HESI Pharmacology Evolve Exam ACTUAL
EXAM 2026/2027 | Elsevier | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1 – CARDIOVASCULAR MEDICATIONS (25 Questions)
Q1: A 68-year-old male with heart failure (HFrEF, LVEF 35%) is prescribed carvedilol 6.25 mg twice daily.
His admission vital signs: BP 118/72, HR 58, RR 16, O2 96%. His current medications include lisinopril 20
mg daily, furosemide 40 mg daily, and spironolactone 25 mg daily. Which nursing action is most
important before administering the first dose of carvedilol?
A. Administer the carvedilol with a full glass of milk
B. Hold the carvedilol and notify the healthcare provider of the heart rate
C. Check the patient's serum potassium level from this morning's draw
D. Give the carvedilol as ordered because all parameters are within normal limits
Correct Answer: B [CORRECT] Rationale: Carvedilol (non-selective beta-blocker with alpha-1 blockade)
causes bradycardia and is contraindicated with HR <60 bpm before first dose in heart failure patients
(ACC/AHA/HFSA guideline). HR 58 is below threshold. Option A – milk does not interact but is not the
priority. Option C – potassium is relevant for diuretics but not the immediate safety priority before beta-
blocker initiation. Option D is dangerous and violates safety protocols.
Q2: A patient on IV heparin for DVT has an aPTT of 98 seconds (therapeutic range 60–80 seconds,
control 30 seconds). The provider orders: "Give 2000 unit IV bolus, increase infusion by 2 units/kg/hr."
What should the nurse do first?
A. Give bolus and increase rate as ordered
B. Hold both and notify provider of aPTT result
C. Give only the bolus, hold rate increase
D. Recheck aPTT in 1 hour before acting
Correct Answer: B [CORRECT] Rationale: The aPTT of 98 seconds is supratherapeutic, indicating
increased bleeding risk. Adding a bolus and increasing the rate would further elevate the aPTT and
bleeding risk. The nurse must hold the heparin, notify the provider of the supratherapeutic result, and
anticipate a rate reduction or holding per protocol. Option A is dangerous. Option C is incomplete.
Option D delays necessary intervention.
,Q3: A patient receiving warfarin 5 mg daily has an INR of 4.2 (therapeutic range 2.0–3.0 for DVT). The
patient has no active bleeding. What is the nurse's priority action?
A. Administer vitamin K 10 mg IV immediately
B. Hold the warfarin dose and notify the provider
C. Continue the warfarin as ordered
D. Administer fresh frozen plasma
Correct Answer: B [CORRECT] Rationale: INR 4.2 is supratherapeutic (moderate elevation). First action
is to hold the warfarin dose and notify the provider. Vitamin K (Option A) is reserved for INR >10 or
serious bleeding per guidelines. Option C is unsafe. Option D is unnecessary without active bleeding. The
provider may order a reduced dose when restarting or low-dose vitamin K (1–2.5 mg PO) for INR 4.5–10
without bleeding.
Q4: A patient with atrial fibrillation is prescribed digoxin 0.25 mg PO daily. Before administration, the
nurse checks the apical pulse and finds it to be 52 bpm. The patient's potassium is 3.2 mEq/L (normal
3.5–5.0). What is the priority nursing action?
A. Give the digoxin and recheck pulse in 1 hour
B. Hold the digoxin and notify the provider
C. Give the digoxin with a banana for potassium
D. Check the digoxin level before giving the dose
Correct Answer: B [CORRECT] Rationale: Digoxin is held for apical pulse <60 bpm (or <100 bpm in
infants). Additionally, hypokalemia (3.2 mEq/L) increases risk of digoxin toxicity. Both findings require
holding the dose and notifying the provider. Option A risks toxicity. Option C – a banana will not
immediately correct hypokalemia. Option D delays necessary intervention; the pulse and potassium
already indicate holding the dose.
Q5: A patient with hypertension is prescribed lisinopril 10 mg daily. Which statement by the patient
indicates understanding of potential adverse effects?
