ATI PN Pharmacology Proctored Exam with
NGN –Questions and Correct Answers with
Rationales (2025/2026)
1. A patient receiving a continuous infusion of heparin develops epistaxis and
bruising. The nurse anticipates administration of which medication?
A. Vitamin K
B. Protamine sulfate
C. Aminocaproic acid
D. Desmopressin
Answer: B
Rationale: Protamine sulfate is the specific antagonist for heparin, binding
and neutralizing it. Vitamin K reverses warfarin, not heparin.
2. A client with myasthenia gravis is prescribed pyridostigmine. Which finding
indicates a cholinergic crisis rather than an exacerbation of the disease?
A. Muscle weakness and ptosis
B. Abdominal cramping and bradycardia
C. Dysphagia and diplopia
D. Respiratory distress and fatigue
Answer: B
Rationale: Cholinergic crisis results from excessive acetylcholine and
causes muscarinic effects (cramping, bradycardia, salivation). Myasthenic
crisis causes weakness without these signs.
3. A nurse is monitoring a patient receiving intravenous lorazepam for status
epilepticus. Which assessment finding is most concerning?
A. Drowsiness
B. Respiratory rate of 8 breaths/minute
C. Hypotension (BP 90/60 mmHg)
D. Injection site pain
Answer: B
Rationale: Lorazepam can cause severe respiratory depression; a rate of 8
requires immediate intervention (naloxone does not reverse benzodiazepines
– consider flumazenil with caution).
4. A patient with heart failure is prescribed carvedilol. The nurse understands
that this medication should be withheld if which finding is present?
, A. Heart rate of 52 beats/minute
B. Blood pressure 110/70 mmHg
C. Weight gain of 1 kg in 24 hours
D. Dyspnea on exertion
Answer: A
Rationale: Carvedilol (beta-blocker) can cause bradycardia; hold if heart
rate <60 bpm or if the patient is symptomatic. Weight gain indicates
worsening HF but does not require automatic withholding.
5. A client is started on linezolid for vancomycin-resistant Enterococcus
(VRE). Which dietary instruction is most important?
A. Avoid aged cheese, red wine, and smoked meats
B. Increase intake of leafy green vegetables
C. Limit potassium-rich foods
D. Take with a full glass of grapefruit juice
Answer: A
Rationale: Linezolid is a monoamine oxidase inhibitor (MAOI) and can
cause hypertensive crisis if combined with tyramine-rich foods (aged cheese,
cured meats, fermented products).
6. A nurse is administering digoxin to a patient with atrial fibrillation. Which
laboratory value increases the risk of digoxin toxicity?
A. Serum potassium 3.2 mEq/L
B. Serum sodium 135 mEq/L
C. Serum calcium 9.5 mg/dL
D. Serum magnesium 2.2 mEq/L
Answer: A
Rationale: Hypokalemia (K+ <3.5) potentiates digoxin binding to cardiac
Na+/K+ ATPase, greatly increasing toxicity risk.
7. A patient with a history of opioid use disorder is prescribed
buprenorphine/naloxone. The nurse explains that the naloxone component is
included primarily to:
A. Enhance analgesic effect
B. Prevent diversion by causing withdrawal if injected
C. Reduce constipation
D. Increase half-life
Answer: B
Rationale: Naloxone is poorly absorbed sublingually but if the tablet is
crushed and injected, it precipitates withdrawal, deterring abuse.
8. A client receiving warfarin has an INR of 4.5 without bleeding. The nurse
expects which intervention?
A. Administer vitamin K 2.5 mg orally
, B. Hold warfarin and give fresh frozen plasma
C. Hold warfarin and recheck INR tomorrow
D. Increase warfarin dose
Answer: C
Rationale: For asymptomatic INR 4.5-5.0, holding one or two doses of
warfarin is standard; vitamin K is reserved for higher INR or bleeding.
9. A nurse is teaching a patient about alendronate for osteoporosis. Which
instruction is essential?
A. Take with orange juice to enhance absorption
B. Remain upright for 30 minutes after taking
C. Take with food to prevent stomach upset
D. Chew the tablet for faster effect
Answer: B
Rationale: Alendronate can cause esophageal irritation; staying upright for
30 minutes with a full glass of water prevents esophagitis.
10.A patient is prescribed furosemide and digoxin. The nurse monitors for
which electrolyte imbalance that increases risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting;
hypokalemia enhances digoxin toxicity.
11.A client with tuberculosis is started on rifampin. Which finding should the
nurse explain as an expected side effect?
A. Yellowing of the skin
B. Orange-red discoloration of urine
C. Blurred vision
D. Ringing in the ears
Answer: B
Rationale: Rifampin causes harmless orange-red discoloration of body
fluids (urine, sweat, tears). Jaundice would indicate hepatotoxicity.
