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Evolve Pharmacology HESI Exam 2026/2027
EVOLVE PHARMACOLOGY
EVOLVE PHARMACOLOGY HESI
HESI EXAM EXAM COMPLETE
SCRIPT
QUESTIONS2026/2027
AND ANSWERS
Comprehensive NGN-Style Pharmacotherapeutics
Competency Assessment for RN Licensure Readiness
Exact Official Count: 250 Multiple-Choice Questions
Aligned with Elsevier Evolve HESI Test Blueprints | NCSBN CJMM | NCLEX-RN Test Plan
Institute for Safe Medication Practices (ISMP) Guidelines
Assessment Duration: 240 Minutes
Passing Score: 850 HESI Score (75-80% | 188-200/250 correct)
Delivery: Computer-Based Proctored via Elsevier Evolve
Complete Exam-Style Questions with Detailed Rationales | 100% Verified | Graded A+
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Evolve Pharmacology HESI Exam 2026/2027
Introduction
This Evolve Pharmacology HESI Exam format for 2026/2027 reflects the standardized competency assessment
used to evaluate proficiency in foundational and advanced pharmacotherapeutic principles for pre-licensure RN
students. The official examination consists of exactly 250 multiple-choice questions (MCQ) covering critical
domains: clinical judgment and medication administration, safety and high-alert medication protocols,
pharmacokinetics and pharmacodynamics, cardiovascular and respiratory pharmacotherapy, neurologic and
psychiatric pharmacology, endocrine and metabolic pharmacotherapy, anti-infectives and antimicrobial
stewardship, oncology and immunomodulators, and NGN case study application. The exam measures knowledge
essential for safe, effective, and evidence-based medication management practice, aligned with current NCSBN
Clinical Judgment Measurement Model (CJMM), NCSBN NCLEX-RN test plan, Elsevier HESI test blueprints,
and institutional RN program learning outcomes.
Exam Structure
• Exact official question count: 250 multiple-choice questions (MCQ) per commonly cited Evolve Pharmacology
HESI specifications and verified Elsevier documentation
• All questions must be presented in MCQ format with four options (A, B, C, D), single-best-answer unless
otherwise specified as SATA or NGN case study format
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend recognition, matrix
multiple-choice, dosage calculation scenarios, and prioritization questions
• Focus on evidence-based pharmacotherapeutic principles, NCSBN Clinical Judgment Measurement Model
(CJMM) application, and professional judgment aligned with NCSBN NCLEX-RN test plan
• Total testing time: 240 minutes (computer-based, proctored format via Elsevier Evolve testing platform or
institutional learning management system)
• Passing score: Typically 850 HESI score or 75-80% required for NCLEX-RN readiness prediction per RN
program policy (188-200/250 correct)
Domain Questions Key Topics Weight
Clinical Judgment & Medication 38 Rights of Medication Administration, BCMA, Patient Education, 15%
Administration Assessment Pre/Post Administration, Route Selection, Documentation
Safety & High-Alert Medication 50 Insulin/Heparin/Opioids/Anticoagulants/Chemotherapy Safety, 20%
Protocols Double-Checks, Error Prevention, ISMP Guidelines, Reconciliation,
Look-Alike/Sound-Alike
Pharmacokinetics & 32 ADME Processes, Half-Life, Therapeutic Range, Drug Interactions, 13%
Pharmacodynamics Receptor Theory, Therapeutic Drug Monitoring, Protein Binding
Cardiovascular & Respiratory 38 Antihypertensives, Antianginals, Anticoagulants, Antiarrhythmics, 15%
Pharmacotherapy Diuretics, Bronchodilators, Corticosteroids, Monitoring Parameters
Neurologic & Psychiatric 32 Antidepressants, Antipsychotics, Anticonvulsants, Anxiolytics, Opioids, 13%
Pharmacology Side Effect Monitoring, Serotonin Syndrome, NMS, Withdrawal
Endocrine & Metabolic 25 Insulin Types, Oral Antidiabetics, Thyroid Medications, 10%
Pharmacotherapy Corticosteroids, Hypoglycemia/Hyperglycemia Management, Adrenal
Disorders
Anti-Infectives & Antimicrobial 20 Antibiotics, Antivirals, Antifungals, Resistance Prevention, Allergy 8%
Stewardship Assessment, Culture-Guided Therapy, C. diff Protocols, Vancomycin
Monitoring
Oncology, Immunomodulators & 15 Chemotherapy Safety, Biologics, Immunotherapy, Extravasation 6%
NGN Application Management, Bow-Tie Items, Trend Recognition, Matrix MCQs
Examination Overview
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Examination Questions
Domain: Clinical Judgment & Medication Administration
1. A nurse is preparing to administer a scheduled dose of metoprolol 50 mg PO to a client with
hypertension. Before giving the medication, which action should the nurse take first?