A. "I should report any persistent dry cough to my doctor"
B. "I need to avoid all potassium-rich foods completely"
C. "I should take this medication on an empty stomach only"
D. "This medication will cause my heart rate to increase significantly"
Correct Answer: A [CORRECT] Rationale: ACE inhibitors like lisinopril commonly cause a dry,
nonproductive cough (bradykinin accumulation) that may require switching to an ARB. Option B is
,incorrect – patients should avoid potassium supplements and salt substitutes but can eat normal dietary
potassium. Option C – lisinopril can be taken with or without food. Option D – ACE inhibitors may cause
hypotension but not significant tachycardia.
Q6: A patient with hyperlipidemia is prescribed atorvastatin 40 mg daily. Which laboratory value
requires immediate notification of the provider?
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 [CORRECT] Rationale: Statins can cause hepatotoxicity. ALT >3 times the upper limit
of normal (>168 U/L) requires discontinuation, but significant elevation (120 U/L) warrants notification
and monitoring. Options A, B, and D are therapeutic or acceptable values. The nurse should monitor for
signs of liver dysfunction and report elevated liver enzymes promptly.
Q7: A patient is receiving amiodarone 400 mg PO three times daily for ventricular tachycardia. Which
assessment finding requires immediate intervention?
A. Blue-gray skin discoloration
B. Corneal microdeposits
C. QT interval 520 ms (baseline 440 ms)
D. Constipation
Correct Answer: C [CORRECT] Rationale: Amiodarone causes QT prolongation and risk of torsades de
pointes. QT >500 ms or increase >60 ms from baseline is dangerous and requires immediate
discontinuation and cardiac monitoring. Options A and B are expected chronic side effects. Option D is
manageable. The prolonged QT represents immediate life-threatening risk.
Q8: [DOSAGE CALCULATION] A patient is prescribed heparin 80 units/kg IV bolus, then 18 units/kg/hr
infusion. The patient weighs 220 lbs. How many units will the patient receive for the bolus dose?
A. 8,000 units
B. 8,800 units
C. 9,600 units
D. 10,000 units
Correct Answer: A [CORRECT] Rationale: Convert weight: 220 lbs ÷ 2.2 = 100 kg. Calculate bolus: 100 kg
× 80 units/kg = 8,000 units. Common errors: Option B (using 220 lbs directly × 80 ÷ 2), Option C
, (rounding errors), Option D (approximation error). Always convert weight to kg first for pediatric and
adult weight-based dosing.
Q9: [SELECT ALL THAT APPLY] A nurse is caring for a patient receiving enalapril (Vasotec). Which
assessments are essential before administration? (Select all that apply)
A. Blood pressure
B. Serum potassium level
C. Heart rate
D. BUN and creatinine
E. Liver function tests
Correct Answer: A, B, D [CORRECT] Rationale: ACE inhibitors require BP monitoring (hypotension risk,
especially first dose), potassium monitoring (hyperkalemia risk, especially with renal impairment or
potassium supplements), and renal function assessment (BUN/creatinine – ACE inhibitors can worsen
renal function in renal artery stenosis or hypovolemia). Heart rate (C) is not specifically required for ACE
inhibitors (unlike beta-blockers or digoxin). Liver function (E) is not routinely monitored with ACE
inhibitors.
Q10: A patient with atrial fibrillation is prescribed rivaroxaban (Xarelto) 20 mg daily with dinner. Which
statement by the patient requires correction?
A. "I should take this medication with food to improve absorption"
B. "I need to have my INR checked monthly"
C. "I should avoid activities that could cause injury or bleeding"
D. "I need to report any unusual bruising immediately"
Correct Answer: B [CORRECT] Rationale: Rivaroxaban is a direct oral anticoagulant (DOAC/NOAC) that
does NOT require INR monitoring (unlike warfarin). The 15 mg and 20 mg doses should be taken with
food for optimal absorption (Option A is correct). Options C and D are appropriate safety teaching.
Patient education must emphasize that routine coagulation monitoring is not needed with DOACs.
Q11: A patient with stable angina is prescribed isosorbide mononitrate 30 mg daily. Which instruction is
most important for the nurse to provide?