12.A nurse is preparing to administer intravenous potassium chloride. Which
action is correct?
A. Administer as a rapid IV push for severe hypokalemia
B. Dilute and infuse at a rate not exceeding 10 mEq/hour
C. Give undiluted through a central line only
D. Mix with lactated Ringer’s solution
Answer: B
, Rationale: IV potassium must be diluted and infused slowly (max 10-20
mEq/hour via peripheral line) to prevent cardiac arrest. Never give as IV
push.
13.A patient receiving lithium reports nausea, tremor, and polyuria. The nurse
notes a lithium level of 1.8 mEq/L. What is the priority action?
A. Administer a dose of lithium as scheduled
B. Hold lithium and notify the provider
C. Increase fluid intake to 3 L/day
D. Give sodium bicarbonate
Answer: B
Rationale: Therapeutic lithium level is 0.6-1.2 mEq/L; 1.8 indicates
toxicity. Hold the medication and notify provider.
14.A client is prescribed metformin for type 2 diabetes. Which instruction is
most important regarding prevention of lactic acidosis?
A. Take with meals to reduce GI upset
B. Hold metformin for 48 hours after iodinated contrast dye
C. Monitor for weight gain
D. Report metallic taste
Answer: B
Rationale: Contrast dye can impair renal function; metformin accumulation
increases lactic acidosis risk. Hold metformin before and for 48 hours after
contrast.
15.A nurse is administering subcutaneous enoxaparin. Which technique is
correct?
A. Aspirate before injection
B. Inject into the deltoid muscle
C. Administer deep subcutaneous in the abdomen without aspirating
D. Massage the site after injection
Answer: C
Rationale: Enoxaparin (LMWH) is given deep subcut in the abdomen; do
not aspirate or massage to avoid bruising and hematoma.
16.A patient with angina uses sublingual nitroglycerin. He develops chest pain
that is not relieved after one tablet. What should the nurse instruct?
A. Call 911 immediately after the first tablet
B. Take one more tablet after 5 minutes, up to three tablets, then call 911
C. Take a tablet every minute for 15 minutes
D. Chew two tablets for faster effect
Answer: B
Rationale: Standard protocol: one tablet, if no relief in 5 minutes, call 911
and take a second; may take a third tablet 5 minutes later.
NGN –Questions and Correct Answers with
Rationales (2025/2026)
1. A patient receiving a continuous infusion of heparin develops epistaxis and
bruising. The nurse anticipates administration of which medication?
A. Vitamin K
B. Protamine sulfate
C. Aminocaproic acid
D. Desmopressin
Answer: B
Rationale: Protamine sulfate is the specific antagonist for heparin, binding
and neutralizing it. Vitamin K reverses warfarin, not heparin.
2. A client with myasthenia gravis is prescribed pyridostigmine. Which finding
indicates a cholinergic crisis rather than an exacerbation of the disease?
A. Muscle weakness and ptosis
B. Abdominal cramping and bradycardia
C. Dysphagia and diplopia
D. Respiratory distress and fatigue
Answer: B
Rationale: Cholinergic crisis results from excessive acetylcholine and
causes muscarinic effects (cramping, bradycardia, salivation). Myasthenic
crisis causes weakness without these signs.
3. A nurse is monitoring a patient receiving intravenous lorazepam for status
epilepticus. Which assessment finding is most concerning?
A. Drowsiness
B. Respiratory rate of 8 breaths/minute
C. Hypotension (BP 90/60 mmHg)
D. Injection site pain
Answer: B
Rationale: Lorazepam can cause severe respiratory depression; a rate of 8
requires immediate intervention (naloxone does not reverse benzodiazepines
– consider flumazenil with caution).
4. A patient with heart failure is prescribed carvedilol. The nurse understands
that this medication should be withheld if which finding is present?
, A. Heart rate of 52 beats/minute
B. Blood pressure 110/70 mmHg
C. Weight gain of 1 kg in 24 hours
D. Dyspnea on exertion
Answer: A
Rationale: Carvedilol (beta-blocker) can cause bradycardia; hold if heart
rate <60 bpm or if the patient is symptomatic. Weight gain indicates
worsening HF but does not require automatic withholding.
5. A client is started on linezolid for vancomycin-resistant Enterococcus
(VRE). Which dietary instruction is most important?
A. Avoid aged cheese, red wine, and smoked meats
B. Increase intake of leafy green vegetables
C. Limit potassium-rich foods
D. Take with a full glass of grapefruit juice
Answer: A
Rationale: Linezolid is a monoamine oxidase inhibitor (MAOI) and can
cause hypertensive crisis if combined with tyramine-rich foods (aged cheese,
cured meats, fermented products).