A. Check the client's blood pressure
B. Verify the medication order in the electronic health record
C. Ask the client if they have any allergies
D. Assess the client's apical heart rate
Correct Answer: D
Rationale: The nurse should assess the client's apical heart rate before administering metoprolol, a beta-
adrenergic blocker, because the primary therapeutic effect is to decrease heart rate. Administering the
medication to a client with bradycardia (heart rate below 60 bpm) could cause serious hemodynamic
compromise. This aligns with the Nursing Process step of Assessment before Implementation and reflects the
Right Assessment principle. While checking blood pressure (A) is also important for an antihypertensive, heart
rate is the most critical pre-administration assessment for a beta-blocker. Verifying the medication order (B)
and checking allergies (C) should have been completed during the initial medication reconciliation process.
2. A nurse is using the Barcode Medication Administration (BCMA) system to administer
medications to a client. The system generates an alert indicating a mismatch. What is the nurse's
best action?
A. Override the alert and administer the medication if the nurse is confident it is correct
B. Stop administration, compare the MAR with the client's wristband and medication, and resolve the
discrepancy
C. Document the alert and proceed with administration as ordered
D. Contact the pharmacist to reorder the medication
Correct Answer: B
Rationale: BCMA alerts are designed to prevent medication errors and must never be overridden without
thorough investigation. The nurse must stop, perform the five rights manually by comparing the Medication
Administration Record (MAR) with the client's identification wristband and the medication itself, and resolve
the discrepancy before proceeding. This demonstrates the Clinical Judgment step of evaluating evidence and
taking appropriate action. Overriding alerts (A) without investigation removes a critical safety safeguard.
Documenting and proceeding (C) ignores a potentially serious error. Contacting the pharmacist to reorder (D)
is premature before determining the cause of the mismatch.
3. A nurse is providing discharge teaching to a client newly prescribed warfarin 5 mg PO daily.
Which statement by the client indicates a need for further teaching?
A. "I should eat a consistent amount of leafy green vegetables each day."
B. "I will take this medication at the same time every evening."
C. "I can take aspirin for my occasional headaches instead of acetaminophen."
D. "I will have my blood drawn regularly to check my INR level."
Correct Answer: C
Rationale: The client's statement about taking aspirin indicates a need for further teaching. Aspirin is a
nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet aggregation and, when combined with
warfarin (a vitamin K antagonist), significantly increases the risk of serious bleeding. Clients on warfarin
should be instructed to avoid aspirin and other NSAIDs and use acetaminophen as the preferred analgesic.
Eating a consistent amount of vitamin K-rich foods (A) is correct because fluctuations in dietary vitamin K
intake can alter warfarin's therapeutic effect. Taking warfarin at the same time each day (B) ensures stable
drug levels. Regular INR monitoring (D) is essential to maintain the therapeutic range and prevent
thromboembolic or hemorrhagic complications.
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4. A nurse is caring for a client receiving morphine sulfate 4 mg IV every 4 hours PRN for pain.
Which assessments should the nurse monitor before and after administration? Select all that
apply.
A. Respiratory rate and depth
B. Pain intensity using a validated pain scale
C. Blood pressure and heart rate
D. Urine output and serum creatinine
E. Level of sedation and consciousness
Correct Answer: A,B,C,E
Rationale: Morphine is an opioid analgesic with several clinically significant effects that require nursing
assessment. Respiratory rate and depth (A) must be monitored because opioid-induced respiratory depression
is the most life-threatening adverse effect. Pain intensity (B) should be assessed before and after
administration to evaluate therapeutic effectiveness and determine the need for dose adjustment. Blood
pressure and heart rate (C) require monitoring because morphine causes histamine release leading to
vasodilation and potential hypotension. Level of sedation and consciousness (E) must be assessed because
excessive CNS depression indicates opioid toxicity. Urine output and serum creatinine (D) are important for
overall renal function but are not immediate pre- and post-administration assessments specific to morphine
dosing.
5. A client with a nasogastric (NG) tube is ordered to receive oral levothyroxine 100 mcg daily.
Which route should the nurse use to administer this medication?
