ATI PHARMACOLOGY MIDTERM
EXAM 2026–2027 Official Exam
1. A nurse is preparing to administer digoxin 0.25 mg PO to a patient with heart
failure. The patient’s apical pulse is 52 bpm. Which action should the nurse take
first?
A. Administer the digoxin as ordered
B. Hold the medication and reassess the pulse in 1 hour
C. Notify the provider immediately
D. Check the digoxin level
Answer: B
Rationale: Digoxin is held if the apical pulse is <60 bpm in adults. The nurse
should reassess after 1 hour; if still low, notify the provider. Checking the level is
not immediate priority.
2. A nurse accidentally administers heparin 10,000 units subcutaneously instead of
the prescribed 5,000 units. Which action is most important?
A. Complete an incident report
B. Assess the patient for signs of bleeding
C. Notify the charge nurse
D. Calculate the patient’s aPTT immediately
Answer: B
Rationale: Patient safety is paramount. The nurse must first assess for bleeding
(e.g., hematoma, hematuria, gum bleeding) before documentation or notification.
3. A patient with a penicillin allergy is prescribed amoxicillin. The nurse verifies
the allergy in the electronic health record. What is the priority action?
A. Administer the medication with diphenhydramine
B. Contact the prescriber to clarify the order
C. Give a test dose of amoxicillin
D. Document the allergy and administer
Answer: B
Rationale: A documented penicillin allergy is a contraindication. The nurse must
hold the medication and contact the prescriber for an alternative antibiotic.
,4. A nurse is using bar-code medication administration (BCMA). The scanner
indicates “medication not found.” What should the nurse do?
A. Bypass the system and manually document administration
B. Verify the medication using the six rights and rescan
C. Return all medications to the pharmacy
D. Administer the medication and scan later
Answer: B
Rationale: BCMA errors require the nurse to verify the correct patient, drug, dose,
route, time, and documentation, then rescan. Never bypass safety systems.
5. A nurse receives a verbal order from a physician for “morphine 2 mg IV now.”
Which action is most appropriate?
A. Administer the medication immediately
B. Repeat the order back to the physician and write it down
C. Ask the physician to come to the unit to write the order
D. Have another nurse listen to the order
Answer: B
Rationale: Verbal orders must be written down, read back to the prescriber for
verification, and then signed as a verbal order. Never administer without read-
back.
6. A patient is receiving IV vancomycin. The infusion is running at 1 gram over 30
minutes. The patient reports severe itching and redness on the face and neck. What
is the nurse’s priority action?
A. Slow the infusion rate
B. Stop the infusion immediately
C. Administer diphenhydramine
D. Document the reaction
Answer: B
Rationale: This describes “Red Man Syndrome” due to rapid vancomycin
infusion. The priority is to stop the infusion to prevent worsening hypotension and
angioedema.
7. A nurse is preparing insulin glargine (Lantus) and regular insulin for a patient.
Which action is correct?
A. Draw up regular insulin first, then glargine in the same syringe
B. Draw up glargine and regular in separate syringes
,C. Draw up glargine first, then regular in the same syringe
D. Glargine cannot be mixed; it is given intranasally
Answer: B
Rationale: Insulin glargine is a long-acting analog that should never be mixed
with any other insulin in the same syringe because pH changes alter absorption.
Use separate syringes.
8. A nurse administers furosemide 40 mg IV push over 1 minute. The patient
complains of tinnitus and hearing loss. Which action is most appropriate?
A. Administer naloxone
B. Stop the injection and notify the provider
C. Flush the IV line with normal saline
D. Continue the injection; these are expected side effects
Answer: B
Rationale: Tinnitus and hearing loss indicate ototoxicity from rapid IV furosemide
administration. Stop the injection immediately and report; ototoxicity may be
irreversible.
9. A patient is prescribed enoxaparin (Lovenox) 40 mg subcutaneously daily.
Which technique is correct?
A. Aspirate before injection to ensure no blood return
B. Inject into the abdomen at least 2 inches from the umbilicus
C. Massage the site after injection to distribute medication
D. Use a 1.5-inch needle at a 90-degree angle
Answer: B
Rationale: Enoxaparin is given subcutaneously into the abdomen (avoiding 2-inch
radius around umbilicus). Do not aspirate or massage; use a 5/8-inch needle at 45–
90 degrees.
10. A nurse needs to administer potassium chloride 20 mEq IV. The pharmacy
sends a bag containing 40 mEq. What should the nurse do?