A. "Take this medication in the morning on an empty stomach"
B. "You may experience headaches that usually improve with continued use"
C. "If chest pain occurs, take an extra dose immediately"
D. "Stop taking this medication if you experience flushing"
EXAM 2026/2027 | Elsevier | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1 – CARDIOVASCULAR MEDICATIONS (25 Questions)
Q1: A 68-year-old male with heart failure (HFrEF, LVEF 35%) is prescribed carvedilol 6.25 mg twice daily.
His admission vital signs: BP 118/72, HR 58, RR 16, O2 96%. His current medications include lisinopril 20
mg daily, furosemide 40 mg daily, and spironolactone 25 mg daily. Which nursing action is most
important before administering the first dose of carvedilol?
A. Administer the carvedilol with a full glass of milk
B. Hold the carvedilol and notify the healthcare provider of the heart rate
C. Check the patient's serum potassium level from this morning's draw
D. Give the carvedilol as ordered because all parameters are within normal limits
Correct Answer: B [CORRECT] Rationale: Carvedilol (non-selective beta-blocker with alpha-1 blockade)
causes bradycardia and is contraindicated with HR <60 bpm before first dose in heart failure patients
(ACC/AHA/HFSA guideline). HR 58 is below threshold. Option A – milk does not interact but is not the
priority. Option C – potassium is relevant for diuretics but not the immediate safety priority before beta-
blocker initiation. Option D is dangerous and violates safety protocols.
Q2: A patient on IV heparin for DVT has an aPTT of 98 seconds (therapeutic range 60–80 seconds,
control 30 seconds). The provider orders: "Give 2000 unit IV bolus, increase infusion by 2 units/kg/hr."
What should the nurse do first?
A. Give bolus and increase rate as ordered
B. Hold both and notify provider of aPTT result
C. Give only the bolus, hold rate increase
D. Recheck aPTT in 1 hour before acting
Correct Answer: B [CORRECT] Rationale: The aPTT of 98 seconds is supratherapeutic, indicating
increased bleeding risk. Adding a bolus and increasing the rate would further elevate the aPTT and
bleeding risk. The nurse must hold the heparin, notify the provider of the supratherapeutic result, and
anticipate a rate reduction or holding per protocol. Option A is dangerous. Option C is incomplete.
Option D delays necessary intervention.
,Q3: A patient receiving warfarin 5 mg daily has an INR of 4.2 (therapeutic range 2.0–3.0 for DVT). The
patient has no active bleeding. What is the nurse's priority action?
A. Administer vitamin K 10 mg IV immediately
B. Hold the warfarin dose and notify the provider
C. Continue the warfarin as ordered
D. Administer fresh frozen plasma
Correct Answer: B [CORRECT] Rationale: INR 4.2 is supratherapeutic (moderate elevation). First action
is to hold the warfarin dose and notify the provider. Vitamin K (Option A) is reserved for INR >10 or
serious bleeding per guidelines. Option C is unsafe. Option D is unnecessary without active bleeding. The
provider may order a reduced dose when restarting or low-dose vitamin K (1–2.5 mg PO) for INR 4.5–10
without bleeding.
Q4: A patient with atrial fibrillation is prescribed digoxin 0.25 mg PO daily. Before administration, the
nurse checks the apical pulse and finds it to be 52 bpm. The patient's potassium is 3.2 mEq/L (normal
3.5–5.0). What is the priority nursing action?
A. Give the digoxin and recheck pulse in 1 hour
B. Hold the digoxin and notify the provider
C. Give the digoxin with a banana for potassium
D. Check the digoxin level before giving the dose
Correct Answer: B [CORRECT] Rationale: Digoxin is held for apical pulse <60 bpm (or <100 bpm in
infants). Additionally, hypokalemia (3.2 mEq/L) increases risk of digoxin toxicity. Both findings require
holding the dose and notifying the provider. Option A risks toxicity. Option C – a banana will not
immediately correct hypokalemia. Option D delays necessary intervention; the pulse and potassium
already indicate holding the dose.
Q5: A patient with hypertension is prescribed lisinopril 10 mg daily. Which statement by the patient
indicates understanding of potential adverse effects?
