium 3.5-5.0. 5.8 is hyperkalemia. Spironolactone should be
held immediately. Furosemide (loop diuretic) may be given to excrete potassium, but
holding the offending drug is first. Potassium foods/supplements are dangerous.
9. A nurse teaches a client about nitroglycerin sublingual tablets. Which statement
is correct?
A) "Take one tablet every 15 minutes for up to 3 doses."
B) "Swallow the tablet with a full glass of water."
C) "Store the bottle in the refrigerator."
D) "Expect a mild burning sensation under the tongue."
