Evolve HESI Pharmacology Exam Script
Complete Questions 1-200 with Answers and Rationales
Cardiovascular Medications
Question 1
A client with hypertension is prescribed captopril (Capoten). Which is the priority
nursing intervention when administering the first dose?
A) Place the client in Trendelenburg position
B) Take the client's apical pulse for 1 full minute
C) Instruct the client to drink 3L of fluid daily
D) Educate the client to sit on the side of the bed for a few minutes before rising
Answer: D) Educate the client to sit on the side of the bed for a few minutes before
rising
Rationale: ACE inhibitors such as captopril can cause severe hypotension with initial use
(first-dose phenomenon). The client should be instructed to rise slowly and sit on the side
of the bed for a few minutes to prevent hypotension-induced falls. Trendelenburg position
may be used if a precipitous drop occurs but is not the priority preventive intervention .
Question 2
A client prescribed lisinopril reports swelling of the lips and tongue. What is the nurse's
priority action?
A) Administer diphenhydramine
B) Hold the next dose and notify the provider
,C) Instruct the client to take the medication with food
D) Document the finding as a common side effect
Answer: B) Hold the next dose and notify the provider
Rationale: Angioedema (swelling of the lips, tongue, or throat) is a life-threatening allergic
reaction to ACE inhibitors requiring immediate intervention. The nurse should hold the
medication and notify the healthcare provider. A dry cough is a common side effect but is
not life-threatening .
Question 3
A client with atrial fibrillation is prescribed amiodarone. Which adverse effects should
the nurse monitor for? (Select all that apply)
A) Hypothyroidism
B) Hyperthyroidism
C) Pulmonary fibrosis
D) Bradycardia
E) Hepatotoxicity
Answer: A, B, C, D, and E
Rationale: Amiodarone can cause both hypothyroidism and hyperthyroidism due to its
high iodine content, pulmonary fibrosis (which is serious and requires immediate
evaluation), bradycardia, and hepatotoxicity. Regular monitoring of thyroid function,
pulmonary status, liver function, and heart rate is essential during therapy .
Question 4
A client is prescribed clopidogrel (Plavix) after a stroke. Which adverse effect should the
nurse monitor for?
A) New-onset confusion
B) Repeated syncope
C) Abdominal distention
D) Spontaneous ecchymosis
Answer: D) Spontaneous ecchymosis
,Rationale: Clopidogrel is an antiplatelet medication that can cause bleeding, bruising, and
liver dysfunction. The nurse should be alert for signs of bleeding such as ecchymosis,
bleeding gums, and tarry stools. Plavix does not cause syncope, confusion, or abdominal
distention .
Question 5
Which statement by a client prescribed clopidogrel indicates understanding of the
medication?
A) "I will take this medication with food to prevent stomach upset."
B) "I will report any unusual bleeding or bruising."
C) "I can stop this medication if I have no chest pain."
D) "I can take ibuprofen if I have a headache."
Answer: B) "I will report any unusual bleeding or bruising."
Rationale: Clopidogrel is an antiplatelet agent that increases bleeding risk. Clients should
report any unusual bleeding or bruising. The medication should not be stopped without
consulting the provider, and NSAIDs like ibuprofen should be avoided due to increased
bleeding risk .
Question 6
A client is prescribed warfarin (Coumadin). Which laboratory value indicates a
therapeutic International Normalized Ratio (INR) for this client?
A) 0.5 to 1.0
B) 1.0 to 1.5
C) 2.0 to 3.0
D) 3.5 to 4.5
Answer: C) 2.0 to 3.0
Rationale: For most indications (atrial fibrillation, DVT, PE), the therapeutic INR target for
warfarin is 2.0 to 3.0. For mechanical heart valves, the target may be higher (2.5 to 3.5).
The INR should be monitored regularly, and doses adjusted accordingly. A subtherapeutic
INR increases clotting risk, while a supratherapeutic INR increases bleeding risk .
, Question 7
A client on warfarin has an INR of 5.2. What is the priority nursing action?
A) Administer vitamin K immediately
B) Hold the dose and notify the provider
C) Increase the warfarin dose
D) Continue the current dose and recheck in 24 hours
Answer: B) Hold the dose and notify the provider
Rationale: An INR above 4.0 indicates a significantly increased bleeding risk. The priority
action is to hold the next dose and notify the healthcare provider. The provider will
determine whether to administer vitamin K or adjust the dose based on the clinical
situation and whether there is active bleeding .
Question 8
A client receiving heparin has an aPTT of 110 seconds (control 35 seconds). What is the
priority nursing action?
A) Continue the infusion and monitor
B) Decrease the infusion rate by half
C) Stop the infusion and prepare protamine sulfate
D) Notify the provider of the therapeutic result
Answer: C) Stop the infusion and prepare protamine sulfate
Rationale: The therapeutic aPTT target is 1.5 to 2.5 times the control (approximately 53-88
seconds). An aPTT of 110 seconds indicates a high bleeding risk requiring immediate
action. The nurse should stop the infusion and prepare protamine sulfate, the antidote for
heparin .
Question 9
A client is prescribed enoxaparin (Lovenox) subcutaneously. Which technique should the
nurse use when administering this medication?
