RN PHARMACOLOGY 2025 EXAM WITH NGN
(ATI STYLE) 200 QUESTIONS | CORRECT
ANSWERS & DETAILED RATIONALES
Exam Blueprint (Based on ATI Pharmacology Content Outline):
Cardiovascular & Hematologic Medications (20%) – 40 Qs
Endocrine & Metabolic Medications (15%) – 30 Qs
Neurologic & Psychiatric Medications (15%) – 30 Qs
Antimicrobial & Anti-infective Medications (15%) – 30 Qs
Respiratory & Allergy Medications (10%) – 20 Qs
Gastrointestinal & Genitourinary Medications (10%) – 20 Qs
Pain Management & Anti-inflammatory Medications (10%) – 20 Qs
NGN Case Studies & Clinical Judgment (5%) – 10 Qs
Exam Format: Next Generation NCLEX (NGN) – includes multiple-choice,
select-all-that-apply, matrix, cloze, and case study questions.
Time limit (simulated): 3 hours
Passing threshold: 70% (140/200)
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC MEDICATIONS –
Questions 1–40
1. A client with heart failure is prescribed furosemide. Which finding
indicates a therapeutic response?
A) Weight gain of 2 kg in 24 hours
B) Increased urine output and decreased edema
C) Dry cough
,D) Serum potassium of 5.5 mEq/L
Answer: B
Rationale: Furosemide (loop diuretic) reduces preload by promoting
diuresis. Therapeutic effects include increased urine output, decreased
edema, and weight loss. Dry cough is associated with ACE inhibitors, not
furosemide. Hypokalemia, not hyperkalemia, is a common adverse effect.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory
test should be monitored to evaluate therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Answer: B
Rationale: Warfarin anticoagulation is monitored by the INR (International
Normalized Ratio). For atrial fibrillation, target INR is typically 2-3. aPTT
monitors heparin. Platelet count monitors for HIT. Bleeding time is not used
for warfarin monitoring.
3. A client is prescribed digoxin for heart failure. The nurse should monitor
for which sign of digoxin toxicity?
A) Heart rate 72 bpm
B) Nausea, vomiting, and yellow-green halos around lights
C) Weight loss
D) Increased urine output
Answer: B
Rationale: Digoxin toxicity causes GI symptoms (nausea, vomiting, anorexia)
and visual disturbances (yellow-green halos, blurred vision). Bradycardia is
another sign. Weight loss and increased urine output are not signs of
toxicity.
,4. A nurse is teaching a client about self-administration of enoxaparin
(Lovenox). Which instruction is correct?
A) “Inject the medication into the deltoid muscle.”
B) “Expel the air bubble from the prefilled syringe before injection.”
C) “Administer the medication into the abdomen, rotating injection sites.”
D) “Massage the injection site thoroughly after administration.”
Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH) given
subcutaneously, preferably in the abdomen. The air bubble should not be
expelled (prevents medication loss). Do not massage the site (may cause
bruising).
5. A client taking clopidogrel after a coronary stent placement should avoid
which over-the-counter medication?
A) Acetaminophen
B) Ibuprofen
C) Diphenhydramine
D) Loratadine
Answer: B
Rationale: NSAIDs (ibuprofen, naproxen) increase the risk of bleeding when
taken with antiplatelet medications like clopidogrel, aspirin, and other
anticoagulants. Acetaminophen is the preferred analgesic for these clients.
6. A client with heart failure is prescribed carvedilol. The nurse should
monitor for which therapeutic effect?
A) Increased heart rate
B) Improved left ventricular ejection fraction (LVEF)
C) Increased blood pressure
, D) Decreased urinary output
Answer: B
Rationale: Carvedilol is a beta-blocker used in heart failure with reduced
ejection fraction (HFrEF). Over time, beta-blockers improve LVEF, reduce
hospitalization, and decrease mortality.
7. A client is prescribed lisinopril for hypertension. Which adverse effect
should the nurse instruct the client to report?
A) Dry cough
B) Weight gain
C) Hyperglycemia
D) Drowsiness
Answer: A
Rationale: ACE inhibitors (lisinopril, enalapril) commonly cause a persistent
dry cough due to bradykinin accumulation. If the cough is intolerable, the
provider may switch to an ARB (e.g., losartan).
8. A client taking spironolactone for heart failure has a potassium level of 5.9
mEq/L. What is the priority nursing action?
A) Administer a potassium supplement.
B) Hold the medication and notify the provider.
C) Increase the spironolactone dose.
D) Document the finding as normal.
Answer: B
*Rationale: Spironolactone is a potassium-sparing diuretic (aldosterone
antagonist). It can cause life-threatening hyperkalemia, especially with ACE
inhibitors or renal impairment. A potassium level >5.5 mEq/L requires
holding the medication and notifying the provider.*
9. A client with a mechanical heart valve is prescribed warfarin. Which food
should the nurse teach the client to keep consistent in their daily intake?
