NURS 4050 -SCHOOL OF NURSING AND MIDWIFERY
EVOLVE HESI PHARMACOLOGY FINAL PROFESSIONAL
EXAMINATION – 2026
QUESTIONS AND ANSWERS WITH CORRECT RATIONALES
| HIGHER TIER EXAM
PASS GUARANTEED | GRADE A+
The nurse is reviewing prescribed medications with a female client who is preparing for
discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the
IV dose that she received during hospitalization. Which response is best for the nurse to
provide?
A. A higher dose of analgesic medication may be needed after discharge.
B. An error in the dose calculation may have occurred when the prescribed dose was converted.
C. The doses should be the same unless the pain is not well controlled.
D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.
D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.
Oral doses of medication are usually larger than parenteral doses to compensate for the first-
pass effect in the liver after oral administration, which metabolizes more of the drug's dose
before affecting its therapeutic response. Although recommended dose ranges for adults should
be individualized, a client's pain should be controlled at discharge, not option A or C. Option B is
inaccurate information to convey to the client.
,The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory
personnel. What is the best schedule for drawing the trough level?
A. Give the dose of medication, and call the laboratory to draw the trough STAT.
B. Arrange for the laboratory to draw the trough 1 hour after the dose is given.
C. Instruct the laboratory to draw the trough immediately before the next scheduled dose.
D. Give the first dose of medication after the laboratory reports that the trough has been drawn.
C. Instruct the laboratory to draw the trough immediately before the next scheduled dose.
The best time to draw a trough is the closest time to the next administration. Option A will
provide a peak level. Option B will not provide the most accurate trough level. The medication is
given before peak and trough levels are obtained.
A male client asks the nurse why condoms should not be lubricated with the spermicide
nonoxynol-9. Which response is best for the nurse to provide?
A. The risk of female infertility and spontaneous abortion is linked with nonoxynol-9.
B. Partners can develop intermittent interstitial cystitis if the spermicide is used after the
expiration date.
C. The spermicide decreases the amount of vaginal and penile sensitivity for up to 8 to 12 hours.
D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of
HIV.
D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of
HIV.
,The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can
cause a rash that allows viruses a portal of entry if the condom breaks, which increases the risk
of transmission of sexually transmitted diseases (STDs), such as human immunodeficiency virus
(HIV), herpes, human papillomavirus (HPV), or hepatitis B virus (HBV). Options A and B are
inaccurate. Nonoxynol-9 may cause vaginal irritation, not option C.
Which intervention is most important for a nurse to implement prior to administering atropine
PO?
A. Determine the presence of 5 to 35 bowel sounds/min.
B. Provide oral care prior to administration.
C. Verify that the client's tendon reflexes are 2+.
D. Have the client rate his or her pain on a 0 to10 scale.
A. Determine the presence of 5 to 35 bowel sounds/min.
Anticholinergic drugs, such as atropine, have antispasmodic and antisecretory properties, which
relax the gastrointestinal tract, and are therefore contraindicated in a client with intestinal
atony. Oral care may be required after administration since atropine can dry secretions. Option
B (used to determine dehydration) or (C). Atropine itself has no analgesic effect; it is used with
opioids to potentiate their effect.
A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently
diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating
this treatment?
A. Electrocardiogram (ECG)
B. Arterial blood gases (ABGs)
, C. Serum cholesterol level
D. Pelvic ultrasound
A. Electrocardiogram (ECG)
Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of
doxorubicin HCl. Option B assesses disturbances of acid-base balance. Option C is not affected
by this chemotherapeutic agent. Option D is used to detect pelvic abnormalities such as tumors
but is not specific for the administration of doxorubicin HCl.
The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client.
The nurse notes that the solution is brown in color. Which action should the nurse implement?
A. Verify the prescribed dose with the health care provider.
B. Discard the solution and reorder from the pharmacy.
C. Dilute the solution with more normal saline until it becomes lighter in color.
D. Administer the drug if the solution's reconstitution time is <24 hours.
D. Administer the drug if the solution's reconstitution time is <24 hours.
The color of the dobutamine solution is normal, and the solution should be administered within
24 hours after reconstitution, so the time of reconstitution should be verified before
administering the solution of medication. Option A is not indicated. Option B is not necessary.
Additional dilution of a drug in solution is stated in the manufacturer's reconstitution
instructions, but option C is not needed.
An older client who had a colon resection yesterday is receiving a constant dose of
hydromorphone via a patient-controlled analgesia (PCA) pump. Which assessment finding is
most significant and requires that the nurse intervene?
