PHARMACOLOGY HESI V2 EXAM
2026/2027 | EXACT OFFICIAL COUNT: 75 QUESTIONS
COMPLETE EXAM-STYLE QUESTIONS WITH DETAILED RATIONALES | 100% VERIFIED |
GRADED A+
HESI Pharmacology V2 Examination - Comprehensive Pharmacotherapeutics Competency Assessment for
Nursing Licensure Readiness (Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment)
Core Domains: Cardiovascular Pharmacology, Respiratory & Gastrointestinal Drugs, Endocrine &
Reproductive Agents, Neurological & Psychiatric Medications, Anti-Infectives, Pain Management,
Pharmacokinetics & Calculations, and Medication Safety | HESI V2 Pharmacology-Aligned Format
Exam Structure
• Exact official question count: 75 multiple-choice questions (MCQ) (per commonly cited HESI
Pharmacology V2 specifications and verified Elsevier Evolve 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
• Questions must be presented in bold
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, prioritization scenarios,
dosage calculation scenarios, and clinical judgment application questions
• Focus on evidence-based pharmacotherapeutic principles, NCSBN Clinical Judgment Measurement
Model (CJMM) application, and professional judgment aligned with NCSBN NCLEX-RN test plan and RN
program competencies
• Total testing time: 120 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
nursing program policy (56-60/75 correct)
• Assessment delivery: Fixed-format objective assessment with clinical case vignettes, drug interaction
scenarios, adverse effect recognition, and clinical reasoning application questions
Introduction
This HESI Pharmacology V2 Exam format for 2026/2027 reflects the standardized competency assessment
used to evaluate proficiency in applied pharmacotherapeutic principles for pre-licensure RN students
preparing for NCLEX-RN licensure. The official examination consists of exactly 75 multiple-choice questions
(MCQ) covering critical domains: cardiovascular pharmacology, respiratory and gastrointestinal drugs,
endocrine and reproductive agents, neurological and psychiatric medications, anti-infectives, pain
management, pharmacokinetics and calculations, and medication safety. 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 nursing program learning outcomes.
Answer Format
All correct answers must be presented in bold, each question must appear in bold, and all rationales
explaining pharmacotherapeutic principles, medication safety protocols, dosage calculations, and scenario-
based professional reasoning must be written in
,Examination Overview (2026/2027)
Domain Questions Key Topics Weight
Cardiovascular & 15 Antihypertensives, 20%
Respiratory Antianginals,
Pharmacotherapy Anticoagulants,
Bronchodilators,
Corticosteroids,
Monitoring Parameters
Neurologic, Psychiatric 15 Antidepressants, 20%
& Pain Management Antipsychotics,
Anticonvulsants,
Opioids, NSAIDs, Side
Effect Monitoring,
Serotonin Syndrome
Endocrine & Metabolic 12 Insulin Types, Oral 16%
Pharmacotherapy Antidiabetics, Thyroid
Medications,
Corticosteroids,
Hypo/Hyperglycemia
Management
Anti-Infectives & 10 Antibiotics, Antivirals, 13%
Immunizations Resistance Prevention,
Allergy Assessment,
Culture-Guided
Therapy, Vaccine
Schedules
GI, GU & Reproductive 10 Antacids, PPIs, 13%
Agents Laxatives, Diuretics,
Hormonal
Contraceptives, Fertility
Agents, Safety
Considerations
Safety, Calculations & 13 Dosage Calculations, 18%
Pharmacokinetics Half-Life, Therapeutic
Range, High-Alert
Protocols,
Administration Routes,
Interactions
TOTAL 75 Comprehensive 100%
Pharmacology
Competency
, Examination Questions
Domain: Cardiovascular & Respiratory Pharmacotherapy
1. A client with heart failure is prescribed digoxin. Which assessment finding would indicate
potential toxicity?
A. Blood pressure of 138/82 mmHg B. Respiratory rate of 18 breaths/min
C. Visual disturbances, specifically yellow-green D. Weight loss of 1 kg in 2 days
halos
Correct Answer: C
Rationale: Visual disturbances, particularly seeing yellow-green halos around lights, are classic signs of
digoxin toxicity. Other signs include anorexia, nausea, vomiting, and cardiac arrhythmias (especially
bradycardia). BP and respiratory rate are typically unaffected unless severe toxicity occurs. Weight loss
may indicate improved heart failure status, not toxicity. The nurse must monitor apical pulse and drug
levels to prevent adverse events.
