ATI RN PHARMACOLOGY – RAPID-REVIEW FINAL (200
QUESTIONS)
Suggested Time: 4 hours (or break into 2 sessions of 100)
PART 1: NGN CASE STUDIES (Questions 1–40)
Case Study 1: Heart Failure – ACE Inhibitor + Spironolactone (1–5)
Client: 68M, HFrEF 30%, lisinopril 20 mg daily, spironolactone 25 mg daily, furosemide 40
mg BID.
Labs: K⁺ 5.9 mEq/L, Cr 1.6 mg/dL.
1. (Bow-tie) Most likely cause and action?
A. Hyperkalemia from spironolactone → Hold spironolactone
B. Hypokalemia from furosemide → Increase furosemide
C. AKI from lisinopril → Hold lisinopril
D. Dehydration → Give IV fluids
Answer: A
2. (Matrix) Which are appropriate?
• Hold spironolactone (Yes)
• Hold lisinopril (Yes, if K⁺ > 5.5)
• Give calcium gluconate if ECG changes (Yes)
, • Give kayexalate (Yes)
• Increase furosemide (Yes, to excrete K⁺)
3. (Drag & drop) Order for hyperkalemia management:
1. ______ Hold spironolactone and lisinopril
2. ______ Obtain ECG
3. ______ Give calcium gluconate if peaked T waves
4. ______ Give kayexalate or patiromer
Answer: 1 → 2 → 3 → 4
4. (Highlight) Critical lab: K⁺ 5.9
5. (Cloze) ECG change in hyperkalemia: Peaked T waves
Case Study 2: Warfarin – Supratherapeutic INR (6–10)
Client: 72F, atrial fibrillation, warfarin 5 mg daily. INR = 4.8, no bleeding.
New med: Amiodarone started 2 weeks ago.
6. (Bow-tie) Cause and action:
A. Amiodarone inhibits warfarin metabolism → Hold warfarin
B. Missed warfarin doses → Increase warfarin
C. Liver disease → Give vitamin K
D. Dietary change → No action
Answer: A
7. (Matrix) Correct:
• Hold warfarin (Yes)
, • Give vitamin K 1-2.5 mg PO (Yes, if INR > 4.5 no bleeding)
• Check INR tomorrow (Yes)
• Stop amiodarone (No)
• Give FFP (No)
8. (Ordered response)
1. ______ Hold warfarin
2. ______ Notify provider
3. ______ Give oral vitamin K
4. ______ Recheck INR in 24 hours
Answer: 1 → 2 → 3 → 4
9. (Highlight) Medication causing interaction: Amiodarone
10. (Cloze) Antidote for life-threatening warfarin bleed: PCC or FFP + IV vitamin K
Case Study 3: Insulin Error – Lispro vs Glargine (11–15)
Client: Type 1 DM, glargine 20 units HS, lispro with meals. Nurse gave lispro 20 units
instead of glargine.
11. (Bow-tie) Complication and action:
A. Hyperglycemia → Give more insulin
B. Hypoglycemia → Give IV dextrose
C. DKA → Start insulin drip
D. Hyperkalemia → Give insulin
Answer: B
, 12. (Matrix) Actions:
• Check BG every 15 min (Yes)
• Give oral juice if awake (Yes)
• Glucagon IM if unconscious (Yes)
• Hold all insulin for 24h (No)
• Notify provider (Yes)
13. (Ordered response)
1. ______ Check BG
2. ______ Give 15g carbohydrate if conscious
3. ______ Recheck BG in 15 min
4. ______ Give glucagon if unconscious
Answer: 1 → 2 → 3 → 4
14. (Highlight) Critical finding: Unconsciousness
15. (Cloze) Lispro onset: 15 minutes
Case Study 4: Lithium Toxicity (16–20)
Client: Bipolar, lithium 900 mg daily. Na⁺ 128 mEq/L, Li 2.2 mEq/L. Tremor, confusion,
nausea.
