1
EVOLVE HESI PHARM EXAM Actual Exam
2026/2027 Complete Questions and Verified
Answers with Detailed Answers Already Graded
A+ Pass Guaranteed - A+ Graded
Question 1
A 68-year-old male with heart failure is prescribed lisinopril 10 mg PO daily. The nurse reviews
his laboratory results and notes a serum creatinine of 2.8 mg/dL (baseline 1.2 mg/dL). Which
action should the nurse take first?
A. Hold the dose and notify the provider
B. Administer the medication as prescribed
C. Check the patient's blood pressure
D. Assess for signs of hyperkalemia
Correct Answer: A
Rationale: Lisinopril is an ACE inhibitor that can cause acute kidney injury (AKI), particularly in
patients with pre-existing renal impairment or heart failure. A creatinine increase of >0.5 mg/dL
from baseline or >30% increase warrants immediate provider notification and likely medication
hold. ACE inhibitors reduce glomerular filtration pressure by dilating efferent arterioles in the
kidney, which can worsen renal function in volume-depleted patients or those with renal artery
stenosis.
Mechanism of Action: ACE inhibitors block the conversion of angiotensin I to angiotensin II,
reducing vasoconstriction, aldosterone secretion, and sodium/water retention.
Key Nursing Point: Monitor serum creatinine and potassium levels within 1-2 weeks of initiation
or dose increase. An increase in creatinine up to 30% may be acceptable, but >30% requires
intervention.
Question 2
A patient receiving warfarin therapy has an INR of 5.2 (therapeutic range 2.0-3.0). The patient
has no active bleeding. Which intervention is most appropriate?
A. Administer vitamin K 10 mg IV immediately
,2
B. Hold warfarin and monitor INR daily
C. Administer fresh frozen plasma (FFP)
D. Give warfarin at a reduced dose
Correct Answer: B
Rationale: For an INR of 5.2 without bleeding, the standard of care is to hold warfarin and
monitor INR daily until it returns to therapeutic range. Vitamin K is reserved for INR >10 or
serious bleeding. FFP is for life-threatening bleeding only. The 2024 CHEST guidelines
emphasize avoiding overtreatment of elevated INRs without bleeding to prevent thrombotic
complications.
Mechanism of Action: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X) and
proteins C and S.
Key Nursing Point: Educate patients to avoid vitamin K-rich foods (dark leafy greens) in
inconsistent amounts, as this can destabilize INR control.
Question 3
A patient with atrial fibrillation is prescribed dabigatran 150 mg PO BID. Which statement by
the patient indicates understanding of the medication teaching?
A. "I will need to have my INR checked monthly."
B. "I should take this medication with food to increase absorption."
C. "I need to store this medication in the original bottle to protect it from moisture."
D. "If I miss a dose, I should double up on the next dose."
Correct Answer: C
Rationale: Dabigatran is a direct thrombin inhibitor (DOAC) that requires storage in the original
container to protect from moisture degradation. Unlike warfarin, it does not require INR
monitoring (A is incorrect). It should be taken with or without food, but not specifically with
food for absorption (B is incorrect). For missed doses, the patient should take it as soon as
remembered on the same day, but never double up (D is incorrect).
Mechanism of Action: Direct thrombin inhibitor that prevents conversion of fibrinogen to fibrin.
Key Nursing Point: Dabigatran has a black box warning for increased risk of thrombotic events
if discontinued prematurely and for spinal/epidural hematoma in patients with indwelling
catheters.
Question 4
,3
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?
A. Administer the medication as ordered
B. Hold the dose and notify the provider
C. Check the radial pulse for 1 full minute
D. Administer half the prescribed dose
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index and can cause severe bradycardia. The
medication should be held and the provider notified if the apical pulse is <60 bpm in adults.
Digoxin slows AV nodal conduction and increases myocardial contractility, but toxicity can
cause life-threatening arrhythmias.
Mechanism of Action: Inhibits Na+/K+-ATPase pump, increasing intracellular calcium and
myocardial contractility; increases vagal tone slowing AV conduction.
Key Nursing Point: Always check apical pulse for 1 full minute before administration.
Therapeutic digoxin level is 0.5-0.9 ng/mL for heart failure (lower than the traditional 0.8-2.0
ng/mL).
Question 5
A patient with hypertension is prescribed metoprolol succinate 50 mg PO daily. Which
assessment finding requires immediate nursing intervention?
A. Blood pressure 128/78 mmHg
B. Heart rate 48 bpm
C. Respiratory rate 16 breaths/min
D. Complaint of mild fatigue
Correct Answer: B
Rationale: Metoprolol is a cardioselective beta-1 blocker that can cause significant bradycardia.
