RN ATI PHARMACOLOGY PROCTORED EXAM WITH
NGN Actual Exam 2026/2027 Complete Questions
and Answers Detailed Rationales Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular and Hematologic Medications | Q1 – Q10
Section 2 | Respiratory and Endocrine Medications | Q11 – Q20
Section 3 | Neurologic and Psychiatric Medications | Q21 – Q30
Section 4 | Antimicrobials, Anti-infectives, and Immunizations | Q31 – Q40
Section 5 | Gastrointestinal, Renal, and Pain Management Medications | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR AND HEMATOLOGIC MEDICATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old client with atrial fibrillation is receiving digoxin 0.25 mg daily. During
morning assessment, the nurse notes a heart rate of 52 bpm, nausea, and the client
reports seeing yellow halos around lights. The provider orders a serum digoxin level.
While awaiting results, what is the nurse's priority action?
A. Hold the next dose of digoxin and continue to monitor the apical pulse every 2 hours
B. Hold the next dose of digoxin and notify the provider immediately of the assessment
findings ✓ CORRECT
C. Administer the next dose of digoxin with a small snack to reduce nausea
D. Administer atropine 0.5 mg IV push and prepare for transcutaneous pacing
Correct Answer: B
,Rationale: Yellow halos, bradycardia, and gastrointestinal upset are classic signs of
digoxin toxicity, so the nurse must withhold the drug and alert the provider promptly.
Continuing to monitor without notifying the provider delays intervention for a potentially
life-threatening arrhythmia. Digoxin immune Fab is the antidote if levels are critically
elevated, and early communication allows the provider to order appropriate labs and
treatment.
Question 2 of 50
A 58-year-old client is admitted for a total knee replacement and is prescribed warfarin
5 mg daily for a mechanical heart valve. The nurse notes the INR is 1.2 on the morning
of surgery. The surgeon asks the nurse to administer a preoperative dose of enoxaparin
40 mg subcutaneously. What is the nurse's best response?
A. Administer the enoxaparin as ordered and document the INR result
B. Clarify the order because bridging with enoxaparin should begin after warfarin is
stopped, not while it is still active
C. Administer the enoxaparin and hold the warfarin until postoperative day one
D. Contact the surgeon to confirm the bridging plan, since warfarin should typically be
held 5 days preoperatively and bridging timed appropriately ✓ CORRECT
Correct Answer: D
Rationale: Warfarin requires approximately 5 days to clear, and bridging with
low-molecular-weight heparin must be timed carefully around surgery to balance
thrombosis and bleeding risk. An INR of 1.2 suggests the warfarin has been stopped
already, but the nurse must verify the complete anticoagulation plan with the surgeon
rather than assuming. Blindly administering anticoagulants preoperatively without
clarifying the bridging protocol places the client at serious risk for intraoperative
bleeding.
Question 3 of 50
,A 64-year-old client with hypertension reports a persistent dry cough that started 3
weeks after beginning lisinopril 10 mg daily. The client denies fever, shortness of breath,
or sputum production. What is the nurse's most appropriate action?
A. Explain that the cough is a known side effect of ACE inhibitors and notify the provider
to discuss an alternative such as an ARB ✓ CORRECT
B. Recommend an over-the-counter cough suppressant and reassure the client the
cough will resolve in a few days
C. Advise the client to stop the lisinopril immediately and schedule a follow-up
appointment next week
D. Tell the client to continue the medication and return only if the cough produces blood
Correct Answer: A
Rationale: A dry, nonproductive cough is a well-documented adverse effect of ACE
inhibitors caused by bradykinin accumulation, and it does not improve with cough
suppressants. The nurse should never tell a client to independently discontinue an
antihypertensive without provider involvement, but should facilitate a discussion about
switching to an ARB which does not affect bradykinin. Documenting the onset after
initiation helps the provider confirm the drug as the cause.
