PN ATI Pharmacology — 190 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Pharmacology for Practical Nurses
Description This exam assesses the practical nurse's ability to apply pharmacological
principles across diverse drug classes, including safe administration, monitoring
for adverse effects, and patient education. Questions integrate pathophysiology,
drug interactions, and nursing interventions at the PN scope of practice.
Expected Grade A+
Total Questions 50
Duration 3 hours
Learning Outcomes 1. Apply pharmacokinetics and pharmacodynamics to medication administration
and monitoring.
2. Identify adverse effects, contraindications, and drug interactions for major drug
classes.
3. Prioritize nursing interventions for safe medication management across the
lifespan.
4. Interpret prescription orders and laboratory values to guide pharmacological
care.
Accreditation Compliant with ATI PN Pharmacology content outline and NCLEX-PN test plan
standards.
Page 1
,1. A client receiving intravenous heparin develops a platelet count drop from
250,000/mm³ to 90,000/mm³ over three days. Which antibody test is most likely to
be positive, and what is the priority nursing action?
A. Anti-factor Xa; administer protamine sulfate immediately.
B. Heparin-induced thrombocytopenia (HIT) antibody; discontinue all heparin products and
start a direct thrombin inhibitor.
C. Platelet factor 4 (PF4)-heparin complex antibody; give aspirin and continue heparin at a
lower dose.
D. Anti-thrombin III; switch from heparin to enoxaparin.
Answer: B. Heparin-induced thrombocytopenia (HIT) antibody; discontinue all
heparin products and start a direct thrombin inhibitor.
HIT is an immune-mediated reaction to heparin, confirmed by PF4-heparin antibody
testing. Protamine reverses heparin but does not treat HIT; discontinuing heparin and
using a direct thrombin inhibitor (e.g., argatroban) is the standard of care. Continuing
heparin or switching to LMWH can worsen thrombocytopenia and thrombosis.
2. A client prescribed lithium carbonate has a serum level of 1.8 mEq/L and presents
with coarse tremors, ataxia, and dysarthria. Which intervention should the nurse
implement first?
A. Administer sodium polystyrene sulfonate to enhance lithium excretion.
B. Hold the next dose and notify the provider; prepare for possible hemodialysis.
C. Increase oral fluid intake to 3 L per day and recheck level in 4 hours.
D. Administer intravenous calcium gluconate to counteract cardiac effects.
Answer: B. Hold the next dose and notify the provider; prepare for possible
hemodialysis.
A lithium level above 1.5 mEq/L with neurological symptoms indicates severe toxicity.
Hemodialysis may be required for levels >2.5 mEq/L or with severe symptoms. Sodium
polystyrene sulfonate is not effective; increasing fluids is insufficient in acute toxicity.
Calcium gluconate is used for hyperkalemia or calcium channel blocker overdose, not
lithium.
Page 2
,3. When administering an opioid analgesic to a client with a history of chronic
obstructive pulmonary disease (COPD), which assessment finding would indicate the
need to withhold the medication and notify the provider?
A. Respiratory rate of 14 breaths per minute with an oxygen saturation of 93%.
B. Report of nausea and dizziness upon standing.
C. Development of a generalized rash and pruritus.
D. Respiratory rate of 10 breaths per minute with shallow breathing.
Answer: D. Respiratory rate of 10 breaths per minute with shallow breathing.
Opioids depress the respiratory center; in COPD clients with already compromised
respiratory function, a rate <12/min or shallow breathing signals significant depression.
A rate of 14 with normal saturation is acceptable. Nausea/dizziness may be opioid side
effects but not life-threatening. Rash suggests allergy, which requires discontinuation
but is not the immediate priority over respiratory depression.
4. A client with type 2 diabetes is started on metformin. Which instruction is most
important for the nurse to include in the discharge teaching?
A. Take the medication with meals to reduce gastrointestinal upset.
B. Monitor blood glucose levels only if symptoms of hyperglycemia occur.
C. Discontinue the medication if a contrast dye study is scheduled.
D. Avoid alcohol consumption to prevent lactic acidosis.
Answer: C. Discontinue the medication if a contrast dye study is scheduled.
