Evolve HESI Pharmacology 3 Full Exams –
2026 Updated 400 NCLEX-Style Questions
with Answers & Rationales
1. A nurse is administering digoxin. The client's apical pulse is 52 bpm. What
should the nurse do first?
A. Administer the medication as ordered
B. Hold the dose and notify the provider
C. Retake the pulse in 15 minutes
D. Give atropine before digoxin
Answer: B
Rationale: Digoxin is held for an apical pulse <60 bpm in adults (unless
ordered otherwise). Bradycardia increases the risk of digoxin toxicity.
2. A client is prescribed warfarin. Which laboratory value should the nurse
monitor to evaluate therapeutic effect?
A. aPTT
B. INR
C. Platelet count
D. Bleeding time
Answer: B
Rationale: INR (international normalized ratio) is used to monitor warfarin
therapy. Therapeutic INR is typically 2.0–3.0 for most indications.
3. A client with type 2 diabetes is prescribed metformin. Which instruction is
most important?
,A. "Take this medication on an empty stomach."
B. "Report any muscle pain or weakness to your provider."
C. "You may experience weight gain with this medication."
D. "Take this medication only when your blood glucose is high."
Answer: B
Rationale: Muscle pain or weakness may indicate lactic acidosis, a rare but
life-threatening side effect of metformin. Metformin is taken with meals to
reduce GI upset.
4. A nurse is administering furosemide 40 mg IV push. The nurse should
administer the medication over:
A. 30 seconds
B. 1–2 minutes
C. 5–10 minutes
D. 30 minutes
Answer: B
Rationale: Rapid IV furosemide can cause ototoxicity (tinnitus, hearing loss).
Administer slowly over 1–2 minutes.
5. A client with a history of anaphylaxis to penicillin is prescribed cephalexin.
What should the nurse do?
A. Administer the medication as ordered
B. Notify the provider of potential cross-sensitivity
C. Give a test dose first
D. Administer diphenhydramine before cephalexin
Answer: B
Rationale: There is cross-sensitivity between penicillins and cephalosporins
(about 1-10%). The provider should be notified to consider an alternative
antibiotic.
,6. A client is prescribed enoxaparin (Lovenox) subcutaneously. Which
technique is correct?
A. Aspirate before injection
B. Massage the site after injection
C. Inject into the deltoid muscle
D. Pinch skin fold and insert needle at 90 degrees into abdomen
Answer: D
Rationale: Enoxaparin is given subcutaneously into the abdomen, 90-degree
angle with skin fold. No aspiration and no massage (prevents bruising).
7. A client is prescribed albuterol via metered-dose inhaler (MDI). Which
instruction is correct?
A. "Shake the inhaler well before each use."
B. "Inhale and then press the canister."
C. "Use only once per day regardless of symptoms."
D. "Avoid rinsing your mouth after use."
Answer: A
Rationale: Shake the inhaler well. Press the canister while inhaling slowly.
Rinse mouth after use to prevent thrush.
8. A client with heart failure is prescribed carvedilol. Which finding requires
withholding the medication?
A. Heart rate 52 bpm
B. Blood pressure 130/80 mm Hg
C. Weight gain of 1 lb in 2 days
D. Mild fatigue
, Answer: A
Rationale: Carvedilol (beta-blocker) is held for a heart rate <60 bpm (or as
ordered). Bradycardia is a common reason to withhold beta-blockers.
9. A client is prescribed lithium for bipolar disorder. Which laboratory value
should the nurse monitor regularly?
A. Hemoglobin
B. Lithium level
C. Thyroid function tests
D. Both B and C
Answer: D
Rationale: Lithium has a narrow therapeutic index (0.6–1.2 mEq/L). Long-
term use can also cause hypothyroidism, so thyroid function should be
monitored.
10. A nurse is teaching a client about warfarin. Which statement indicates a
need for further teaching?
A. "I will use an electric razor to shave."
B. "I will avoid eating large amounts of spinach."
C. "I can take ibuprofen for my headaches."
D. "I will get my blood tested regularly."
Answer: C
Rationale: NSAIDs (ibuprofen) increase bleeding risk with warfarin.
Acetaminophen is safer. Electric razors and avoiding vitamin K-rich foods
are correct.
11. A client is prescribed lisinopril. Which side effect should the nurse report
to the provider immediately?