A. Crush the tablet and administer through the NG tube followed by 30 mL of water
B. Administer the tablet through the NG tube whole with adequate water flush
C. Hold the medication and contact the healthcare provider for an alternative route
D. Mix the crushed tablet in the next scheduled tube feeding
Correct Answer: C
Rationale: Levothyroxine has very specific absorption requirements. It should be taken on an empty stomach,
and its bioavailability is significantly affected by food, tube feedings, and many medications. The tablet should
not be crushed and mixed with tube feedings (D) because calcium and other components in the feeding bind
levothyroxine and reduce absorption. The safest and most appropriate action is to hold the medication and
contact the healthcare provider for an IV or alternative formulation. Even crushing and administering through
the NG tube (A) is not ideal because the NG tube is often clamped during medication administration, and
absorption variability in the GI tract of a critically ill patient makes oral dosing unreliable. Administering the
tablet whole (B) is not possible through an NG tube. This demonstrates the nurse's role in patient advocacy and
ensuring the Right Route.
6. A nurse administers furosemide 40 mg IV to a client with heart failure. The medication was
given 30 minutes ago. Which documentation is most appropriate for the nurse to record?
A. "Furosemide 40 mg IV given at 0900 per order. Client tolerated well."
B. "Furosemide 40 mg IV administered at 0900. Client voided 250 mL clear yellow urine at 0930."
C. "Furosemide 40 mg IV given. BP before 150/90, after 130/80. Lung sounds clearer bilaterally."
D. "Furosemide 40 mg IV pushed at 0900 over 2 minutes in right forearm. BP 148/92 pre-administration."
Correct Answer: D
Rationale: The most comprehensive and appropriate documentation includes the medication, dose, route, time,
administration technique (pushed over 2 minutes), and relevant pre-administration assessment data (blood
pressure). This fulfills the nursing documentation standards for medication administration, which should
capture the Right Dose, Right Time, Right Route, and Right Assessment. While option A is too brief and lacks
assessment data, option B focuses on the outcome (diuresis) but misses critical pre-administration data. Option
C documents pre- and post-data but lacks the administration technique and site. Furosemide should be
administered slowly (over 1-2 minutes) to prevent ototoxicity, making documentation of the administration
technique especially important.
7. A nurse is performing medication reconciliation at admission for a client transferred from a
long-term care facility. The client's current home medications include metformin, lisinopril, and
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Evolve Pharmacology HESI Exam 2026/2027
EVOLVE PHARMACOLOGY
EVOLVE PHARMACOLOGY HESI
HESI EXAM EXAM COMPLETE
SCRIPT
QUESTIONS2026/2027
AND ANSWERS
Comprehensive NGN-Style Pharmacotherapeutics
Competency Assessment for RN Licensure Readiness
Exact Official Count: 250 Multiple-Choice Questions
Aligned with Elsevier Evolve HESI Test Blueprints | NCSBN CJMM | NCLEX-RN Test Plan
Institute for Safe Medication Practices (ISMP) Guidelines
Assessment Duration: 240 Minutes
Passing Score: 850 HESI Score (75-80% | 188-200/250 correct)
Delivery: Computer-Based Proctored via Elsevier Evolve
Complete Exam-Style Questions with Detailed Rationales | 100% Verified | Graded A+
Page 1
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, classmerit.com — The Marketplace to Buy and Sell Study Materials
Evolve Pharmacology HESI Exam 2026/2027
Introduction
This Evolve Pharmacology HESI Exam format for 2026/2027 reflects the standardized competency assessment
used to evaluate proficiency in foundational and advanced pharmacotherapeutic principles for pre-licensure RN
students. The official examination consists of exactly 250 multiple-choice questions (MCQ) covering critical
domains: clinical judgment and medication administration, safety and high-alert medication protocols,
pharmacokinetics and pharmacodynamics, cardiovascular and respiratory pharmacotherapy, neurologic and
psychiatric pharmacology, endocrine and metabolic pharmacotherapy, anti-infectives and antimicrobial
stewardship, oncology and immunomodulators, and NGN case study application. The exam measures knowledge
essential for safe, effective, and evidence-based medication management practice, aligned with current NCSBN
Clinical Judgment Measurement Model (CJMM), NCSBN NCLEX-RN test plan, Elsevier HESI test blueprints,
and institutional RN program learning outcomes.