2. A client is receiving a continuous IV heparin infusion for a DVT. The aPTT is 90 seconds
(therapeutic range 60-80 seconds). What is the nurse's most appropriate action?
A. Continue the infusion at the current rate B. Increase the infusion rate per protocol
C. Hold the infusion for 1 hour and notify the D. Administer vitamin K as an antidote
provider
Correct Answer: C
Rationale: An aPTT of 90 seconds exceeds the therapeutic range, indicating over-anticoagulation and
increased bleeding risk. The appropriate action is to hold the infusion per protocol and notify the provider
for dose adjustment. Vitamin K is the antidote for warfarin, not heparin (protamine sulfate reverses
heparin). This scenario tests the "Analyze Cues" and "Take Action" steps of the CJMM for high-alert
medication management.
3. Select All That Apply: Which instructions should the nurse include for a client prescribed
lisinopril? (Select All That Apply)
A. Avoid potassium supplements or salt substitutes B. Report facial swelling or difficulty breathing
immediately
C. Take the medication with a high-protein meal D. Change positions slowly to prevent orthostatic
hypotension
Correct Answer: A,B,D
Rationale: Lisinopril is an ACE inhibitor. It can cause hyperkalemia, so avoiding potassium
supplements/salt substitutes (A) is crucial. It can cause angioedema (facial swelling), which is a medical
emergency (B). It causes orthostatic hypotension, requiring slow position changes (D). Protein intake (C)
does not significantly affect lisinopril absorption; consistency is key but specific high-protein meals are not
required.
4. A client with atrial fibrillation is prescribed warfarin 5 mg daily. The INR is 4.5 (therapeutic
range 2.0-3.0). Which action should the nurse take?
A. Administer the next dose as scheduled B. Hold the warfarin and notify the provider
C. Administer vitamin K 10 mg IV push D. Increase the dose to 7.5 mg
Correct Answer: B
2026/2027 | EXACT OFFICIAL COUNT: 75 QUESTIONS
COMPLETE EXAM-STYLE QUESTIONS WITH DETAILED RATIONALES | 100% VERIFIED |
GRADED A+
HESI Pharmacology V2 Examination - Comprehensive Pharmacotherapeutics Competency Assessment for
Nursing Licensure Readiness (Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment)
Core Domains: Cardiovascular Pharmacology, Respiratory & Gastrointestinal Drugs, Endocrine &
Reproductive Agents, Neurological & Psychiatric Medications, Anti-Infectives, Pain Management,
Pharmacokinetics & Calculations, and Medication Safety | HESI V2 Pharmacology-Aligned Format
Exam Structure
• Exact official question count: 75 multiple-choice questions (MCQ) (per commonly cited HESI
Pharmacology V2 specifications and verified Elsevier Evolve 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
• Questions must be presented in bold
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, prioritization scenarios,
dosage calculation scenarios, and clinical judgment application questions
• Focus on evidence-based pharmacotherapeutic principles, NCSBN Clinical Judgment Measurement
Model (CJMM) application, and professional judgment aligned with NCSBN NCLEX-RN test plan and RN
program competencies
• Total testing time: 120 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
nursing program policy (56-60/75 correct)
• Assessment delivery: Fixed-format objective assessment with clinical case vignettes, drug interaction
scenarios, adverse effect recognition, and clinical reasoning application questions
Introduction
This HESI Pharmacology V2 Exam format for 2026/2027 reflects the standardized competency assessment
used to evaluate proficiency in applied pharmacotherapeutic principles for pre-licensure RN students
preparing for NCLEX-RN licensure. The official examination consists of exactly 75 multiple-choice questions
(MCQ) covering critical domains: cardiovascular pharmacology, respiratory and gastrointestinal drugs,
endocrine and reproductive agents, neurological and psychiatric medications, anti-infectives, pain
management, pharmacokinetics and calculations, and medication safety. 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 nursing program learning outcomes.