Metformin must be temporarily discontinued before procedures using iodinated
contrast due to the risk of contrast-induced nephropathy and subsequent lactic acidosis.
Taking with meals reduces GI upset but is not the most critical instruction. Blood
glucose monitoring is necessary even without symptoms. Alcohol increases lactic
acidosis risk but the contrast medium interaction is a more immediate and common
safety concern.
Page 3
, 5. A client receiving gentamicin develops tinnitus and vertigo. Which laboratory
value should the nurse monitor closely?
A. Serum creatinine and BUN.
B. Serum potassium and magnesium.
C. Hemoglobin and hematocrit.
D. White blood cell count with differential.
Answer: A. Serum creatinine and BUN.
Gentamicin is an aminoglycoside with ototoxic and nephrotoxic potential. Tinnitus and
vertigo indicate ototoxicity, which often accompanies nephrotoxicity. Monitoring renal
function (creatinine, BUN) is essential to adjust dosing and prevent further damage.
Electrolytes (potassium, magnesium) are not directly affected by gentamicin. CBC is
not specific to gentamicin toxicity.
6. A client with heart failure is prescribed digoxin. Which finding would indicate
digoxin toxicity?
A. Heart rate of 72 bpm and a PR interval of 0.18 seconds on ECG.
B. Serum potassium level of 3.2 mEq/L and complaints of visual disturbances (yellow
halos).
C. Serum digoxin level of 0.8 ng/mL and a normal sinus rhythm.
D. Report of increased urine output and decreased peripheral edema.
Answer: B. Serum potassium level of 3.2 mEq/L and complaints of visual
disturbances (yellow halos).
Visual disturbances (yellow-green halos) are classic signs of digoxin toxicity.
Hypokalemia (K+ <3.5 mEq/L) increases the risk of toxicity and potentiates digoxin's
effects. A normal heart rate and PR interval are not indicative of toxicity. A digoxin
level of 0.8 ng/mL is within therapeutic range (0.5-2 ng/mL). Increased urine output
indicates therapeutic response, not toxicity.
Page 4
Graded A+ Premium Exam Tested And Verified
Subject Area Pharmacology for Practical Nurses
Description This exam assesses the practical nurse's ability to apply pharmacological
principles across diverse drug classes, including safe administration, monitoring
for adverse effects, and patient education. Questions integrate pathophysiology,
drug interactions, and nursing interventions at the PN scope of practice.
Expected Grade A+
Total Questions 50
Duration 3 hours
Learning Outcomes 1. Apply pharmacokinetics and pharmacodynamics to medication administration
and monitoring.
2. Identify adverse effects, contraindications, and drug interactions for major drug
classes.
3. Prioritize nursing interventions for safe medication management across the
lifespan.
4. Interpret prescription orders and laboratory values to guide pharmacological
care.
Accreditation Compliant with ATI PN Pharmacology content outline and NCLEX-PN test plan
standards.
Page 1
,1. A client receiving intravenous heparin develops a platelet count drop from
250,000/mm³ to 90,000/mm³ over three days. Which antibody test is most likely to
be positive, and what is the priority nursing action?
A. Anti-factor Xa; administer protamine sulfate immediately.
B. Heparin-induced thrombocytopenia (HIT) antibody; discontinue all heparin products and
start a direct thrombin inhibitor.
C. Platelet factor 4 (PF4)-heparin complex antibody; give aspirin and continue heparin at a
lower dose.
D. Anti-thrombin III; switch from heparin to enoxaparin.
Answer: B. Heparin-induced thrombocytopenia (HIT) antibody; discontinue all
heparin products and start a direct thrombin inhibitor.
HIT is an immune-mediated reaction to heparin, confirmed by PF4-heparin antibody
testing. Protamine reverses heparin but does not treat HIT; discontinuing heparin and
using a direct thrombin inhibitor (e.g., argatroban) is the standard of care. Continuing
heparin or switching to LMWH can worsen thrombocytopenia and thrombosis.
2. A client prescribed lithium carbonate has a serum level of 1.8 mEq/L and presents
with coarse tremors, ataxia, and dysarthria. Which intervention should the nurse
implement first?
