ATI Pharmacology
Proctored Exam
Assessment Technologies Institute (ATI)
Comprehensive Pharmacological Competency Evaluation
for NCLEX-RN Readiness | NGN-Style Clinical Judgment
2026/2027 Edition
70 Questions | Multiple-Choice & NGN Item Types
Testing Time: 90–120 Minutes | Passing Benchmark: 75–85%
ATI/NGN/CJMM–Aligned | NCSBN Test Plan Compliant
,Table of Contents
Section 1: Drug Classifications & Prototype Recognition (Q1–14)
Section 2: Adverse Effects Differentiation (Q15–24)
Section 3: Pharmacokinetics & Pharmacodynamics (Q25–35)
Section 4: Dosage Calculations & Safe Administration (Q36–45)
Section 5: NGN Clinical Judgment Integration (Q46–55)
Section 6: Patient Education & Health Literacy (Q56–63)
Section 7: Scenario-Based Clinical Decision-Making (Q64–70)
Answer Key Summary
, Section 1: Drug Classifications & Prototype Recognition (Q1–14)
1. A nurse is reviewing the mechanism of action of lisinopril with a nursing student. Which
statement by the student indicates an understanding of how ACE inhibitors work?
A) It blocks angiotensin II from binding to its receptor, causing vasodilation.
B) It prevents the conversion of angiotensin I to angiotensin II and inhibits the
breakdown of bradykinin.
C) It increases the reabsorption of sodium and water in the distal tubule.
D) It directly relaxes vascular smooth muscle by stimulating nitric oxide release.
Rationale: ACE inhibitors such as lisinopril block the angiotensin-converting enzyme, preventing the
conversion of angiotensin I to the potent vasoconstrictor angiotensin II. This also reduces
aldosterone secretion and prevents the breakdown of bradykinin, a vasodilator, which contributes to
the therapeutic effect and to the common side effect of a dry cough. Option A describes the
mechanism of angiotensin II receptor blockers (ARBs) rather than ACE inhibitors.
2. A client who has been taking lisinopril for 2 weeks reports a persistent dry,
nonproductive cough. What is the nurse's best response?
A) This is an expected response; take an over-the-counter cough suppressant and continue the
medication.
B) The cough indicates you may be developing angioedema; go to the emergency department
immediately.
C) This is a common adverse effect of ACE inhibitors; notify your provider who may
switch you to an ARB.
D) The cough is caused by fluid retention; your provider may need to increase your dose.
Rationale: A dry, nonproductive cough occurs in up to 20% of patients taking ACE inhibitors and is
caused by the accumulation of bradykinin in the lungs due to ACE inhibition. It is not dangerous but
can be bothersome; switching to an angiotensin II receptor blocker (ARB), which does not affect
bradykinin, typically resolves the cough. Angioedema (Option B) presents with facial/lip swelling
and stridor, not cough alone, and is a medical emergency requiring immediate treatment.
3. A nurse is providing discharge teaching to a client newly prescribed lisinopril for
hypertension. Which instruction should the nurse include?
A) Eat foods rich in potassium, such as bananas and oranges, daily.
B) Report any facial swelling, difficulty breathing, or swelling of the tongue
immediately.
C) Take an NSAID like ibuprofen if you develop a headache.
D) Expect to feel dizzy when you first stand up; this will not improve over time.
Rationale: ACE inhibitors can cause angioedema, a life-threatening adverse effect involving swelling
of the face, lips, tongue, and throat that can compromise the airway. Patients must be instructed to
seek emergency care if these symptoms occur. ACE inhibitors reduce aldosterone, which can lead to
hyperkalemia, so patients should avoid potassium supplements and potassium-rich salt substitutes
(Option A is incorrect). NSAIDs (Option C) should be avoided because they reduce the
antihypertensive effect of ACE inhibitors and increase the risk of renal impairment and
hyperkalemia. Orthostatic hypotension (Option D) may occur initially but typically improves with
continued therapy and should be reported if persistent.
4. A nurse is teaching a client about metoprolol, a selective beta-1 blocker. Which expected
therapeutic effect should the nurse include?
A) Increased heart rate and improved cardiac output.
B) Decreased heart rate, decreased myocardial contractility, and decreased blood
pressure.
C) Bronchodilation and increased respiratory rate.
D) Increased renal perfusion and urine output.
