1
2025-2026 ATI RN Comprehensive Exit Exam: 180
Verified Pharmacology Questions & Detailed Rationales
– Guaranteed Pass!
1
A 68-year-old client with chronic obstructive pulmonary disease (COPD) is
receiving a new prescription for ipratropium (inhaler). Which statement by the
client indicates correct understanding?
A. “I’ll use this inhaler when I feel short of breath for quick relief.”
B. “I should rinse my mouth after each use to prevent thrush.”
C. “This medication is an anticholinergic and works by blocking muscarinic
receptors to bronchodilate.”
D. “I should take this medication only at bedtime.”
Correct Answer: C. “This medication is an anticholinergic and works by
blocking muscarinic receptors to bronchodilate.”
Rationale: Ipratropium is an inhaled anticholinergic that causes bronchodilation
by blocking muscarinic receptors in the airways; that mechanism statement is
accurate. It is not primarily a rescue inhaler like a short-acting beta agonist (so A is
incorrect). Rinsing the mouth is important after inhaled corticosteroids to prevent
, 2
thrush, but ipratropium does not require this routine (so B is misleading). It is used
as prescribed for maintenance or symptomatic relief and not reserved only for
bedtime (D is incorrect).
2
A postoperative client who received morphine 4 hours ago is drowsy and has a
respiratory rate of 8 breaths/min. What is the nurse’s best immediate action?
A. Stimulate the client by calling their name and rubbing their sternum.
B. Administer naloxone per standing order.
C. Place the client in a high-Fowler’s position.
D. Call the physician and await further orders.
Correct Answer: B. Administer naloxone per standing order.
Rationale: Respiratory depression (RR 8) with decreased responsiveness after
opioids is life-threatening; naloxone is the opioid antagonist that reverses opioid-
induced respiratory depression and should be given promptly (if standing order
exists). Stimulation (A) is a temporary measure but insufficient when RR is
dangerously low. Positioning (C) and calling the physician (D) delay a definitive
reversal and place the client at risk.
3
A client on warfarin (Coumadin) has an INR of 4.6 (therapeutic 2–3). The client
has no bleeding. What should the nurse anticipate?
A. Continue the dose and recheck INR in 1 week.
B. Give vitamin K orally and hold warfarin per provider instructions.
, 3
C. Increase warfarin dose to achieve therapeutic INR faster.
D. Administer protamine sulfate immediately.
Correct Answer: B. Give vitamin K orally and hold warfarin per provider
instructions.
Rationale: An INR of 4.6 increases bleeding risk. The usual action for elevated
INR without major bleeding is to hold warfarin and give low-dose oral vitamin K
per provider guidance to bring INR down safely. Continuing the dose (A) is unsafe.
Increasing warfarin (C) would worsen INR. Protamine sulfate (D) reverses
heparin, not warfarin.
4
A 24-hour urine collection is ordered for a client. Which instruction should the
nurse give the client?
A. Discard the first urine and then collect all urine for the next 24 hours, including
the final void.
B. Begin collecting with the first urine of the morning and end with the first urine
the next morning.
C. Collect one noon urine sample and refrigerate it.
D. Void and include that specimen as the start of the 24-hour collection.
Correct Answer: A. Discard the first urine and then collect all urine for the
next 24 hours, including the final void.
Rationale: Standard 24-hour urine collection instructions are to discard the first
morning void, then collect all urine for the subsequent 24 hours, including the final
void at the 24-hour mark. Beginning with the first morning urine and then taking
the next day’s first morning urine (B) is equivalent in timing but the teaching
, 4
typically uses the discard-first method. Collecting a single noon sample (C) is
incorrect. Void-and-include (D) would alter total volume and timing.
5
A client taking levothyroxine asks when to take the medication. What is the nurse’s
best response?
A. “Take it with your morning coffee to prevent stomach upset.”
B. “Take it on an empty stomach at least 30–60 minutes before breakfast.”
C. “Take it only when you feel tired.”
D. “Take it with iron supplements to increase absorption.”
Correct Answer: B. “Take it on an empty stomach at least 30–60 minutes
before breakfast.”
Rationale: Levothyroxine is best absorbed on an empty stomach; instructing the
client to take it 30–60 minutes before breakfast optimizes absorption. Coffee can
reduce absorption (A is incorrect). It must be taken daily as prescribed, not
intermittently when tired (C). Iron interferes with absorption and should not be
taken at the same time (D is incorrect).
6
A nurse is triaging a toddler with dehydration. Which sign is most indicative of
severe dehydration?