A. Administer sodium polystyrene sulfonate to enhance lithium excretion.
B. Hold the next dose and notify the provider; prepare for possible hemodialysis.
C. Increase oral fluid intake to 3 L per day and recheck level in 4 hours.
D. Administer intravenous calcium gluconate to counteract cardiac effects.
Answer: B. Hold the next dose and notify the provider; prepare for possible
hemodialysis.
A lithium level above 1.5 mEq/L with neurological symptoms indicates severe toxicity.
Hemodialysis may be required for levels >2.5 mEq/L or with severe symptoms. Sodium
polystyrene sulfonate is not effective; increasing fluids is insufficient in acute toxicity.
Calcium gluconate is used for hyperkalemia or calcium channel blocker overdose, not
lithium.
Page 2
,3. When administering an opioid analgesic to a client with a history of chronic
obstructive pulmonary disease (COPD), which assessment finding would indicate the
need to withhold the medication and notify the provider?
A. Respiratory rate of 14 breaths per minute with an oxygen saturation of 93%.
B. Report of nausea and dizziness upon standing.
C. Development of a generalized rash and pruritus.
D. Respiratory rate of 10 breaths per minute with shallow breathing.
Answer: D. Respiratory rate of 10 breaths per minute with shallow breathing.
Opioids depress the respiratory center; in COPD clients with already compromised
respiratory function, a rate <12/min or shallow breathing signals significant depression.
A rate of 14 with normal saturation is acceptable. Nausea/dizziness may be opioid side
effects but not life-threatening. Rash suggests allergy, which requires discontinuation
but is not the immediate priority over respiratory depression.
4. A client with type 2 diabetes is started on metformin. Which instruction is most
important for the nurse to include in the discharge teaching?
A. Take the medication with meals to reduce gastrointestinal upset.
B. Monitor blood glucose levels only if symptoms of hyperglycemia occur.
C. Discontinue the medication if a contrast dye study is scheduled.
D. Avoid alcohol consumption to prevent lactic acidosis.
Answer: C. Discontinue the medication if a contrast dye study is scheduled.
Metformin must be temporarily discontinued before procedures using iodinated
contrast due to the risk of contrast-induced nephropathy and subsequent lactic acidosis.
Taking with meals reduces GI upset but is not the most critical instruction. Blood
glucose monitoring is necessary even without symptoms. Alcohol increases lactic
acidosis risk but the contrast medium interaction is a more immediate and common
safety concern.
Page 3
, 5. A client receiving gentamicin develops tinnitus and vertigo. Which laboratory
value should the nurse monitor closely?
A. Serum creatinine and BUN.
B. Serum potassium and magnesium.
C. Hemoglobin and hematocrit.
D. White blood cell count with differential.
Answer: A. Serum creatinine and BUN.
Gentamicin is an aminoglycoside with ototoxic and nephrotoxic potential. Tinnitus and
vertigo indicate ototoxicity, which often accompanies nephrotoxicity. Monitoring renal
function (creatinine, BUN) is essential to adjust dosing and prevent further damage.
Electrolytes (potassium, magnesium) are not directly affected by gentamicin. CBC is
not specific to gentamicin toxicity.
6. A client with heart failure is prescribed digoxin. Which finding would indicate
digoxin toxicity?
A. Heart rate of 72 bpm and a PR interval of 0.18 seconds on ECG.
B. Serum potassium level of 3.2 mEq/L and complaints of visual disturbances (yellow
halos).
C. Serum digoxin level of 0.8 ng/mL and a normal sinus rhythm.
D. Report of increased urine output and decreased peripheral edema.
Answer: B. Serum potassium level of 3.2 mEq/L and complaints of visual
disturbances (yellow halos).
Visual disturbances (yellow-green halos) are classic signs of digoxin toxicity.
Hypokalemia (K+ <3.5 mEq/L) increases the risk of toxicity and potentiates digoxin's
effects. A normal heart rate and PR interval are not indicative of toxicity. A digoxin
level of 0.8 ng/mL is within therapeutic range (0.5-2 ng/mL). Increased urine output
indicates therapeutic response, not toxicity.
Page 4