Exam Structure
• Exact official question count: 250 multiple-choice questions (MCQ) per commonly cited Evolve Pharmacology
HESI specifications and verified Elsevier documentation
• All questions must be presented in MCQ format with four options (A, B, C, D), single-best-answer unless
otherwise specified as SATA or NGN case study format
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend recognition, matrix
multiple-choice, dosage calculation scenarios, and prioritization questions
• Focus on evidence-based pharmacotherapeutic principles, NCSBN Clinical Judgment Measurement Model
(CJMM) application, and professional judgment aligned with NCSBN NCLEX-RN test plan
• Total testing time: 240 minutes (computer-based, proctored format via Elsevier Evolve testing platform or
institutional learning management system)
• Passing score: Typically 850 HESI score or 75-80% required for NCLEX-RN readiness prediction per RN
program policy (188-200/250 correct)
Domain Questions Key Topics Weight
Clinical Judgment & Medication 38 Rights of Medication Administration, BCMA, Patient Education, 15%
Administration Assessment Pre/Post Administration, Route Selection, Documentation
Safety & High-Alert Medication 50 Insulin/Heparin/Opioids/Anticoagulants/Chemotherapy Safety, 20%
Protocols Double-Checks, Error Prevention, ISMP Guidelines, Reconciliation,
Look-Alike/Sound-Alike
Pharmacokinetics & 32 ADME Processes, Half-Life, Therapeutic Range, Drug Interactions, 13%
Pharmacodynamics Receptor Theory, Therapeutic Drug Monitoring, Protein Binding
Cardiovascular & Respiratory 38 Antihypertensives, Antianginals, Anticoagulants, Antiarrhythmics, 15%
Pharmacotherapy Diuretics, Bronchodilators, Corticosteroids, Monitoring Parameters
Neurologic & Psychiatric 32 Antidepressants, Antipsychotics, Anticonvulsants, Anxiolytics, Opioids, 13%
Pharmacology Side Effect Monitoring, Serotonin Syndrome, NMS, Withdrawal
Endocrine & Metabolic 25 Insulin Types, Oral Antidiabetics, Thyroid Medications, 10%
Pharmacotherapy Corticosteroids, Hypoglycemia/Hyperglycemia Management, Adrenal
Disorders
Anti-Infectives & Antimicrobial 20 Antibiotics, Antivirals, Antifungals, Resistance Prevention, Allergy 8%
Stewardship Assessment, Culture-Guided Therapy, C. diff Protocols, Vancomycin
Monitoring
Oncology, Immunomodulators & 15 Chemotherapy Safety, Biologics, Immunotherapy, Extravasation 6%
NGN Application Management, Bow-Tie Items, Trend Recognition, Matrix MCQs
Examination Overview
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Evolve Pharmacology HESI Exam 2026/2027
Examination Questions
Domain: Clinical Judgment & Medication Administration
1. A nurse is preparing to administer a scheduled dose of metoprolol 50 mg PO to a client with
hypertension. Before giving the medication, which action should the nurse take first?
A. Check the client's blood pressure
B. Verify the medication order in the electronic health record
C. Ask the client if they have any allergies
D. Assess the client's apical heart rate
Correct Answer: D
Rationale: The nurse should assess the client's apical heart rate before administering metoprolol, a beta-
adrenergic blocker, because the primary therapeutic effect is to decrease heart rate. Administering the
medication to a client with bradycardia (heart rate below 60 bpm) could cause serious hemodynamic
compromise. This aligns with the Nursing Process step of Assessment before Implementation and reflects the
Right Assessment principle. While checking blood pressure (A) is also important for an antihypertensive, heart
rate is the most critical pre-administration assessment for a beta-blocker. Verifying the medication order (B)
and checking allergies (C) should have been completed during the initial medication reconciliation process.
2. A nurse is using the Barcode Medication Administration (BCMA) system to administer
medications to a client. The system generates an alert indicating a mismatch. What is the nurse's
best action?
A. Override the alert and administer the medication if the nurse is confident it is correct
B. Stop administration, compare the MAR with the client's wristband and medication, and resolve the
discrepancy
C. Document the alert and proceed with administration as ordered
D. Contact the pharmacist to reorder the medication
Correct Answer: B
Rationale: BCMA alerts are designed to prevent medication errors and must never be overridden without
thorough investigation. The nurse must stop, perform the five rights manually by comparing the Medication
Administration Record (MAR) with the client's identification wristband and the medication itself, and resolve
the discrepancy before proceeding. This demonstrates the Clinical Judgment step of evaluating evidence and
taking appropriate action. Overriding alerts (A) without investigation removes a critical safety safeguard.
Documenting and proceeding (C) ignores a potentially serious error. Contacting the pharmacist to reorder (D)
is premature before determining the cause of the mismatch.
3. A nurse is providing discharge teaching to a client newly prescribed warfarin 5 mg PO daily.
Which statement by the client indicates a need for further teaching?