A. Dry cough
2026 Updated 400 NCLEX-Style Questions
with Answers & Rationales
1. A nurse is administering digoxin. The client's apical pulse is 52 bpm. What
should the nurse do first?
A. Administer the medication as ordered
B. Hold the dose and notify the provider
C. Retake the pulse in 15 minutes
D. Give atropine before digoxin
Answer: B
Rationale: Digoxin is held for an apical pulse <60 bpm in adults (unless
ordered otherwise). Bradycardia increases the risk of digoxin toxicity.
2. A client is prescribed warfarin. Which laboratory value should the nurse
monitor to evaluate therapeutic effect?
A. aPTT
B. INR
C. Platelet count
D. Bleeding time
Answer: B
Rationale: INR (international normalized ratio) is used to monitor warfarin
therapy. Therapeutic INR is typically 2.0–3.0 for most indications.
3. A client with type 2 diabetes is prescribed metformin. Which instruction is
most important?
,A. "Take this medication on an empty stomach."
B. "Report any muscle pain or weakness to your provider."
C. "You may experience weight gain with this medication."
D. "Take this medication only when your blood glucose is high."
Answer: B
Rationale: Muscle pain or weakness may indicate lactic acidosis, a rare but
life-threatening side effect of metformin. Metformin is taken with meals to
reduce GI upset.
4. A nurse is administering furosemide 40 mg IV push. The nurse should
administer the medication over:
A. 30 seconds
B. 1–2 minutes
C. 5–10 minutes
D. 30 minutes
Answer: B
Rationale: Rapid IV furosemide can cause ototoxicity (tinnitus, hearing loss).
Administer slowly over 1–2 minutes.
5. A client with a history of anaphylaxis to penicillin is prescribed cephalexin.
What should the nurse do?
A. Administer the medication as ordered
B. Notify the provider of potential cross-sensitivity
C. Give a test dose first
D. Administer diphenhydramine before cephalexin
Answer: B
Rationale: There is cross-sensitivity between penicillins and cephalosporins
(about 1-10%). The provider should be notified to consider an alternative
antibiotic.
,6. A client is prescribed enoxaparin (Lovenox) subcutaneously. Which
technique is correct?
A. Aspirate before injection
B. Massage the site after injection
C. Inject into the deltoid muscle
D. Pinch skin fold and insert needle at 90 degrees into abdomen
Answer: D
Rationale: Enoxaparin is given subcutaneously into the abdomen, 90-degree
angle with skin fold. No aspiration and no massage (prevents bruising).
7. A client is prescribed albuterol via metered-dose inhaler (MDI). Which
instruction is correct?
A. "Shake the inhaler well before each use."
B. "Inhale and then press the canister."
C. "Use only once per day regardless of symptoms."
D. "Avoid rinsing your mouth after use."
Answer: A
Rationale: Shake the inhaler well. Press the canister while inhaling slowly.
Rinse mouth after use to prevent thrush.
8. A client with heart failure is prescribed carvedilol. Which finding requires
withholding the medication?
A. Heart rate 52 bpm
B. Blood pressure 130/80 mm Hg
C. Weight gain of 1 lb in 2 days
D. Mild fatigue
, Answer: A
Rationale: Carvedilol (beta-blocker) is held for a heart rate <60 bpm (or as
ordered). Bradycardia is a common reason to withhold beta-blockers.
9. A client is prescribed lithium for bipolar disorder. Which laboratory value
should the nurse monitor regularly?
A. Hemoglobin
B. Lithium level
C. Thyroid function tests
D. Both B and C
Answer: D
Rationale: Lithium has a narrow therapeutic index (0.6–1.2 mEq/L). Long-
term use can also cause hypothyroidism, so thyroid function should be
monitored.
10. A nurse is teaching a client about warfarin. Which statement indicates a
need for further teaching?
A. "I will use an electric razor to shave."
B. "I will avoid eating large amounts of spinach."
C. "I can take ibuprofen for my headaches."
D. "I will get my blood tested regularly."
Answer: C
Rationale: NSAIDs (ibuprofen) increase bleeding risk with warfarin.
Acetaminophen is safer. Electric razors and avoiding vitamin K-rich foods
are correct.
11. A client is prescribed lisinopril. Which side effect should the nurse report
to the provider immediately?
A. Dry cough