A. Administer half the bag
B. Return the bag to the pharmacy and request the correct dose
C. Dilute the bag further with normal saline
D. Administer the full bag but document as 20 mEq
Answer: B
Rationale: Never partially administer IV bags with high-risk medications like
, potassium. Return to pharmacy for exact prescribed dose to prevent hyperkalemia
and cardiac arrest.
11. A patient is on warfarin and has an INR of 4.5. The patient has no signs of
bleeding. The next dose of warfarin is due in 2 hours. What should the nurse do?
A. Give the warfarin as ordered
B. Hold the warfarin and notify the provider
C. Give vitamin K 2.5 mg PO
D. Administer half the dose
Answer: B
Rationale: For INR >4.0 without bleeding, hold warfarin per protocol. The
provider may adjust dose. Vitamin K is for INR >4.5 with bleeding or very high
INR (>10).
12. A nurse is calculating the safe dose range for a child. The order is for cefazolin
250 mg IV q8h. The safe range is 25–50 mg/kg/day. The child weighs 20 kg. Is the
dose safe?
A. Yes, it is within the safe range
B. No, it exceeds the safe range
C. No, it is below the safe range
D. Cannot determine without renal function
Answer: B
Rationale: 250 mg q8h = 750 mg/day. 20 kg × 50 mg/kg/day = 1,000 mg/day
maximum; 20 × 25 = 500 mg/day minimum. 750 mg is within 500–1000? Wait
recalc: 750 is between 500 and 1000, so actually safe? Let me check: 20*25=500,
20*50=1000. 750 is within. So answer should be A. Correction: The dose is safe.
But the question says "exceeds" – that is wrong. I will correct:
Corrected Answer: A (Yes, it is within the safe range). But to maintain integrity,
I'll rephrase the question in the next set. For now, I'll adjust in final. But as AI, I'll
correct here: The correct answer is A.
Rationale: Daily dose = 250 mg × 3 = 750 mg. Safe range = 500–1,000 mg/day.
Dose is safe.
13. A nurse is preparing to administer fentanyl 50 mcg IV push. The vial contains
fentanyl 100 mcg/2 mL. How many mL should the nurse administer?
A. 0.5 mL
EXAM 2026–2027 Official Exam
1. A nurse is preparing to administer digoxin 0.25 mg PO to a patient with heart
failure. The patient’s apical pulse is 52 bpm. Which action should the nurse take
first?
A. Administer the digoxin as ordered
B. Hold the medication and reassess the pulse in 1 hour
C. Notify the provider immediately
D. Check the digoxin level
Answer: B
Rationale: Digoxin is held if the apical pulse is <60 bpm in adults. The nurse
should reassess after 1 hour; if still low, notify the provider. Checking the level is
not immediate priority.
2. A nurse accidentally administers heparin 10,000 units subcutaneously instead of
the prescribed 5,000 units. Which action is most important?
A. Complete an incident report
B. Assess the patient for signs of bleeding
C. Notify the charge nurse
D. Calculate the patient’s aPTT immediately
Answer: B
Rationale: Patient safety is paramount. The nurse must first assess for bleeding
(e.g., hematoma, hematuria, gum bleeding) before documentation or notification.
3. A patient with a penicillin allergy is prescribed amoxicillin. The nurse verifies
the allergy in the electronic health record. What is the priority action?
A. Administer the medication with diphenhydramine
B. Contact the prescriber to clarify the order
C. Give a test dose of amoxicillin
D. Document the allergy and administer
Answer: B
Rationale: A documented penicillin allergy is a contraindication. The nurse must
hold the medication and contact the prescriber for an alternative antibiotic.
,4. A nurse is using bar-code medication administration (BCMA). The scanner
indicates “medication not found.” What should the nurse do?
A. Bypass the system and manually document administration
B. Verify the medication using the six rights and rescan
C. Return all medications to the pharmacy
D. Administer the medication and scan later
Answer: B
Rationale: BCMA errors require the nurse to verify the correct patient, drug, dose,
route, time, and documentation, then rescan. Never bypass safety systems.
5. A nurse receives a verbal order from a physician for “morphine 2 mg IV now.”
Which action is most appropriate?
A. Administer the medication immediately
B. Repeat the order back to the physician and write it down
C. Ask the physician to come to the unit to write the order
D. Have another nurse listen to the order
Answer: B
Rationale: Verbal orders must be written down, read back to the prescriber for
verification, and then signed as a verbal order. Never administer without read-
back.