A) Aspirate before injecting
Complete Questions 1-200 with Answers and Rationales
Cardiovascular Medications
Question 1
A client with hypertension is prescribed captopril (Capoten). Which is the priority
nursing intervention when administering the first dose?
A) Place the client in Trendelenburg position
B) Take the client's apical pulse for 1 full minute
C) Instruct the client to drink 3L of fluid daily
D) Educate the client to sit on the side of the bed for a few minutes before rising
Answer: D) Educate the client to sit on the side of the bed for a few minutes before
rising
Rationale: ACE inhibitors such as captopril can cause severe hypotension with initial use
(first-dose phenomenon). The client should be instructed to rise slowly and sit on the side
of the bed for a few minutes to prevent hypotension-induced falls. Trendelenburg position
may be used if a precipitous drop occurs but is not the priority preventive intervention .
Question 2
A client prescribed lisinopril reports swelling of the lips and tongue. What is the nurse's
priority action?
A) Administer diphenhydramine
B) Hold the next dose and notify the provider
,C) Instruct the client to take the medication with food
D) Document the finding as a common side effect
Answer: B) Hold the next dose and notify the provider
Rationale: Angioedema (swelling of the lips, tongue, or throat) is a life-threatening allergic
reaction to ACE inhibitors requiring immediate intervention. The nurse should hold the
medication and notify the healthcare provider. A dry cough is a common side effect but is
not life-threatening .
Question 3
A client with atrial fibrillation is prescribed amiodarone. Which adverse effects should
the nurse monitor for? (Select all that apply)
A) Hypothyroidism
B) Hyperthyroidism
C) Pulmonary fibrosis
D) Bradycardia
E) Hepatotoxicity
Answer: A, B, C, D, and E
Rationale: Amiodarone can cause both hypothyroidism and hyperthyroidism due to its
high iodine content, pulmonary fibrosis (which is serious and requires immediate
evaluation), bradycardia, and hepatotoxicity. Regular monitoring of thyroid function,
pulmonary status, liver function, and heart rate is essential during therapy .
Question 4
A client is prescribed clopidogrel (Plavix) after a stroke. Which adverse effect should the
nurse monitor for?
A) New-onset confusion
B) Repeated syncope
C) Abdominal distention
D) Spontaneous ecchymosis
Answer: D) Spontaneous ecchymosis
,Rationale: Clopidogrel is an antiplatelet medication that can cause bleeding, bruising, and
liver dysfunction. The nurse should be alert for signs of bleeding such as ecchymosis,
bleeding gums, and tarry stools. Plavix does not cause syncope, confusion, or abdominal
distention .
Question 5
Which statement by a client prescribed clopidogrel indicates understanding of the
medication?
A) "I will take this medication with food to prevent stomach upset."
B) "I will report any unusual bleeding or bruising."
C) "I can stop this medication if I have no chest pain."
D) "I can take ibuprofen if I have a headache."
Answer: B) "I will report any unusual bleeding or bruising."
Rationale: Clopidogrel is an antiplatelet agent that increases bleeding risk. Clients should
report any unusual bleeding or bruising. The medication should not be stopped without
consulting the provider, and NSAIDs like ibuprofen should be avoided due to increased
bleeding risk .
Question 6
A client is prescribed warfarin (Coumadin). Which laboratory value indicates a
therapeutic International Normalized Ratio (INR) for this client?
A) 0.5 to 1.0
B) 1.0 to 1.5
C) 2.0 to 3.0
D) 3.5 to 4.5
Answer: C) 2.0 to 3.0
Rationale: For most indications (atrial fibrillation, DVT, PE), the therapeutic INR target for
warfarin is 2.0 to 3.0. For mechanical heart valves, the target may be higher (2.5 to 3.5).
The INR should be monitored regularly, and doses adjusted accordingly. A subtherapeutic
INR increases clotting risk, while a supratherapeutic INR increases bleeding risk .
, Question 7
A client on warfarin has an INR of 5.2. What is the priority nursing action?
A) Administer vitamin K immediately
B) Hold the dose and notify the provider
C) Increase the warfarin dose
D) Continue the current dose and recheck in 24 hours
Answer: B) Hold the dose and notify the provider
Rationale: An INR above 4.0 indicates a significantly increased bleeding risk. The priority
action is to hold the next dose and notify the healthcare provider. The provider will
determine whether to administer vitamin K or adjust the dose based on the clinical
situation and whether there is active bleeding .
Question 8
A client receiving heparin has an aPTT of 110 seconds (control 35 seconds). What is the
priority nursing action?
A) Continue the infusion and monitor
B) Decrease the infusion rate by half
C) Stop the infusion and prepare protamine sulfate
D) Notify the provider of the therapeutic result
Answer: C) Stop the infusion and prepare protamine sulfate
Rationale: The therapeutic aPTT target is 1.5 to 2.5 times the control (approximately 53-88
seconds). An aPTT of 110 seconds indicates a high bleeding risk requiring immediate
action. The nurse should stop the infusion and prepare protamine sulfate, the antidote for
heparin .
Question 9
A client is prescribed enoxaparin (Lovenox) subcutaneously. Which technique should the
nurse use when administering this medication?
A) Aspirate before injecting