(ATI STYLE) 200 QUESTIONS | CORRECT
ANSWERS & DETAILED RATIONALES
Exam Blueprint (Based on ATI Pharmacology Content Outline):
Cardiovascular & Hematologic Medications (20%) – 40 Qs
Endocrine & Metabolic Medications (15%) – 30 Qs
Neurologic & Psychiatric Medications (15%) – 30 Qs
Antimicrobial & Anti-infective Medications (15%) – 30 Qs
Respiratory & Allergy Medications (10%) – 20 Qs
Gastrointestinal & Genitourinary Medications (10%) – 20 Qs
Pain Management & Anti-inflammatory Medications (10%) – 20 Qs
NGN Case Studies & Clinical Judgment (5%) – 10 Qs
Exam Format: Next Generation NCLEX (NGN) – includes multiple-choice,
select-all-that-apply, matrix, cloze, and case study questions.
Time limit (simulated): 3 hours
Passing threshold: 70% (140/200)
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC MEDICATIONS –
Questions 1–40
1. A client with heart failure is prescribed furosemide. Which finding
indicates a therapeutic response?
A) Weight gain of 2 kg in 24 hours
B) Increased urine output and decreased edema
C) Dry cough
,D) Serum potassium of 5.5 mEq/L
Answer: B
Rationale: Furosemide (loop diuretic) reduces preload by promoting
diuresis. Therapeutic effects include increased urine output, decreased
edema, and weight loss. Dry cough is associated with ACE inhibitors, not
furosemide. Hypokalemia, not hyperkalemia, is a common adverse effect.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory
test should be monitored to evaluate therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Answer: B
Rationale: Warfarin anticoagulation is monitored by the INR (International
Normalized Ratio). For atrial fibrillation, target INR is typically 2-3. aPTT
monitors heparin. Platelet count monitors for HIT. Bleeding time is not used
for warfarin monitoring.
3. A client is prescribed digoxin for heart failure. The nurse should monitor
for which sign of digoxin toxicity?
A) Heart rate 72 bpm
B) Nausea, vomiting, and yellow-green halos around lights
C) Weight loss
D) Increased urine output
Answer: B
Rationale: Digoxin toxicity causes GI symptoms (nausea, vomiting, anorexia)
and visual disturbances (yellow-green halos, blurred vision). Bradycardia is
another sign. Weight loss and increased urine output are not signs of
toxicity.
,4. A nurse is teaching a client about self-administration of enoxaparin
(Lovenox). Which instruction is correct?
A) “Inject the medication into the deltoid muscle.”
B) “Expel the air bubble from the prefilled syringe before injection.”
C) “Administer the medication into the abdomen, rotating injection sites.”
D) “Massage the injection site thoroughly after administration.”
Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH) given
subcutaneously, preferably in the abdomen. The air bubble should not be
expelled (prevents medication loss). Do not massage the site (may cause
bruising).
5. A client taking clopidogrel after a coronary stent placement should avoid
which over-the-counter medication?
A) Acetaminophen
B) Ibuprofen
C) Diphenhydramine
D) Loratadine
Answer: B
Rationale: NSAIDs (ibuprofen, naproxen) increase the risk of bleeding when
taken with antiplatelet medications like clopidogrel, aspirin, and other
anticoagulants. Acetaminophen is the preferred analgesic for these clients.
6. A client with heart failure is prescribed carvedilol. The nurse should
monitor for which therapeutic effect?
A) Increased heart rate
B) Improved left ventricular ejection fraction (LVEF)
C) Increased blood pressure
, D) Decreased urinary output
Answer: B
Rationale: Carvedilol is a beta-blocker used in heart failure with reduced
ejection fraction (HFrEF). Over time, beta-blockers improve LVEF, reduce
hospitalization, and decrease mortality.
7. A client is prescribed lisinopril for hypertension. Which adverse effect
should the nurse instruct the client to report?
A) Dry cough
B) Weight gain
C) Hyperglycemia
D) Drowsiness
Answer: A
Rationale: ACE inhibitors (lisinopril, enalapril) commonly cause a persistent
dry cough due to bradykinin accumulation. If the cough is intolerable, the
provider may switch to an ARB (e.g., losartan).
8. A client taking spironolactone for heart failure has a potassium level of 5.9
mEq/L. What is the priority nursing action?
A) Administer a potassium supplement.
B) Hold the medication and notify the provider.
C) Increase the spironolactone dose.
D) Document the finding as normal.
Answer: B
*Rationale: Spironolactone is a potassium-sparing diuretic (aldosterone
antagonist). It can cause life-threatening hyperkalemia, especially with ACE
inhibitors or renal impairment. A potassium level >5.5 mEq/L requires
holding the medication and notifying the provider.*
9. A client with a mechanical heart valve is prescribed warfarin. Which food
should the nurse teach the client to keep consistent in their daily intake?