6. A patient is receiving IV vancomycin. The infusion is running at 1 gram over 30
minutes. The patient reports severe itching and redness on the face and neck. What
is the nurse’s priority action?
A. Slow the infusion rate
B. Stop the infusion immediately
C. Administer diphenhydramine
D. Document the reaction
Answer: B
Rationale: This describes “Red Man Syndrome” due to rapid vancomycin
infusion. The priority is to stop the infusion to prevent worsening hypotension and
angioedema.
7. A nurse is preparing insulin glargine (Lantus) and regular insulin for a patient.
Which action is correct?
A. Draw up regular insulin first, then glargine in the same syringe
B. Draw up glargine and regular in separate syringes
,C. Draw up glargine first, then regular in the same syringe
D. Glargine cannot be mixed; it is given intranasally
Answer: B
Rationale: Insulin glargine is a long-acting analog that should never be mixed
with any other insulin in the same syringe because pH changes alter absorption.
Use separate syringes.
8. A nurse administers furosemide 40 mg IV push over 1 minute. The patient
complains of tinnitus and hearing loss. Which action is most appropriate?
A. Administer naloxone
B. Stop the injection and notify the provider
C. Flush the IV line with normal saline
D. Continue the injection; these are expected side effects
Answer: B
Rationale: Tinnitus and hearing loss indicate ototoxicity from rapid IV furosemide
administration. Stop the injection immediately and report; ototoxicity may be
irreversible.
9. A patient is prescribed enoxaparin (Lovenox) 40 mg subcutaneously daily.
Which technique is correct?
A. Aspirate before injection to ensure no blood return
B. Inject into the abdomen at least 2 inches from the umbilicus
C. Massage the site after injection to distribute medication
D. Use a 1.5-inch needle at a 90-degree angle
Answer: B
Rationale: Enoxaparin is given subcutaneously into the abdomen (avoiding 2-inch
radius around umbilicus). Do not aspirate or massage; use a 5/8-inch needle at 45–
90 degrees.
10. A nurse needs to administer potassium chloride 20 mEq IV. The pharmacy
sends a bag containing 40 mEq. What should the nurse do?
A. Administer half the bag
B. Return the bag to the pharmacy and request the correct dose
C. Dilute the bag further with normal saline
D. Administer the full bag but document as 20 mEq
Answer: B
Rationale: Never partially administer IV bags with high-risk medications like
, potassium. Return to pharmacy for exact prescribed dose to prevent hyperkalemia
and cardiac arrest.
11. A patient is on warfarin and has an INR of 4.5. The patient has no signs of
bleeding. The next dose of warfarin is due in 2 hours. What should the nurse do?
A. Give the warfarin as ordered
B. Hold the warfarin and notify the provider
C. Give vitamin K 2.5 mg PO
D. Administer half the dose
Answer: B
Rationale: For INR >4.0 without bleeding, hold warfarin per protocol. The
provider may adjust dose. Vitamin K is for INR >4.5 with bleeding or very high
INR (>10).
12. A nurse is calculating the safe dose range for a child. The order is for cefazolin
250 mg IV q8h. The safe range is 25–50 mg/kg/day. The child weighs 20 kg. Is the
dose safe?
A. Yes, it is within the safe range
B. No, it exceeds the safe range
C. No, it is below the safe range
D. Cannot determine without renal function
Answer: B
Rationale: 250 mg q8h = 750 mg/day. 20 kg × 50 mg/kg/day = 1,000 mg/day
maximum; 20 × 25 = 500 mg/day minimum. 750 mg is within 500–1000? Wait
recalc: 750 is between 500 and 1000, so actually safe? Let me check: 20*25=500,
20*50=1000. 750 is within. So answer should be A. Correction: The dose is safe.
But the question says "exceeds" – that is wrong. I will correct:
Corrected Answer: A (Yes, it is within the safe range). But to maintain integrity,
I'll rephrase the question in the next set. For now, I'll adjust in final. But as AI, I'll
correct here: The correct answer is A.
Rationale: Daily dose = 250 mg × 3 = 750 mg. Safe range = 500–1,000 mg/day.
Dose is safe.
13. A nurse is preparing to administer fentanyl 50 mcg IV push. The vial contains
fentanyl 100 mcg/2 mL. How many mL should the nurse administer?
A. 0.5 mL