A heart rate of 48 bpm requires immediate assessment and likely medication hold. While mild
fatigue is common initially, severe bradycardia (<50 bpm) can compromise cardiac output and
requires intervention.
Mechanism of Action: Selective beta-1 adrenergic antagonist that reduces heart rate, myocardial
contractility, and renin release.
, 4
Key Nursing Point: Never abruptly discontinue beta-blockers due to risk of rebound
hypertension, tachycardia, and myocardial ischemia. Taper over 1-2 weeks.
Question 6
A patient is prescribed atorvastatin 40 mg PO at bedtime. Which laboratory value requires
immediate follow-up?
A. LDL cholesterol 95 mg/dL
B. HDL cholesterol 55 mg/dL
C. ALT 120 U/L (normal 7-56 U/L)
D. Total cholesterol 180 mg/dL
Correct Answer: C
Rationale: Statins can cause hepatotoxicity. ALT or AST >3 times the upper limit of normal
requires discontinuation and provider notification. The FDA removed the requirement for routine
liver function monitoring in 2012, but baseline and symptom-driven testing remains essential.
Muscle symptoms with CK >10x ULN or myoglobinuria also require immediate discontinuation.
Mechanism of Action: HMG-CoA reductase inhibitor that blocks cholesterol synthesis in the
liver, upregulating LDL receptors.
Key Nursing Point: Educate patients to report muscle pain, weakness, or dark urine immediately.
Grapefruit juice increases statin levels and should be avoided.
Question 7
A patient with acute coronary syndrome is receiving heparin IV infusion. The aPTT is 95
seconds (control 30 seconds, therapeutic range 60-80 seconds). Which action should the nurse
take?
A. Continue the infusion at the current rate
B. Increase the infusion rate by 2 units/kg/hr
C. Stop the infusion for 1 hour, then resume at decreased rate
D. Administer protamine sulfate
Correct Answer: C
Rationale: For aPTT >90 seconds (supratherapeutic but not critically high), the standard protocol
is to stop the infusion for 1 hour, then resume at a decreased rate (typically by 2-4 units/kg/hr).
Protamine sulfate (D) is reserved for severe bleeding or aPTT >120 seconds. The 2024
EVOLVE HESI PHARM EXAM Actual Exam
2026/2027 Complete Questions and Verified
Answers with Detailed Answers Already Graded
A+ Pass Guaranteed - A+ Graded
Question 1
A 68-year-old male with heart failure is prescribed lisinopril 10 mg PO daily. The nurse reviews
his laboratory results and notes a serum creatinine of 2.8 mg/dL (baseline 1.2 mg/dL). Which
action should the nurse take first?
A. Hold the dose and notify the provider
B. Administer the medication as prescribed
C. Check the patient's blood pressure
D. Assess for signs of hyperkalemia
Correct Answer: A
Rationale: Lisinopril is an ACE inhibitor that can cause acute kidney injury (AKI), particularly in
patients with pre-existing renal impairment or heart failure. A creatinine increase of >0.5 mg/dL
from baseline or >30% increase warrants immediate provider notification and likely medication
hold. ACE inhibitors reduce glomerular filtration pressure by dilating efferent arterioles in the
kidney, which can worsen renal function in volume-depleted patients or those with renal artery
stenosis.
Mechanism of Action: ACE inhibitors block the conversion of angiotensin I to angiotensin II,
reducing vasoconstriction, aldosterone secretion, and sodium/water retention.
Key Nursing Point: Monitor serum creatinine and potassium levels within 1-2 weeks of initiation
or dose increase. An increase in creatinine up to 30% may be acceptable, but >30% requires
intervention.
Question 2
A patient receiving warfarin therapy has an INR of 5.2 (therapeutic range 2.0-3.0). The patient
has no active bleeding. Which intervention is most appropriate?
A. Administer vitamin K 10 mg IV immediately
,2
B. Hold warfarin and monitor INR daily
C. Administer fresh frozen plasma (FFP)
D. Give warfarin at a reduced dose
Correct Answer: B
Rationale: For an INR of 5.2 without bleeding, the standard of care is to hold warfarin and
monitor INR daily until it returns to therapeutic range. Vitamin K is reserved for INR >10 or
serious bleeding. FFP is for life-threatening bleeding only. The 2024 CHEST guidelines
emphasize avoiding overtreatment of elevated INRs without bleeding to prevent thrombotic
complications.
Mechanism of Action: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X) and
proteins C and S.