EVOLVE HESI PHARMACOLOGY FINAL PROFESSIONAL
EXAMINATION – 2026
QUESTIONS AND ANSWERS WITH CORRECT RATIONALES
| HIGHER TIER EXAM
PASS GUARANTEED | GRADE A+
The nurse is reviewing prescribed medications with a female client who is preparing for
discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the
IV dose that she received during hospitalization. Which response is best for the nurse to
provide?
A. A higher dose of analgesic medication may be needed after discharge.
B. An error in the dose calculation may have occurred when the prescribed dose was converted.
C. The doses should be the same unless the pain is not well controlled.
D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.
D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolized.
Oral doses of medication are usually larger than parenteral doses to compensate for the first-
pass effect in the liver after oral administration, which metabolizes more of the drug's dose
before affecting its therapeutic response. Although recommended dose ranges for adults should
be individualized, a client's pain should be controlled at discharge, not option A or C. Option B is
inaccurate information to convey to the client.
,The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory
personnel. What is the best schedule for drawing the trough level?
A. Give the dose of medication, and call the laboratory to draw the trough STAT.
B. Arrange for the laboratory to draw the trough 1 hour after the dose is given.
C. Instruct the laboratory to draw the trough immediately before the next scheduled dose.
D. Give the first dose of medication after the laboratory reports that the trough has been drawn.
C. Instruct the laboratory to draw the trough immediately before the next scheduled dose.
The best time to draw a trough is the closest time to the next administration. Option A will
provide a peak level. Option B will not provide the most accurate trough level. The medication is
given before peak and trough levels are obtained.
A male client asks the nurse why condoms should not be lubricated with the spermicide
nonoxynol-9. Which response is best for the nurse to provide?
A. The risk of female infertility and spontaneous abortion is linked with nonoxynol-9.
B. Partners can develop intermittent interstitial cystitis if the spermicide is used after the
expiration date.
C. The spermicide decreases the amount of vaginal and penile sensitivity for up to 8 to 12 hours.
D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of
HIV.
D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of
HIV.
,The use of condoms and a water-based spermicide is recommended because nonoxynol-9 can
cause a rash that allows viruses a portal of entry if the condom breaks, which increases the risk
of transmission of sexually transmitted diseases (STDs), such as human immunodeficiency virus
(HIV), herpes, human papillomavirus (HPV), or hepatitis B virus (HBV). Options A and B are
inaccurate. Nonoxynol-9 may cause vaginal irritation, not option C.
Which intervention is most important for a nurse to implement prior to administering atropine
PO?
A. Determine the presence of 5 to 35 bowel sounds/min.
B. Provide oral care prior to administration.
C. Verify that the client's tendon reflexes are 2+.
D. Have the client rate his or her pain on a 0 to10 scale.
A. Determine the presence of 5 to 35 bowel sounds/min.
Anticholinergic drugs, such as atropine, have antispasmodic and antisecretory properties, which
relax the gastrointestinal tract, and are therefore contraindicated in a client with intestinal
atony. Oral care may be required after administration since atropine can dry secretions. Option
B (used to determine dehydration) or (C). Atropine itself has no analgesic effect; it is used with
opioids to potentiate their effect.
A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently
diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating
this treatment?
A. Electrocardiogram (ECG)
B. Arterial blood gases (ABGs)
, C. Serum cholesterol level
D. Pelvic ultrasound
A. Electrocardiogram (ECG)
Baseline cardiac function studies are required to monitor the irreversible cardiotoxic effects of
doxorubicin HCl. Option B assesses disturbances of acid-base balance. Option C is not affected
by this chemotherapeutic agent. Option D is used to detect pelvic abnormalities such as tumors
but is not specific for the administration of doxorubicin HCl.
The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client.
The nurse notes that the solution is brown in color. Which action should the nurse implement?
A. Verify the prescribed dose with the health care provider.
B. Discard the solution and reorder from the pharmacy.
C. Dilute the solution with more normal saline until it becomes lighter in color.
D. Administer the drug if the solution's reconstitution time is <24 hours.
D. Administer the drug if the solution's reconstitution time is <24 hours.
The color of the dobutamine solution is normal, and the solution should be administered within
24 hours after reconstitution, so the time of reconstitution should be verified before
administering the solution of medication. Option A is not indicated. Option B is not necessary.
Additional dilution of a drug in solution is stated in the manufacturer's reconstitution
instructions, but option C is not needed.
An older client who had a colon resection yesterday is receiving a constant dose of
hydromorphone via a patient-controlled analgesia (PCA) pump. Which assessment finding is
most significant and requires that the nurse intervene?