A. "I should report any persistent dry cough to my doctor"
B. "I need to avoid all potassium-rich foods completely"
C. "I should take this medication on an empty stomach only"
D. "This medication will cause my heart rate to increase significantly"
Correct Answer: A [CORRECT] Rationale: ACE inhibitors like lisinopril commonly cause a dry,
nonproductive cough (bradykinin accumulation) that may require switching to an ARB. Option B is
,incorrect – patients should avoid potassium supplements and salt substitutes but can eat normal dietary
potassium. Option C – lisinopril can be taken with or without food. Option D – ACE inhibitors may cause
hypotension but not significant tachycardia.
Q6: A patient with hyperlipidemia is prescribed atorvastatin 40 mg daily. Which laboratory value
requires immediate notification of the provider?
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 [CORRECT] Rationale: Statins can cause hepatotoxicity. ALT >3 times the upper limit
of normal (>168 U/L) requires discontinuation, but significant elevation (120 U/L) warrants notification
and monitoring. Options A, B, and D are therapeutic or acceptable values. The nurse should monitor for
signs of liver dysfunction and report elevated liver enzymes promptly.
Q7: A patient is receiving amiodarone 400 mg PO three times daily for ventricular tachycardia. Which
assessment finding requires immediate intervention?
A. Blue-gray skin discoloration
B. Corneal microdeposits
C. QT interval 520 ms (baseline 440 ms)
D. Constipation
Correct Answer: C [CORRECT] Rationale: Amiodarone causes QT prolongation and risk of torsades de
pointes. QT >500 ms or increase >60 ms from baseline is dangerous and requires immediate
discontinuation and cardiac monitoring. Options A and B are expected chronic side effects. Option D is
manageable. The prolonged QT represents immediate life-threatening risk.
Q8: [DOSAGE CALCULATION] A patient is prescribed heparin 80 units/kg IV bolus, then 18 units/kg/hr
infusion. The patient weighs 220 lbs. How many units will the patient receive for the bolus dose?
A. 8,000 units
B. 8,800 units
C. 9,600 units
D. 10,000 units
Correct Answer: A [CORRECT] Rationale: Convert weight: 220 lbs ÷ 2.2 = 100 kg. Calculate bolus: 100 kg
× 80 units/kg = 8,000 units. Common errors: Option B (using 220 lbs directly × 80 ÷ 2), Option C
, (rounding errors), Option D (approximation error). Always convert weight to kg first for pediatric and
adult weight-based dosing.
Q9: [SELECT ALL THAT APPLY] A nurse is caring for a patient receiving enalapril (Vasotec). Which
assessments are essential before administration? (Select all that apply)
A. Blood pressure
B. Serum potassium level
C. Heart rate
D. BUN and creatinine
E. Liver function tests
Correct Answer: A, B, D [CORRECT] Rationale: ACE inhibitors require BP monitoring (hypotension risk,
especially first dose), potassium monitoring (hyperkalemia risk, especially with renal impairment or
potassium supplements), and renal function assessment (BUN/creatinine – ACE inhibitors can worsen
renal function in renal artery stenosis or hypovolemia). Heart rate (C) is not specifically required for ACE
inhibitors (unlike beta-blockers or digoxin). Liver function (E) is not routinely monitored with ACE
inhibitors.
Q10: A patient with atrial fibrillation is prescribed rivaroxaban (Xarelto) 20 mg daily with dinner. Which
statement by the patient requires correction?
A. "I should take this medication with food to improve absorption"
B. "I need to have my INR checked monthly"
C. "I should avoid activities that could cause injury or bleeding"
D. "I need to report any unusual bruising immediately"
Correct Answer: B [CORRECT] Rationale: Rivaroxaban is a direct oral anticoagulant (DOAC/NOAC) that
does NOT require INR monitoring (unlike warfarin). The 15 mg and 20 mg doses should be taken with
food for optimal absorption (Option A is correct). Options C and D are appropriate safety teaching.
Patient education must emphasize that routine coagulation monitoring is not needed with DOACs.
Q11: A patient with stable angina is prescribed isosorbide mononitrate 30 mg daily. Which instruction is
most important for the nurse to provide?
A. "Take this medication in the morning on an empty stomach"
B. "You may experience headaches that usually improve with continued use"
C. "If chest pain occurs, take an extra dose immediately"
D. "Stop taking this medication if you experience flushing"