16. (Bow-tie) Cause and action:
A. Hypernatremia → Increase lithium
B. Hyponatremia → Hold lithium
C. Renal failure → Dialysis
QUESTIONS)
Suggested Time: 4 hours (or break into 2 sessions of 100)
PART 1: NGN CASE STUDIES (Questions 1–40)
Case Study 1: Heart Failure – ACE Inhibitor + Spironolactone (1–5)
Client: 68M, HFrEF 30%, lisinopril 20 mg daily, spironolactone 25 mg daily, furosemide 40
mg BID.
Labs: K⁺ 5.9 mEq/L, Cr 1.6 mg/dL.
1. (Bow-tie) Most likely cause and action?
A. Hyperkalemia from spironolactone → Hold spironolactone
B. Hypokalemia from furosemide → Increase furosemide
C. AKI from lisinopril → Hold lisinopril
D. Dehydration → Give IV fluids
Answer: A
2. (Matrix) Which are appropriate?
• Hold spironolactone (Yes)
• Hold lisinopril (Yes, if K⁺ > 5.5)
• Give calcium gluconate if ECG changes (Yes)
, • Give kayexalate (Yes)
• Increase furosemide (Yes, to excrete K⁺)
3. (Drag & drop) Order for hyperkalemia management:
1. ______ Hold spironolactone and lisinopril
2. ______ Obtain ECG
3. ______ Give calcium gluconate if peaked T waves
4. ______ Give kayexalate or patiromer
Answer: 1 → 2 → 3 → 4
4. (Highlight) Critical lab: K⁺ 5.9
5. (Cloze) ECG change in hyperkalemia: Peaked T waves
Case Study 2: Warfarin – Supratherapeutic INR (6–10)
Client: 72F, atrial fibrillation, warfarin 5 mg daily. INR = 4.8, no bleeding.
New med: Amiodarone started 2 weeks ago.
6. (Bow-tie) Cause and action:
A. Amiodarone inhibits warfarin metabolism → Hold warfarin
B. Missed warfarin doses → Increase warfarin
C. Liver disease → Give vitamin K
D. Dietary change → No action
Answer: A
7. (Matrix) Correct:
• Hold warfarin (Yes)
, • Give vitamin K 1-2.5 mg PO (Yes, if INR > 4.5 no bleeding)
• Check INR tomorrow (Yes)
• Stop amiodarone (No)
• Give FFP (No)
8. (Ordered response)
1. ______ Hold warfarin
2. ______ Notify provider
3. ______ Give oral vitamin K
4. ______ Recheck INR in 24 hours
Answer: 1 → 2 → 3 → 4
9. (Highlight) Medication causing interaction: Amiodarone
10. (Cloze) Antidote for life-threatening warfarin bleed: PCC or FFP + IV vitamin K
Case Study 3: Insulin Error – Lispro vs Glargine (11–15)
Client: Type 1 DM, glargine 20 units HS, lispro with meals. Nurse gave lispro 20 units
instead of glargine.
11. (Bow-tie) Complication and action:
A. Hyperglycemia → Give more insulin
B. Hypoglycemia → Give IV dextrose
C. DKA → Start insulin drip
D. Hyperkalemia → Give insulin
Answer: B
, 12. (Matrix) Actions:
• Check BG every 15 min (Yes)
• Give oral juice if awake (Yes)
• Glucagon IM if unconscious (Yes)
• Hold all insulin for 24h (No)
• Notify provider (Yes)
13. (Ordered response)
1. ______ Check BG
2. ______ Give 15g carbohydrate if conscious
3. ______ Recheck BG in 15 min
4. ______ Give glucagon if unconscious
Answer: 1 → 2 → 3 → 4
14. (Highlight) Critical finding: Unconsciousness
15. (Cloze) Lispro onset: 15 minutes
Case Study 4: Lithium Toxicity (16–20)
Client: Bipolar, lithium 900 mg daily. Na⁺ 128 mEq/L, Li 2.2 mEq/L. Tremor, confusion,
nausea.
16. (Bow-tie) Cause and action:
A. Hypernatremia → Increase lithium
B. Hyponatremia → Hold lithium
C. Renal failure → Dialysis