Question 4 of 50
A 55-year-old client with hyperlipidemia has been taking atorvastatin 40 mg at bedtime
for 6 months. The client reports new-onset muscle pain in both thighs and dark-colored
urine over the past week. Laboratory results show creatine kinase (CK) 3,850 U/L. What
is the nurse's priority intervention?
A. Instruct the client to take the statin every other day until the muscle pain subsides
B. Recommend increasing fluid intake and applying heat to the thighs for comfort
C. Hold the atorvastatin and notify the provider immediately ✓ CORRECT
D. Document the findings and reassure the client that mild myalgia is expected with
statin therapy
, Correct Answer: C
Rationale: A CK level significantly elevated above baseline with dark urine suggests
rhabdomyolysis, a rare but serious complication of statin therapy that can lead to acute
kidney injury. The nurse must stop the drug and alert the provider so creatinine and
urinalysis can be evaluated promptly. Telling the client to continue or reduce the dose
independently ignores the risk of renal damage, and heat application does not address
the underlying muscle breakdown.
Question 5 of 50
A 67-year-old client takes aspirin 81 mg daily for secondary prevention of myocardial
infarction and is scheduled for an elective colonoscopy in 3 days. The client asks the
nurse whether to stop the aspirin before the procedure. What is the nurse's best
response?
A. Stop the aspirin 7 days before the procedure to prevent bleeding during polypectomy
B. Instruct the client to continue the aspirin and clarify with the gastroenterologist
whether polypectomy is planned ✓ CORRECT
C. Stop the aspirin 3 days before and substitute with clopidogrel 75 mg daily
D. Hold the aspirin the morning of the procedure only and resume that evening
Correct Answer: B
Rationale: Low-dose aspirin for cardiac protection is typically continued for diagnostic
colonoscopy, but the plan changes if polypectomy or biopsy is anticipated due to
bleeding risk. The nurse should never advise a client to independently stop antiplatelet
therapy without provider guidance, especially with a cardiac history. Coordinating with
the gastroenterologist ensures the procedural plan aligns with the client's thrombosis
risk.
Question 6 of 50
NGN Actual Exam 2026/2027 Complete Questions
and Answers Detailed Rationales Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular and Hematologic Medications | Q1 – Q10
Section 2 | Respiratory and Endocrine Medications | Q11 – Q20
Section 3 | Neurologic and Psychiatric Medications | Q21 – Q30
Section 4 | Antimicrobials, Anti-infectives, and Immunizations | Q31 – Q40
Section 5 | Gastrointestinal, Renal, and Pain Management Medications | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR AND HEMATOLOGIC MEDICATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old client with atrial fibrillation is receiving digoxin 0.25 mg daily. During
morning assessment, the nurse notes a heart rate of 52 bpm, nausea, and the client
reports seeing yellow halos around lights. The provider orders a serum digoxin level.
While awaiting results, what is the nurse's priority action?
A. Hold the next dose of digoxin and continue to monitor the apical pulse every 2 hours
B. Hold the next dose of digoxin and notify the provider immediately of the assessment
findings ✓ CORRECT
C. Administer the next dose of digoxin with a small snack to reduce nausea
D. Administer atropine 0.5 mg IV push and prepare for transcutaneous pacing
Correct Answer: B
,Rationale: Yellow halos, bradycardia, and gastrointestinal upset are classic signs of
digoxin toxicity, so the nurse must withhold the drug and alert the provider promptly.
Continuing to monitor without notifying the provider delays intervention for a potentially
life-threatening arrhythmia. Digoxin immune Fab is the antidote if levels are critically
elevated, and early communication allows the provider to order appropriate labs and
treatment.
Question 2 of 50
A 58-year-old client is admitted for a total knee replacement and is prescribed warfarin
5 mg daily for a mechanical heart valve. The nurse notes the INR is 1.2 on the morning
of surgery. The surgeon asks the nurse to administer a preoperative dose of enoxaparin
40 mg subcutaneously. What is the nurse's best response?
