Comprehensive ATI RN Pharmacology NGN
Exam Prep Featuring Updated Proctored
Practice Questions, Rationales & High-Yield
Nursing Review for 2026 Success
• This study guide contains 200 practice questions mirroring the ATI RN
Pharmacology Proctored Exam NGN 2026 format, covering all major drug classes,
mechanisms, nursing considerations, and client safety priorities.
• Use this material by reading each question independently before checking the
correct answer and EXPERT RATIONALE — this active recall method strengthens
retention and prepares you for the adaptive NGN item types.
1. A nurse is caring for a client who is prescribed warfarin. Which laboratory
value should the nurse monitor to evaluate the therapeutic effect of this
medication?
A. Activated partial thromboplastin time (aPTT)
B. Complete blood count (CBC)
C. Serum potassium level
D. Prothrombin time/INR
E. Serum creatinine level
Correct Answer: D. Prothrombin time/INR
EXPERT RATIONALE: Warfarin is a vitamin K antagonist anticoagulant. Its
therapeutic effect is monitored using the PT/INR. The target INR for most
indications is 2.0–3.0. aPTT is used to monitor heparin therapy, not warfarin.
2. A nurse is preparing to administer digoxin to a client. Which assessment
finding should prompt the nurse to withhold the medication and notify the
provider?
A. Blood pressure of 130/80 mmHg
B. Apical pulse of 56 beats per minute
,C. Respiratory rate of 18 breaths per minute
D. Blood glucose of 110 mg/dL
E. Temperature of 37.2°C
Correct Answer: B. Apical pulse of 56 beats per minute
EXPERT RATIONALE: Digoxin slows the heart rate. The nurse should withhold
digoxin and notify the provider if the apical pulse is below 60 beats per minute in
an adult, as the medication can cause life-threatening bradycardia and heart block.
3. A client is prescribed metformin for type 2 diabetes. Which condition in the
client's history should the nurse identify as a contraindication to this
medication?
A. Hypertension
B. Chronic kidney disease stage 4
C. Hypothyroidism
D. Osteoarthritis
E. Mild anemia
Correct Answer: B. Chronic kidney disease stage 4
EXPERT RATIONALE: Metformin is contraindicated in significant renal impairment
(eGFR <30) due to the risk of lactic acidosis, a rare but potentially fatal complication.
The kidneys are responsible for clearing metformin from the body.
4. A nurse is teaching a client who is prescribed alendronate (Fosamax). Which
instruction should the nurse include?
A. Take the medication with a full meal
B. Lie down for 30 minutes after taking the medication
C. Take the medication with a full glass of water and remain upright for 30 minutes
,D. Crush the tablet if swallowing is difficult
E. Take it at bedtime for best absorption
Correct Answer: C. Take the medication with a full glass of water and remain
upright for 30 minutes
EXPERT RATIONALE: Alendronate is a bisphosphonate that can cause esophageal
irritation and ulceration. Clients must take it with 8 oz of water, remain upright
(sitting or standing) for at least 30 minutes, and take it on an empty stomach to
ensure proper absorption.
5. A nurse is administering IV vancomycin to a client. The client develops
flushing, erythema, and hypotension during the infusion. What is the nurse's
priority action?
A. Administer diphenhydramine immediately
B. Stop the infusion and notify the provider
C. Slow the infusion rate
D. Apply a cold compress to the flushed area
E. Document the reaction and continue monitoring
Correct Answer: C. Slow the infusion rate
EXPERT RATIONALE: The client is experiencing Red Man Syndrome, a non-allergic
infusion-related reaction to vancomycin caused by too-rapid infusion. The first
intervention is to slow the infusion rate. If symptoms persist, the infusion may be
stopped and diphenhydramine administered.
6. A nurse is caring for a client receiving heparin infusion. Which antidote
should the nurse have available in case of heparin toxicity?
A. Vitamin K
B. Naloxone
, C. Flumazenil
D. Protamine sulfate
E. Acetylcysteine
Correct Answer: D. Protamine sulfate
EXPERT RATIONALE: Protamine sulfate is the antidote for heparin overdose. It
binds to heparin and forms a stable complex, neutralizing its anticoagulant effect.
Vitamin K is the antidote for warfarin toxicity.
7. A nurse is reviewing a client's medication list. Which medication puts the
client at the greatest risk for hypokalemia?
A. Lisinopril
B. Spironolactone
C. Furosemide
D. Metoprolol
E. Amlodipine
Correct Answer: C. Furosemide
EXPERT RATIONALE: Furosemide is a loop diuretic that causes significant
potassium wasting through the kidneys. Clients taking furosemide are at high risk
for hypokalemia and should be monitored closely. Lisinopril and spironolactone are
potassium-sparing.
8. A client prescribed lithium carbonate for bipolar disorder reports nausea,
tremors, and confusion. The nurse checks the serum lithium level, which is 2.1
mEq/L. What is the nurse's priority action?