Key Nursing Point: Educate patients to avoid vitamin K-rich foods (dark leafy greens) in
inconsistent amounts, as this can destabilize INR control.
Question 3
A patient with atrial fibrillation is prescribed dabigatran 150 mg PO BID. Which statement by
the patient indicates understanding of the medication teaching?
A. "I will need to have my INR checked monthly."
B. "I should take this medication with food to increase absorption."
C. "I need to store this medication in the original bottle to protect it from moisture."
D. "If I miss a dose, I should double up on the next dose."
Correct Answer: C
Rationale: Dabigatran is a direct thrombin inhibitor (DOAC) that requires storage in the original
container to protect from moisture degradation. Unlike warfarin, it does not require INR
monitoring (A is incorrect). It should be taken with or without food, but not specifically with
food for absorption (B is incorrect). For missed doses, the patient should take it as soon as
remembered on the same day, but never double up (D is incorrect).
Mechanism of Action: Direct thrombin inhibitor that prevents conversion of fibrinogen to fibrin.
Key Nursing Point: Dabigatran has a black box warning for increased risk of thrombotic events
if discontinued prematurely and for spinal/epidural hematoma in patients with indwelling
catheters.
Question 4
,3
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?
A. Administer the medication as ordered
B. Hold the dose and notify the provider
C. Check the radial pulse for 1 full minute
D. Administer half the prescribed dose
Correct Answer: B
Rationale: Digoxin has a narrow therapeutic index and can cause severe bradycardia. The
medication should be held and the provider notified if the apical pulse is <60 bpm in adults.
Digoxin slows AV nodal conduction and increases myocardial contractility, but toxicity can
cause life-threatening arrhythmias.
Mechanism of Action: Inhibits Na+/K+-ATPase pump, increasing intracellular calcium and
myocardial contractility; increases vagal tone slowing AV conduction.
Key Nursing Point: Always check apical pulse for 1 full minute before administration.
Therapeutic digoxin level is 0.5-0.9 ng/mL for heart failure (lower than the traditional 0.8-2.0
ng/mL).
Question 5
A patient with hypertension is prescribed metoprolol succinate 50 mg PO daily. Which
assessment finding requires immediate nursing intervention?
A. Blood pressure 128/78 mmHg
B. Heart rate 48 bpm
C. Respiratory rate 16 breaths/min
D. Complaint of mild fatigue
Correct Answer: B
Rationale: Metoprolol is a cardioselective beta-1 blocker that can cause significant bradycardia.
A heart rate of 48 bpm requires immediate assessment and likely medication hold. While mild
fatigue is common initially, severe bradycardia (<50 bpm) can compromise cardiac output and
requires intervention.
Mechanism of Action: Selective beta-1 adrenergic antagonist that reduces heart rate, myocardial
contractility, and renin release.
, 4
Key Nursing Point: Never abruptly discontinue beta-blockers due to risk of rebound
hypertension, tachycardia, and myocardial ischemia. Taper over 1-2 weeks.
Question 6
A patient is prescribed atorvastatin 40 mg PO at bedtime. Which laboratory value requires
immediate follow-up?
A. LDL cholesterol 95 mg/dL
B. HDL cholesterol 55 mg/dL
C. ALT 120 U/L (normal 7-56 U/L)
D. Total cholesterol 180 mg/dL
Correct Answer: C
Rationale: Statins can cause hepatotoxicity. ALT or AST >3 times the upper limit of normal
requires discontinuation and provider notification. The FDA removed the requirement for routine
liver function monitoring in 2012, but baseline and symptom-driven testing remains essential.
Muscle symptoms with CK >10x ULN or myoglobinuria also require immediate discontinuation.
Mechanism of Action: HMG-CoA reductase inhibitor that blocks cholesterol synthesis in the
liver, upregulating LDL receptors.
Key Nursing Point: Educate patients to report muscle pain, weakness, or dark urine immediately.
Grapefruit juice increases statin levels and should be avoided.
Question 7
A patient with acute coronary syndrome is receiving heparin IV infusion. The aPTT is 95
seconds (control 30 seconds, therapeutic range 60-80 seconds). Which action should the nurse
take?
A. Continue the infusion at the current rate
B. Increase the infusion rate by 2 units/kg/hr
C. Stop the infusion for 1 hour, then resume at decreased rate
D. Administer protamine sulfate
Correct Answer: C
Rationale: For aPTT >90 seconds (supratherapeutic but not critically high), the standard protocol
is to stop the infusion for 1 hour, then resume at a decreased rate (typically by 2-4 units/kg/hr).
Protamine sulfate (D) is reserved for severe bleeding or aPTT >120 seconds. The 2024