A. Slightly dry mucous membranes and normal capillary refill
B. Sunken fontanel and capillary refill >4 seconds
2025-2026 ATI RN Comprehensive Exit Exam: 180
Verified Pharmacology Questions & Detailed Rationales
– Guaranteed Pass!
1
A 68-year-old client with chronic obstructive pulmonary disease (COPD) is
receiving a new prescription for ipratropium (inhaler). Which statement by the
client indicates correct understanding?
A. “I’ll use this inhaler when I feel short of breath for quick relief.”
B. “I should rinse my mouth after each use to prevent thrush.”
C. “This medication is an anticholinergic and works by blocking muscarinic
receptors to bronchodilate.”
D. “I should take this medication only at bedtime.”
Correct Answer: C. “This medication is an anticholinergic and works by
blocking muscarinic receptors to bronchodilate.”
Rationale: Ipratropium is an inhaled anticholinergic that causes bronchodilation
by blocking muscarinic receptors in the airways; that mechanism statement is
accurate. It is not primarily a rescue inhaler like a short-acting beta agonist (so A is
incorrect). Rinsing the mouth is important after inhaled corticosteroids to prevent
, 2
thrush, but ipratropium does not require this routine (so B is misleading). It is used
as prescribed for maintenance or symptomatic relief and not reserved only for
bedtime (D is incorrect).
2
A postoperative client who received morphine 4 hours ago is drowsy and has a
respiratory rate of 8 breaths/min. What is the nurse’s best immediate action?
A. Stimulate the client by calling their name and rubbing their sternum.
B. Administer naloxone per standing order.
C. Place the client in a high-Fowler’s position.
D. Call the physician and await further orders.
Correct Answer: B. Administer naloxone per standing order.
Rationale: Respiratory depression (RR 8) with decreased responsiveness after
opioids is life-threatening; naloxone is the opioid antagonist that reverses opioid-
induced respiratory depression and should be given promptly (if standing order
exists). Stimulation (A) is a temporary measure but insufficient when RR is
dangerously low. Positioning (C) and calling the physician (D) delay a definitive
reversal and place the client at risk.
3
A client on warfarin (Coumadin) has an INR of 4.6 (therapeutic 2–3). The client
has no bleeding. What should the nurse anticipate?
A. Continue the dose and recheck INR in 1 week.
B. Give vitamin K orally and hold warfarin per provider instructions.
, 3
C. Increase warfarin dose to achieve therapeutic INR faster.
D. Administer protamine sulfate immediately.
Correct Answer: B. Give vitamin K orally and hold warfarin per provider
instructions.
Rationale: An INR of 4.6 increases bleeding risk. The usual action for elevated
INR without major bleeding is to hold warfarin and give low-dose oral vitamin K
per provider guidance to bring INR down safely. Continuing the dose (A) is unsafe.
Increasing warfarin (C) would worsen INR. Protamine sulfate (D) reverses
heparin, not warfarin.
4
A 24-hour urine collection is ordered for a client. Which instruction should the
nurse give the client?
A. Discard the first urine and then collect all urine for the next 24 hours, including
the final void.
B. Begin collecting with the first urine of the morning and end with the first urine
the next morning.
C. Collect one noon urine sample and refrigerate it.
D. Void and include that specimen as the start of the 24-hour collection.
Correct Answer: A. Discard the first urine and then collect all urine for the
next 24 hours, including the final void.
Rationale: Standard 24-hour urine collection instructions are to discard the first
morning void, then collect all urine for the subsequent 24 hours, including the final
void at the 24-hour mark. Beginning with the first morning urine and then taking
the next day’s first morning urine (B) is equivalent in timing but the teaching
, 4
typically uses the discard-first method. Collecting a single noon sample (C) is
incorrect. Void-and-include (D) would alter total volume and timing.
5
A client taking levothyroxine asks when to take the medication. What is the nurse’s
best response?
A. “Take it with your morning coffee to prevent stomach upset.”
B. “Take it on an empty stomach at least 30–60 minutes before breakfast.”
C. “Take it only when you feel tired.”
D. “Take it with iron supplements to increase absorption.”
Correct Answer: B. “Take it on an empty stomach at least 30–60 minutes
before breakfast.”
Rationale: Levothyroxine is best absorbed on an empty stomach; instructing the
client to take it 30–60 minutes before breakfast optimizes absorption. Coffee can
reduce absorption (A is incorrect). It must be taken daily as prescribed, not
intermittently when tired (C). Iron interferes with absorption and should not be
taken at the same time (D is incorrect).
6
A nurse is triaging a toddler with dehydration. Which sign is most indicative of
severe dehydration?
A. Slightly dry mucous membranes and normal capillary refill
B. Sunken fontanel and capillary refill >4 seconds