Answer Format
All correct answers must be presented in bold, each question must appear in bold, and all rationales
explaining pharmacotherapeutic principles, medication safety protocols, dosage calculations, and scenario-
based professional reasoning must be written in
,Examination Overview (2026/2027)
Domain Questions Key Topics Weight
Cardiovascular & 15 Antihypertensives, 20%
Respiratory Antianginals,
Pharmacotherapy Anticoagulants,
Bronchodilators,
Corticosteroids,
Monitoring Parameters
Neurologic, Psychiatric 15 Antidepressants, 20%
& Pain Management Antipsychotics,
Anticonvulsants,
Opioids, NSAIDs, Side
Effect Monitoring,
Serotonin Syndrome
Endocrine & Metabolic 12 Insulin Types, Oral 16%
Pharmacotherapy Antidiabetics, Thyroid
Medications,
Corticosteroids,
Hypo/Hyperglycemia
Management
Anti-Infectives & 10 Antibiotics, Antivirals, 13%
Immunizations Resistance Prevention,
Allergy Assessment,
Culture-Guided
Therapy, Vaccine
Schedules
GI, GU & Reproductive 10 Antacids, PPIs, 13%
Agents Laxatives, Diuretics,
Hormonal
Contraceptives, Fertility
Agents, Safety
Considerations
Safety, Calculations & 13 Dosage Calculations, 18%
Pharmacokinetics Half-Life, Therapeutic
Range, High-Alert
Protocols,
Administration Routes,
Interactions
TOTAL 75 Comprehensive 100%
Pharmacology
Competency
, Examination Questions
Domain: Cardiovascular & Respiratory Pharmacotherapy
1. A client with heart failure is prescribed digoxin. Which assessment finding would indicate
potential toxicity?
A. Blood pressure of 138/82 mmHg B. Respiratory rate of 18 breaths/min
C. Visual disturbances, specifically yellow-green D. Weight loss of 1 kg in 2 days
halos
Correct Answer: C
Rationale: Visual disturbances, particularly seeing yellow-green halos around lights, are classic signs of
digoxin toxicity. Other signs include anorexia, nausea, vomiting, and cardiac arrhythmias (especially
bradycardia). BP and respiratory rate are typically unaffected unless severe toxicity occurs. Weight loss
may indicate improved heart failure status, not toxicity. The nurse must monitor apical pulse and drug
levels to prevent adverse events.
2. A client is receiving a continuous IV heparin infusion for a DVT. The aPTT is 90 seconds
(therapeutic range 60-80 seconds). What is the nurse's most appropriate action?
A. Continue the infusion at the current rate B. Increase the infusion rate per protocol
C. Hold the infusion for 1 hour and notify the D. Administer vitamin K as an antidote
provider
Correct Answer: C
Rationale: An aPTT of 90 seconds exceeds the therapeutic range, indicating over-anticoagulation and
increased bleeding risk. The appropriate action is to hold the infusion per protocol and notify the provider
for dose adjustment. Vitamin K is the antidote for warfarin, not heparin (protamine sulfate reverses
heparin). This scenario tests the "Analyze Cues" and "Take Action" steps of the CJMM for high-alert
medication management.
3. Select All That Apply: Which instructions should the nurse include for a client prescribed
lisinopril? (Select All That Apply)
A. Avoid potassium supplements or salt substitutes B. Report facial swelling or difficulty breathing
immediately
C. Take the medication with a high-protein meal D. Change positions slowly to prevent orthostatic
hypotension
Correct Answer: A,B,D
Rationale: Lisinopril is an ACE inhibitor. It can cause hyperkalemia, so avoiding potassium
supplements/salt substitutes (A) is crucial. It can cause angioedema (facial swelling), which is a medical
emergency (B). It causes orthostatic hypotension, requiring slow position changes (D). Protein intake (C)
does not significantly affect lisinopril absorption; consistency is key but specific high-protein meals are not
required.
4. A client with atrial fibrillation is prescribed warfarin 5 mg daily. The INR is 4.5 (therapeutic
range 2.0-3.0). Which action should the nurse take?
A. Administer the next dose as scheduled B. Hold the warfarin and notify the provider
C. Administer vitamin K 10 mg IV push D. Increase the dose to 7.5 mg
Correct Answer: B