A. Administer an antiemetic and reassure the client
B. Encourage the client to increase fluid intake
Exam Prep Featuring Updated Proctored
Practice Questions, Rationales & High-Yield
Nursing Review for 2026 Success
• This study guide contains 200 practice questions mirroring the ATI RN
Pharmacology Proctored Exam NGN 2026 format, covering all major drug classes,
mechanisms, nursing considerations, and client safety priorities.
• Use this material by reading each question independently before checking the
correct answer and EXPERT RATIONALE — this active recall method strengthens
retention and prepares you for the adaptive NGN item types.
1. A nurse is caring for a client who is prescribed warfarin. Which laboratory
value should the nurse monitor to evaluate the therapeutic effect of this
medication?
A. Activated partial thromboplastin time (aPTT)
B. Complete blood count (CBC)
C. Serum potassium level
D. Prothrombin time/INR
E. Serum creatinine level
Correct Answer: D. Prothrombin time/INR
EXPERT RATIONALE: Warfarin is a vitamin K antagonist anticoagulant. Its
therapeutic effect is monitored using the PT/INR. The target INR for most
indications is 2.0–3.0. aPTT is used to monitor heparin therapy, not warfarin.
2. A nurse is preparing to administer digoxin to a client. Which assessment
finding should prompt the nurse to withhold the medication and notify the
provider?
A. Blood pressure of 130/80 mmHg
B. Apical pulse of 56 beats per minute
,C. Respiratory rate of 18 breaths per minute
D. Blood glucose of 110 mg/dL
E. Temperature of 37.2°C
Correct Answer: B. Apical pulse of 56 beats per minute
EXPERT RATIONALE: Digoxin slows the heart rate. The nurse should withhold
digoxin and notify the provider if the apical pulse is below 60 beats per minute in
an adult, as the medication can cause life-threatening bradycardia and heart block.
3. A client is prescribed metformin for type 2 diabetes. Which condition in the
client's history should the nurse identify as a contraindication to this
medication?
A. Hypertension
B. Chronic kidney disease stage 4
C. Hypothyroidism
D. Osteoarthritis
E. Mild anemia
Correct Answer: B. Chronic kidney disease stage 4
EXPERT RATIONALE: Metformin is contraindicated in significant renal impairment
(eGFR <30) due to the risk of lactic acidosis, a rare but potentially fatal complication.
The kidneys are responsible for clearing metformin from the body.
4. A nurse is teaching a client who is prescribed alendronate (Fosamax). Which
instruction should the nurse include?
A. Take the medication with a full meal
B. Lie down for 30 minutes after taking the medication
C. Take the medication with a full glass of water and remain upright for 30 minutes
,D. Crush the tablet if swallowing is difficult
E. Take it at bedtime for best absorption
Correct Answer: C. Take the medication with a full glass of water and remain
upright for 30 minutes
EXPERT RATIONALE: Alendronate is a bisphosphonate that can cause esophageal
irritation and ulceration. Clients must take it with 8 oz of water, remain upright
(sitting or standing) for at least 30 minutes, and take it on an empty stomach to
ensure proper absorption.
5. A nurse is administering IV vancomycin to a client. The client develops
flushing, erythema, and hypotension during the infusion. What is the nurse's
priority action?
A. Administer diphenhydramine immediately
B. Stop the infusion and notify the provider
C. Slow the infusion rate
D. Apply a cold compress to the flushed area
E. Document the reaction and continue monitoring
Correct Answer: C. Slow the infusion rate
EXPERT RATIONALE: The client is experiencing Red Man Syndrome, a non-allergic
infusion-related reaction to vancomycin caused by too-rapid infusion. The first
intervention is to slow the infusion rate. If symptoms persist, the infusion may be
stopped and diphenhydramine administered.
6. A nurse is caring for a client receiving heparin infusion. Which antidote
should the nurse have available in case of heparin toxicity?
A. Vitamin K
B. Naloxone
, C. Flumazenil
D. Protamine sulfate
E. Acetylcysteine
Correct Answer: D. Protamine sulfate
EXPERT RATIONALE: Protamine sulfate is the antidote for heparin overdose. It
binds to heparin and forms a stable complex, neutralizing its anticoagulant effect.
Vitamin K is the antidote for warfarin toxicity.
7. A nurse is reviewing a client's medication list. Which medication puts the
client at the greatest risk for hypokalemia?
A. Lisinopril
B. Spironolactone
C. Furosemide
D. Metoprolol
E. Amlodipine
Correct Answer: C. Furosemide
EXPERT RATIONALE: Furosemide is a loop diuretic that causes significant
potassium wasting through the kidneys. Clients taking furosemide are at high risk
for hypokalemia and should be monitored closely. Lisinopril and spironolactone are
potassium-sparing.
8. A client prescribed lithium carbonate for bipolar disorder reports nausea,
tremors, and confusion. The nurse checks the serum lithium level, which is 2.1
mEq/L. What is the nurse's priority action?
A. Administer an antiemetic and reassure the client
B. Encourage the client to increase fluid intake