Rationale: Metoprolol is a cardioselective beta-1 adrenergic antagonist. Blocking beta-1 receptors in
the heart decreases heart rate (negative chronotropy), decreases myocardial contractility (negative
Proctored Exam
Assessment Technologies Institute (ATI)
Comprehensive Pharmacological Competency Evaluation
for NCLEX-RN Readiness | NGN-Style Clinical Judgment
2026/2027 Edition
70 Questions | Multiple-Choice & NGN Item Types
Testing Time: 90–120 Minutes | Passing Benchmark: 75–85%
ATI/NGN/CJMM–Aligned | NCSBN Test Plan Compliant
,Table of Contents
Section 1: Drug Classifications & Prototype Recognition (Q1–14)
Section 2: Adverse Effects Differentiation (Q15–24)
Section 3: Pharmacokinetics & Pharmacodynamics (Q25–35)
Section 4: Dosage Calculations & Safe Administration (Q36–45)
Section 5: NGN Clinical Judgment Integration (Q46–55)
Section 6: Patient Education & Health Literacy (Q56–63)
Section 7: Scenario-Based Clinical Decision-Making (Q64–70)
Answer Key Summary
, Section 1: Drug Classifications & Prototype Recognition (Q1–14)
1. A nurse is reviewing the mechanism of action of lisinopril with a nursing student. Which
statement by the student indicates an understanding of how ACE inhibitors work?
A) It blocks angiotensin II from binding to its receptor, causing vasodilation.
B) It prevents the conversion of angiotensin I to angiotensin II and inhibits the
breakdown of bradykinin.
C) It increases the reabsorption of sodium and water in the distal tubule.
D) It directly relaxes vascular smooth muscle by stimulating nitric oxide release.
Rationale: ACE inhibitors such as lisinopril block the angiotensin-converting enzyme, preventing the
conversion of angiotensin I to the potent vasoconstrictor angiotensin II. This also reduces
aldosterone secretion and prevents the breakdown of bradykinin, a vasodilator, which contributes to
the therapeutic effect and to the common side effect of a dry cough. Option A describes the
mechanism of angiotensin II receptor blockers (ARBs) rather than ACE inhibitors.
2. A client who has been taking lisinopril for 2 weeks reports a persistent dry,
nonproductive cough. What is the nurse's best response?
A) This is an expected response; take an over-the-counter cough suppressant and continue the
medication.
B) The cough indicates you may be developing angioedema; go to the emergency department
immediately.
C) This is a common adverse effect of ACE inhibitors; notify your provider who may
switch you to an ARB.
D) The cough is caused by fluid retention; your provider may need to increase your dose.
Rationale: A dry, nonproductive cough occurs in up to 20% of patients taking ACE inhibitors and is
caused by the accumulation of bradykinin in the lungs due to ACE inhibition. It is not dangerous but
can be bothersome; switching to an angiotensin II receptor blocker (ARB), which does not affect
bradykinin, typically resolves the cough. Angioedema (Option B) presents with facial/lip swelling
and stridor, not cough alone, and is a medical emergency requiring immediate treatment.
3. A nurse is providing discharge teaching to a client newly prescribed lisinopril for
hypertension. Which instruction should the nurse include?
A) Eat foods rich in potassium, such as bananas and oranges, daily.
B) Report any facial swelling, difficulty breathing, or swelling of the tongue
immediately.
C) Take an NSAID like ibuprofen if you develop a headache.
D) Expect to feel dizzy when you first stand up; this will not improve over time.
Rationale: ACE inhibitors can cause angioedema, a life-threatening adverse effect involving swelling
of the face, lips, tongue, and throat that can compromise the airway. Patients must be instructed to
seek emergency care if these symptoms occur. ACE inhibitors reduce aldosterone, which can lead to
hyperkalemia, so patients should avoid potassium supplements and potassium-rich salt substitutes
(Option A is incorrect). NSAIDs (Option C) should be avoided because they reduce the
antihypertensive effect of ACE inhibitors and increase the risk of renal impairment and
hyperkalemia. Orthostatic hypotension (Option D) may occur initially but typically improves with
continued therapy and should be reported if persistent.
4. A nurse is teaching a client about metoprolol, a selective beta-1 blocker. Which expected
therapeutic effect should the nurse include?
A) Increased heart rate and improved cardiac output.
B) Decreased heart rate, decreased myocardial contractility, and decreased blood
pressure.
C) Bronchodilation and increased respiratory rate.
D) Increased renal perfusion and urine output.
Rationale: Metoprolol is a cardioselective beta-1 adrenergic antagonist. Blocking beta-1 receptors in
the heart decreases heart rate (negative chronotropy), decreases myocardial contractility (negative