6. A nurse is administering digoxin to a patient with atrial fibrillation. Which
laboratory value increases the risk of digoxin toxicity?
A. Serum potassium 3.2 mEq/L
B. Serum sodium 135 mEq/L
C. Serum calcium 9.5 mg/dL
D. Serum magnesium 2.2 mEq/L
Answer: A
Rationale: Hypokalemia (K+ <3.5) potentiates digoxin binding to cardiac
Na+/K+ ATPase, greatly increasing toxicity risk.
7. A patient with a history of opioid use disorder is prescribed
buprenorphine/naloxone. The nurse explains that the naloxone component is
included primarily to:
A. Enhance analgesic effect
B. Prevent diversion by causing withdrawal if injected
C. Reduce constipation
D. Increase half-life
Answer: B
Rationale: Naloxone is poorly absorbed sublingually but if the tablet is
crushed and injected, it precipitates withdrawal, deterring abuse.
8. A client receiving warfarin has an INR of 4.5 without bleeding. The nurse
expects which intervention?
A. Administer vitamin K 2.5 mg orally
, B. Hold warfarin and give fresh frozen plasma
C. Hold warfarin and recheck INR tomorrow
D. Increase warfarin dose
Answer: C
Rationale: For asymptomatic INR 4.5-5.0, holding one or two doses of
warfarin is standard; vitamin K is reserved for higher INR or bleeding.
9. A nurse is teaching a patient about alendronate for osteoporosis. Which
instruction is essential?
A. Take with orange juice to enhance absorption
B. Remain upright for 30 minutes after taking
C. Take with food to prevent stomach upset
D. Chew the tablet for faster effect
Answer: B
Rationale: Alendronate can cause esophageal irritation; staying upright for
30 minutes with a full glass of water prevents esophagitis.
10.A patient is prescribed furosemide and digoxin. The nurse monitors for
which electrolyte imbalance that increases risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting;
hypokalemia enhances digoxin toxicity.
11.A client with tuberculosis is started on rifampin. Which finding should the
nurse explain as an expected side effect?
A. Yellowing of the skin
B. Orange-red discoloration of urine
C. Blurred vision
D. Ringing in the ears
Answer: B
Rationale: Rifampin causes harmless orange-red discoloration of body
fluids (urine, sweat, tears). Jaundice would indicate hepatotoxicity.
12.A nurse is preparing to administer intravenous potassium chloride. Which
action is correct?
A. Administer as a rapid IV push for severe hypokalemia
B. Dilute and infuse at a rate not exceeding 10 mEq/hour
C. Give undiluted through a central line only
D. Mix with lactated Ringer’s solution
Answer: B
, Rationale: IV potassium must be diluted and infused slowly (max 10-20
mEq/hour via peripheral line) to prevent cardiac arrest. Never give as IV
push.
13.A patient receiving lithium reports nausea, tremor, and polyuria. The nurse
notes a lithium level of 1.8 mEq/L. What is the priority action?
A. Administer a dose of lithium as scheduled
B. Hold lithium and notify the provider
C. Increase fluid intake to 3 L/day
D. Give sodium bicarbonate
Answer: B
Rationale: Therapeutic lithium level is 0.6-1.2 mEq/L; 1.8 indicates
toxicity. Hold the medication and notify provider.
14.A client is prescribed metformin for type 2 diabetes. Which instruction is
most important regarding prevention of lactic acidosis?
A. Take with meals to reduce GI upset
B. Hold metformin for 48 hours after iodinated contrast dye
C. Monitor for weight gain
D. Report metallic taste
Answer: B
Rationale: Contrast dye can impair renal function; metformin accumulation
increases lactic acidosis risk. Hold metformin before and for 48 hours after
contrast.
15.A nurse is administering subcutaneous enoxaparin. Which technique is
correct?
A. Aspirate before injection
B. Inject into the deltoid muscle
C. Administer deep subcutaneous in the abdomen without aspirating
D. Massage the site after injection
Answer: C
Rationale: Enoxaparin (LMWH) is given deep subcut in the abdomen; do
not aspirate or massage to avoid bruising and hematoma.
16.A patient with angina uses sublingual nitroglycerin. He develops chest pain
that is not relieved after one tablet. What should the nurse instruct?
A. Call 911 immediately after the first tablet
B. Take one more tablet after 5 minutes, up to three tablets, then call 911
C. Take a tablet every minute for 15 minutes
D. Chew two tablets for faster effect
Answer: B
Rationale: Standard protocol: one tablet, if no relief in 5 minutes, call 911
and take a second; may take a third tablet 5 minutes later.
