ATI PN Pharmacology Level 3
Proctored Exam 2023 with NGN All
120 Questions With Answers
EXAM
Question 1
A client with heart failure is prescribed digoxin. Which finding
requires immediate action?
A) Apical pulse 58 bpm
B) Serum potassium 3.2 mEq/L
C) Nausea and vomiting
D) Vision changes (yellow halos)
Answer: D
Rationale: Yellow or green halos around lights are classic signs of
digoxin toxicity, which can be life-threatening and requires
immediate intervention. Hypokalemia (B) predisposes to toxicity
but the symptom is the direct danger. Nausea (C) can also occur
with toxicity but visual changes are more specific. A pulse of 58
(A) is below 60 but may be therapeutic; hold dose and notify
provider but not as emergent as visual changes.
Question 2
A client is taking warfarin. Which INR result indicates therapeutic
range for atrial fibrillation?
,A) 1.0
B) 1.5
C) 2.5
D) 4.0
Answer: C
Rationale: For atrial fibrillation and most non-mechanical valve
indications, target INR is 2.0–3.0. 2.5 is within range. 1.0 is normal
(no effect), 1.5 is subtherapeutic, 4.0 increases bleeding risk.
Question 3 (NGN-style)
A nurse reviews a client's morning labs: lithium level = 1.8 mEq/L
(normal 0.6-1.2). The client reports nausea, hand tremor, and mild
confusion.
Which action should the nurse take first?
A) Administer a PRN antiemetic
B) Hold the next dose of lithium and notify provider
C) Give the usual morning lithium dose
D) Increase fluid intake to 3 L/day
Answer: B
Rationale: Lithium level >1.5 mEq/L with symptoms (nausea,
tremor, confusion) indicates toxicity. The first action is to hold the
medication and notify the provider. Antiemetic (A) treats a
symptom but not the cause. Giving more lithium (C) would
worsen toxicity. Increasing fluids (D) is helpful in mild toxicity but
not the priority when neurologic symptoms appear.
,Question 4
A client on furosemide reports muscle weakness and cramping.
Which electrolyte imbalance is most likely?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B
Rationale: Loop diuretics (furosemide) cause potassium wasting,
leading to hypokalemia, which presents with muscle weakness,
cramping, fatigue, and dysrhythmias. Hyponatremia (not
hypernatremia) can occur but doesn't typically cause muscle
cramps. Hypomagnesemia can occur with loop diuretics but is less
common and cramps are more characteristic of hypokalemia.
Question 5
A client receives a dose of enoxaparin subcutaneously. Which
injection technique is correct?
A) Inject into deltoid muscle with a 90-degree angle
B) Aspirate before injection to check for blood return
C) Administer into the abdomen, pinch skin, insert needle fully, do
not aspirate
D) Rub the site vigorously after injection to distribute medication
, Answer: C
Rationale: Enoxaparin (low molecular weight heparin) is given
subcutaneously in the abdomen, pinching a skin fold, inserting
the needle fully, and not aspirating. Aspiration (B) increases
bruising risk. Rubbing (D) can cause hematoma. Deltoid muscle
(A) is for IM injections.
Question 6
A client with COPD uses albuterol and ipratropium inhalers. Which
instruction is correct about ordering?
A) Use ipratropium first, then albuterol 5 minutes later
B) Use albuterol first, then ipratropium 5 minutes later
C) Use both simultaneously in the same spacer
D) Use ipratropium once daily and albuterol as needed only
Answer: B
Rationale: Albuterol (bronchodilator) should be used first to open
airways, then ipratropium (anticholinergic) 5 minutes later
penetrates deeper. This maximizes effect. Simultaneous use (C)
reduces efficacy. Ipratropium is typically QID (not once daily).
Question 7
A client is prescribed metformin for type 2 diabetes. Which lab
finding requires immediate reporting?
A) HbA1c 7.2%
Proctored Exam 2023 with NGN All
120 Questions With Answers
EXAM
Question 1
A client with heart failure is prescribed digoxin. Which finding
requires immediate action?
A) Apical pulse 58 bpm
B) Serum potassium 3.2 mEq/L
C) Nausea and vomiting
D) Vision changes (yellow halos)
Answer: D
Rationale: Yellow or green halos around lights are classic signs of
digoxin toxicity, which can be life-threatening and requires
immediate intervention. Hypokalemia (B) predisposes to toxicity
but the symptom is the direct danger. Nausea (C) can also occur
with toxicity but visual changes are more specific. A pulse of 58
(A) is below 60 but may be therapeutic; hold dose and notify
provider but not as emergent as visual changes.
Question 2
A client is taking warfarin. Which INR result indicates therapeutic
range for atrial fibrillation?
,A) 1.0
B) 1.5
C) 2.5
D) 4.0
Answer: C
Rationale: For atrial fibrillation and most non-mechanical valve
indications, target INR is 2.0–3.0. 2.5 is within range. 1.0 is normal
(no effect), 1.5 is subtherapeutic, 4.0 increases bleeding risk.
Question 3 (NGN-style)
A nurse reviews a client's morning labs: lithium level = 1.8 mEq/L
(normal 0.6-1.2). The client reports nausea, hand tremor, and mild
confusion.
Which action should the nurse take first?
A) Administer a PRN antiemetic
B) Hold the next dose of lithium and notify provider
C) Give the usual morning lithium dose
D) Increase fluid intake to 3 L/day
Answer: B
Rationale: Lithium level >1.5 mEq/L with symptoms (nausea,
tremor, confusion) indicates toxicity. The first action is to hold the
medication and notify the provider. Antiemetic (A) treats a
symptom but not the cause. Giving more lithium (C) would
worsen toxicity. Increasing fluids (D) is helpful in mild toxicity but
not the priority when neurologic symptoms appear.
,Question 4
A client on furosemide reports muscle weakness and cramping.
Which electrolyte imbalance is most likely?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B
Rationale: Loop diuretics (furosemide) cause potassium wasting,
leading to hypokalemia, which presents with muscle weakness,
cramping, fatigue, and dysrhythmias. Hyponatremia (not
hypernatremia) can occur but doesn't typically cause muscle
cramps. Hypomagnesemia can occur with loop diuretics but is less
common and cramps are more characteristic of hypokalemia.
Question 5
A client receives a dose of enoxaparin subcutaneously. Which
injection technique is correct?
A) Inject into deltoid muscle with a 90-degree angle
B) Aspirate before injection to check for blood return
C) Administer into the abdomen, pinch skin, insert needle fully, do
not aspirate
D) Rub the site vigorously after injection to distribute medication
, Answer: C
Rationale: Enoxaparin (low molecular weight heparin) is given
subcutaneously in the abdomen, pinching a skin fold, inserting
the needle fully, and not aspirating. Aspiration (B) increases
bruising risk. Rubbing (D) can cause hematoma. Deltoid muscle
(A) is for IM injections.
Question 6
A client with COPD uses albuterol and ipratropium inhalers. Which
instruction is correct about ordering?
A) Use ipratropium first, then albuterol 5 minutes later
B) Use albuterol first, then ipratropium 5 minutes later
C) Use both simultaneously in the same spacer
D) Use ipratropium once daily and albuterol as needed only
Answer: B
Rationale: Albuterol (bronchodilator) should be used first to open
airways, then ipratropium (anticholinergic) 5 minutes later
penetrates deeper. This maximizes effect. Simultaneous use (C)
reduces efficacy. Ipratropium is typically QID (not once daily).
Question 7
A client is prescribed metformin for type 2 diabetes. Which lab
finding requires immediate reporting?
A) HbA1c 7.2%