A. Administer the enoxaparin as ordered and document the INR result
B. Clarify the order because bridging with enoxaparin should begin after warfarin is
stopped, not while it is still active
C. Administer the enoxaparin and hold the warfarin until postoperative day one
D. Contact the surgeon to confirm the bridging plan, since warfarin should typically be
held 5 days preoperatively and bridging timed appropriately ✓ CORRECT
Correct Answer: D
Rationale: Warfarin requires approximately 5 days to clear, and bridging with
low-molecular-weight heparin must be timed carefully around surgery to balance
thrombosis and bleeding risk. An INR of 1.2 suggests the warfarin has been stopped
already, but the nurse must verify the complete anticoagulation plan with the surgeon
rather than assuming. Blindly administering anticoagulants preoperatively without
clarifying the bridging protocol places the client at serious risk for intraoperative
bleeding.
Question 3 of 50
,A 64-year-old client with hypertension reports a persistent dry cough that started 3
weeks after beginning lisinopril 10 mg daily. The client denies fever, shortness of breath,
or sputum production. What is the nurse's most appropriate action?
A. Explain that the cough is a known side effect of ACE inhibitors and notify the provider
to discuss an alternative such as an ARB ✓ CORRECT
B. Recommend an over-the-counter cough suppressant and reassure the client the
cough will resolve in a few days
C. Advise the client to stop the lisinopril immediately and schedule a follow-up
appointment next week
D. Tell the client to continue the medication and return only if the cough produces blood
Correct Answer: A
Rationale: A dry, nonproductive cough is a well-documented adverse effect of ACE
inhibitors caused by bradykinin accumulation, and it does not improve with cough
suppressants. The nurse should never tell a client to independently discontinue an
antihypertensive without provider involvement, but should facilitate a discussion about
switching to an ARB which does not affect bradykinin. Documenting the onset after
initiation helps the provider confirm the drug as the cause.
Question 4 of 50
A 55-year-old client with hyperlipidemia has been taking atorvastatin 40 mg at bedtime
for 6 months. The client reports new-onset muscle pain in both thighs and dark-colored
urine over the past week. Laboratory results show creatine kinase (CK) 3,850 U/L. What
is the nurse's priority intervention?
A. Instruct the client to take the statin every other day until the muscle pain subsides
B. Recommend increasing fluid intake and applying heat to the thighs for comfort
C. Hold the atorvastatin and notify the provider immediately ✓ CORRECT
D. Document the findings and reassure the client that mild myalgia is expected with
statin therapy
, Correct Answer: C
Rationale: A CK level significantly elevated above baseline with dark urine suggests
rhabdomyolysis, a rare but serious complication of statin therapy that can lead to acute
kidney injury. The nurse must stop the drug and alert the provider so creatinine and
urinalysis can be evaluated promptly. Telling the client to continue or reduce the dose
independently ignores the risk of renal damage, and heat application does not address
the underlying muscle breakdown.
Question 5 of 50
A 67-year-old client takes aspirin 81 mg daily for secondary prevention of myocardial
infarction and is scheduled for an elective colonoscopy in 3 days. The client asks the
nurse whether to stop the aspirin before the procedure. What is the nurse's best
response?
A. Stop the aspirin 7 days before the procedure to prevent bleeding during polypectomy
B. Instruct the client to continue the aspirin and clarify with the gastroenterologist
whether polypectomy is planned ✓ CORRECT
C. Stop the aspirin 3 days before and substitute with clopidogrel 75 mg daily
D. Hold the aspirin the morning of the procedure only and resume that evening
Correct Answer: B
Rationale: Low-dose aspirin for cardiac protection is typically continued for diagnostic
colonoscopy, but the plan changes if polypectomy or biopsy is anticipated due to
bleeding risk. The nurse should never advise a client to independently stop antiplatelet
therapy without provider guidance, especially with a cardiac history. Coordinating with
the gastroenterologist ensures the procedural plan aligns with the client's thrombosis
risk.
Question 6 of 50