A. "I should eat a consistent amount of leafy green vegetables each day."
B. "I will take this medication at the same time every evening."
C. "I can take aspirin for my occasional headaches instead of acetaminophen."
D. "I will have my blood drawn regularly to check my INR level."
Correct Answer: C
Rationale: The client's statement about taking aspirin indicates a need for further teaching. Aspirin is a
nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet aggregation and, when combined with
warfarin (a vitamin K antagonist), significantly increases the risk of serious bleeding. Clients on warfarin
should be instructed to avoid aspirin and other NSAIDs and use acetaminophen as the preferred analgesic.
Eating a consistent amount of vitamin K-rich foods (A) is correct because fluctuations in dietary vitamin K
intake can alter warfarin's therapeutic effect. Taking warfarin at the same time each day (B) ensures stable
drug levels. Regular INR monitoring (D) is essential to maintain the therapeutic range and prevent
thromboembolic or hemorrhagic complications.
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4. A nurse is caring for a client receiving morphine sulfate 4 mg IV every 4 hours PRN for pain.
Which assessments should the nurse monitor before and after administration? Select all that
apply.
A. Respiratory rate and depth
B. Pain intensity using a validated pain scale
C. Blood pressure and heart rate
D. Urine output and serum creatinine
E. Level of sedation and consciousness
Correct Answer: A,B,C,E
Rationale: Morphine is an opioid analgesic with several clinically significant effects that require nursing
assessment. Respiratory rate and depth (A) must be monitored because opioid-induced respiratory depression
is the most life-threatening adverse effect. Pain intensity (B) should be assessed before and after
administration to evaluate therapeutic effectiveness and determine the need for dose adjustment. Blood
pressure and heart rate (C) require monitoring because morphine causes histamine release leading to
vasodilation and potential hypotension. Level of sedation and consciousness (E) must be assessed because
excessive CNS depression indicates opioid toxicity. Urine output and serum creatinine (D) are important for
overall renal function but are not immediate pre- and post-administration assessments specific to morphine
dosing.
5. A client with a nasogastric (NG) tube is ordered to receive oral levothyroxine 100 mcg daily.
Which route should the nurse use to administer this medication?
A. Crush the tablet and administer through the NG tube followed by 30 mL of water
B. Administer the tablet through the NG tube whole with adequate water flush
C. Hold the medication and contact the healthcare provider for an alternative route
D. Mix the crushed tablet in the next scheduled tube feeding
Correct Answer: C
Rationale: Levothyroxine has very specific absorption requirements. It should be taken on an empty stomach,
and its bioavailability is significantly affected by food, tube feedings, and many medications. The tablet should
not be crushed and mixed with tube feedings (D) because calcium and other components in the feeding bind
levothyroxine and reduce absorption. The safest and most appropriate action is to hold the medication and
contact the healthcare provider for an IV or alternative formulation. Even crushing and administering through
the NG tube (A) is not ideal because the NG tube is often clamped during medication administration, and
absorption variability in the GI tract of a critically ill patient makes oral dosing unreliable. Administering the
tablet whole (B) is not possible through an NG tube. This demonstrates the nurse's role in patient advocacy and
ensuring the Right Route.
6. A nurse administers furosemide 40 mg IV to a client with heart failure. The medication was
given 30 minutes ago. Which documentation is most appropriate for the nurse to record?
A. "Furosemide 40 mg IV given at 0900 per order. Client tolerated well."
B. "Furosemide 40 mg IV administered at 0900. Client voided 250 mL clear yellow urine at 0930."
C. "Furosemide 40 mg IV given. BP before 150/90, after 130/80. Lung sounds clearer bilaterally."
D. "Furosemide 40 mg IV pushed at 0900 over 2 minutes in right forearm. BP 148/92 pre-administration."
Correct Answer: D
Rationale: The most comprehensive and appropriate documentation includes the medication, dose, route, time,
administration technique (pushed over 2 minutes), and relevant pre-administration assessment data (blood
pressure). This fulfills the nursing documentation standards for medication administration, which should
capture the Right Dose, Right Time, Right Route, and Right Assessment. While option A is too brief and lacks
assessment data, option B focuses on the outcome (diuresis) but misses critical pre-administration data. Option
C documents pre- and post-data but lacks the administration technique and site. Furosemide should be
administered slowly (over 1-2 minutes) to prevent ototoxicity, making documentation of the administration
technique especially important.
7. A nurse is performing medication reconciliation at admission for a client transferred from a
long-term care facility. The client's current home medications include metformin, lisinopril, and
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