NGN ATI RN Pharmacology Proctored Exam 2023–2026
200 NGN‑Style Practice Questions with Answers & Rationales
Question 1 (NGN – Recognizing Cues)
A nurse reviews a client's chart:
- Diagnosis: Heart failure, HTN
- Medications: Lisinopril 20 mg daily, Furosemide 40 mg daily, Digoxin 0.25 mg daily
- Lab: K⁺ 3.2 mEq/L, Creatinine 1.2 mg/dL
Which finding requires immediate action?
A. Lisinopril dose
B. Digoxin dose
C. Serum potassium
D. Creatinine level
Correct Answer: C – Serum potassium
Rationale: Low potassium (3.2 mEq/L) increases the risk of digoxin toxicity. Hypokalemia potentiates
digoxin’s effect on cardiac muscle, which can lead to life‑threatening dysrhythmias. The nurse should
notify the provider and consider potassium replacement.
Question 2
A client on warfarin has an INR of 4.5. No bleeding is present. What should the nurse do first?
A. Administer vitamin K
B. Hold the next dose of warfarin
,C. Transfuse fresh frozen plasma
D. Notify the provider
Correct Answer: B – Hold the next dose of warfarin
Rationale: For an INR >4.0 without active bleeding, the standard practice is to hold the next dose of
warfarin. Vitamin K or fresh frozen plasma is reserved for active bleeding or an extremely high INR (>10).
Question 3 (SATA)
A client is starting amiodarone for atrial fibrillation. Which findings should the nurse report to the
provider?
A. Shortness of breath and dry cough
B. Bluish‑gray skin discoloration
C. Thyroid function tests abnormal
D. Heart rate 72 bpm
E. BP 130/80 mmHg
Correct Answer: A, B, C
Rationale: Amiodarone can cause pulmonary toxicity (cough, SOB), skin discoloration, and thyroid
dysfunction. Heart rate 72 bpm and BP 130/80 mmHg are within normal limits.
Question 4 (NGN – Prioritization)
A client is receiving IV heparin. The nurse notes a sudden drop in BP, back pain, and blood in the urine.
What is the priority action?
,A. Stop the heparin infusion
B. Apply oxygen
C. Draw aPTT level
D. Give protamine sulfate
Correct Answer: A – Stop the heparin infusion
Rationale: The findings suggest heparin‑induced hemorrhage or a retroperitoneal bleed. The priority is
to stop the heparin infusion first; then give protamine sulfate and support ABCs.
Question 5
A nurse teaches a client about levothyroxine. Which statement indicates understanding?
A. “I’ll take it with breakfast.”
B. “I can stop it when I feel better.”
C. “I’ll take it on an empty stomach in the morning.”
D. “I’ll take antacids at the same time.”
Correct Answer: C – “I’ll take it on an empty stomach in the morning.”
Rationale: Levothyroxine should be taken on an empty stomach 30–60 minutes before breakfast to
ensure optimal absorption. It must not be stopped without provider guidance, and antacids can
interfere with absorption.
Question 6
, A nurse is preparing to administer a medication to a client who has a history of renal failure. Which
pharmacokinetic process should the nurse expect to be most affected?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Correct Answer: D – Excretion
Rationale: The kidneys are the primary organs responsible for drug excretion. In renal failure, drug
clearance is decreased, leading to a high risk for toxicity, and dosage adjustments are often required.
Question 7
A nurse is preparing to administer 0.5 g of a medication. The available dose is 250 mg tablets. How many
tablets should the nurse administer?
A. 0.5 tablets
B. 1 tablet
C. 2 tablets
D. 4 tablets
Correct Answer: C – 2 tablets
Rationale: Convert grams to milligrams: 0.5 g = 500 mg. Divide the ordered dose (500 mg) by the
available dose (250 mg) → 2 tablets.
200 NGN‑Style Practice Questions with Answers & Rationales
Question 1 (NGN – Recognizing Cues)
A nurse reviews a client's chart:
- Diagnosis: Heart failure, HTN
- Medications: Lisinopril 20 mg daily, Furosemide 40 mg daily, Digoxin 0.25 mg daily
- Lab: K⁺ 3.2 mEq/L, Creatinine 1.2 mg/dL
Which finding requires immediate action?
A. Lisinopril dose
B. Digoxin dose
C. Serum potassium
D. Creatinine level
Correct Answer: C – Serum potassium
Rationale: Low potassium (3.2 mEq/L) increases the risk of digoxin toxicity. Hypokalemia potentiates
digoxin’s effect on cardiac muscle, which can lead to life‑threatening dysrhythmias. The nurse should
notify the provider and consider potassium replacement.
Question 2
A client on warfarin has an INR of 4.5. No bleeding is present. What should the nurse do first?
A. Administer vitamin K
B. Hold the next dose of warfarin
,C. Transfuse fresh frozen plasma
D. Notify the provider
Correct Answer: B – Hold the next dose of warfarin
Rationale: For an INR >4.0 without active bleeding, the standard practice is to hold the next dose of
warfarin. Vitamin K or fresh frozen plasma is reserved for active bleeding or an extremely high INR (>10).
Question 3 (SATA)
A client is starting amiodarone for atrial fibrillation. Which findings should the nurse report to the
provider?
A. Shortness of breath and dry cough
B. Bluish‑gray skin discoloration
C. Thyroid function tests abnormal
D. Heart rate 72 bpm
E. BP 130/80 mmHg
Correct Answer: A, B, C
Rationale: Amiodarone can cause pulmonary toxicity (cough, SOB), skin discoloration, and thyroid
dysfunction. Heart rate 72 bpm and BP 130/80 mmHg are within normal limits.
Question 4 (NGN – Prioritization)
A client is receiving IV heparin. The nurse notes a sudden drop in BP, back pain, and blood in the urine.
What is the priority action?
,A. Stop the heparin infusion
B. Apply oxygen
C. Draw aPTT level
D. Give protamine sulfate
Correct Answer: A – Stop the heparin infusion
Rationale: The findings suggest heparin‑induced hemorrhage or a retroperitoneal bleed. The priority is
to stop the heparin infusion first; then give protamine sulfate and support ABCs.
Question 5
A nurse teaches a client about levothyroxine. Which statement indicates understanding?
A. “I’ll take it with breakfast.”
B. “I can stop it when I feel better.”
C. “I’ll take it on an empty stomach in the morning.”
D. “I’ll take antacids at the same time.”
Correct Answer: C – “I’ll take it on an empty stomach in the morning.”
Rationale: Levothyroxine should be taken on an empty stomach 30–60 minutes before breakfast to
ensure optimal absorption. It must not be stopped without provider guidance, and antacids can
interfere with absorption.
Question 6
, A nurse is preparing to administer a medication to a client who has a history of renal failure. Which
pharmacokinetic process should the nurse expect to be most affected?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
Correct Answer: D – Excretion
Rationale: The kidneys are the primary organs responsible for drug excretion. In renal failure, drug
clearance is decreased, leading to a high risk for toxicity, and dosage adjustments are often required.
Question 7
A nurse is preparing to administer 0.5 g of a medication. The available dose is 250 mg tablets. How many
tablets should the nurse administer?
A. 0.5 tablets
B. 1 tablet
C. 2 tablets
D. 4 tablets
Correct Answer: C – 2 tablets
Rationale: Convert grams to milligrams: 0.5 g = 500 mg. Divide the ordered dose (500 mg) by the
available dose (250 mg) → 2 tablets.
