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HESI PHARMACOLOGY EVOLVE TEST BANK NGN QUESTION
SET WITH CLINICAL SOLUTIONS
HESI PHARMACOLOGY EVOLVE TEST BANK (NGN)
2026/2027 Academic Year
Comprehensive NGN-Style Pharmacotherapeutics Competency Assessment for Registered
Nursing
Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment
Abstract
This examination assesses proficiency in foundational and advanced
pharmacotherapeutic principles for pre-licensure registered nursing students aligned
with the HESI Pharmacology Evolve testing standards and the NCSBN Clinical
Judgment Measurement Model (CJMM). The assessment comprises 100 multiple-
choice questions spanning 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, and NGN case study application. All items are designed to
measure knowledge essential for safe, effective, and evidence-based medication
management practice, consistent with the current NCSBN NCLEX-RN Test Plan,
Elsevier HESI test blueprints, and institutional RN program learning outcomes.
Keywords: HESI Pharmacology, NGN, Clinical Judgment Measurement Model,
NCLEX-RN, high-alert medications, pharmacokinetics, pharmacotherapy,
antimicrobial stewardship, medication safety, dosage calculation
Total Questions 100 MCQ
Testing Time 120 Minutes
Passing Score 850 HESI Score / 75–80%
Format Computer-Based, Proctored (Elsevier
Evolve)
Alignment NCSBN CJMM / NCLEX-RN / HESI
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Examination Overview
Domain Questions Key Topics Weight
Clinical Judgment & 15 Rights of Medication Administration, 15%
Medication BCMA, Patient Education, Assessment
Administration Pre/Post Administration
Safety & High-Alert 18 Insulin/Heparin/Opioids/Anticoagulants 18%
Medication Protocols Safety, Double-Checks, Error Prevention,
ISMP Guidelines
Pharmacokinetics & 12 ADME Processes, Half-Life, Therapeutic 12%
Pharmacodynamics Range, Drug Interactions, Receptor
Theory
Cardiovascular & 15 Antihypertensives, Antianginals, 15%
Respiratory Anticoagulants, Bronchodilators,
Pharmacotherapy Corticosteroids, Monitoring Parameters
Neurologic & 12 Antidepressants, Antipsychotics, 12%
Psychiatric Anticonvulsants, Anxiolytics, Opioids,
Pharmacology Side Effect Monitoring
Endocrine & 10 Insulin Types, Oral Antidiabetics, 10%
Metabolic Thyroid Medications, Corticosteroids,
Pharmacotherapy Hypoglycemia Management
Anti-Infectives & 10 Antibiotics, Antivirals, Antifungals, 10%
Antimicrobial Resistance Prevention, Allergy
Stewardship Assessment, Culture-Guided Therapy
NGN Case Study 8 Bow-Tie Items, Trend Recognition, 8%
Application Matrix MCQs, Multi-Dose Safety, Clinical
Prioritization
Name: ________________________ Date: _______________ Score: ____ / 100
Instructions: Select the single best answer for each question unless marked as Select-All-That-Apply
(SATA). Total time: 120 minutes | Passing score: 850 HESI Score or 75–80%
Section I: Clinical Judgment & Medication Administration
1. The RN is preparing to administer metoprolol 50 mg PO to a client with hypertension.
Which assessment finding requires the RN to hold the dose and notify the provider?
A. Blood pressure of 138/82 mmHg
B. Apical pulse of 54 beats per minute
C. Respiratory rate of 18 breaths per minute
D. Blood glucose of 110 mg/dL
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that decreases heart rate; an apical pulse below 60 bpm is
a common parameter for holding the dose due to risk of severe bradycardia and hypotension. Blood
pressure of 138/82 (A) is acceptable. Respiratory rate (C) and blood glucose (D) are within normal
limits and not contraindications. The RN must know medication-specific parameters for holding
doses and when to escalate concerns, aligning with safe medication administration standards and
the "Recognize Cues" step of the CJMM.
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2. Select All That Apply: Which actions should the RN take when administering insulin to a
client with type 1 diabetes? [SATA]
A. Verify the insulin type and dose with another licensed nurse per facility policy for
high-alert medications
B. Rotate injection sites within the same anatomical area to prevent lipohypertrophy
C. Administer rapid-acting insulin 30 minutes before a meal
D. Mix NPH and regular insulin in the same syringe by drawing up NPH first
Correct Answer: A, B
Rationale: Appropriate RN actions include: verifying high-alert medications like insulin with
another licensed nurse (A) per ISMP safety protocols, and rotating injection sites within the same
anatomical area (B) to prevent tissue damage. Rapid-acting insulin (C) should be administered 0-15
minutes before a meal, not 30 minutes. When mixing NPH and regular insulin (D), regular (clear)
insulin should be drawn up first, then NPH (cloudy) to prevent contaminating the regular insulin
vial with NPH. These actions align with the "Take Action" step of the Clinical Judgment
Measurement Model.
3. A client is receiving a continuous IV heparin infusion. The aPTT is 98 seconds
(therapeutic range 60-80 seconds). What is the RN'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 provider
D. Administer vitamin K as an antidote
Correct Answer: C
Rationale: An aPTT of 98 seconds exceeds the therapeutic range (60-80 seconds), indicating over-
anticoagulation and increased bleeding risk. The appropriate action is to hold the infusion per
protocol and notify the provider for dose adjustment. Continuing the infusion (A) or increasing the
rate (B) would worsen over-anticoagulation. Vitamin K (D) is the antidote for warfarin, not heparin;
protamine sulfate reverses heparin. This scenario tests the RN's ability to "Analyze Cues" and "Take
Action" per the CJMM framework for high-alert medication management.
4. The RN is preparing to administer morphine 4 mg IV push for postoperative pain. Which
action is essential to prevent respiratory depression?
A. Administer the dose rapidly over 10 seconds for rapid pain relief
B. Dilute the morphine in 10 mL normal saline and administer slowly over 4-5 minutes,
monitoring respiratory status before, during, and after administration
C. Administer the dose without monitoring because the client has tolerated morphine previously
D. Give naloxone prophylactically before administering morphine
Correct Answer: B
Rationale: IV push opioids should be diluted and administered slowly (over 4-5 minutes for
morphine) with continuous respiratory monitoring to prevent respiratory depression, the most
serious opioid adverse effect. Rapid administration (A) increases respiratory depression risk.
Assuming tolerance (C) ignores individual variability and cumulative dosing effects. Prophylactic
naloxone (D) is not standard practice and may precipitate withdrawal or reduce analgesic efficacy.
This action aligns with ISMP high-alert medication safety protocols and the "Take Action" step of the
CJMM.
5. A medication has a half-life of 6 hours. If a dose is administered at 0800, approximately
what time will the plasma concentration reach steady state?
A. 1400 (6 hours later)
B. 2000 (12 hours later)
C. 0200 the next day (18 hours later)
D. 0800 the next day (24 hours later)
Correct Answer: D
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Rationale: Steady state is typically reached after 4-5 half-lives of a medication. With a half-life of 6
hours: 6 hours x 4 = 24 hours. Therefore, steady state would be reached approximately at 0800 the
next day. Understanding half-life and steady state is essential for predicting when therapeutic effects
will be achieved and for timing therapeutic drug monitoring. This pharmacokinetic principle guides
dosing interval decisions and patient education about medication onset.
6. A client with heart failure is prescribed furosemide 40 mg IV daily. Which assessment
finding indicates the medication is effective?
A. Weight gain of 2 kg in 24 hours
B. Increased crackles in lung bases
C. Urine output of 200 mL in the past hour
D. Blood pressure of 90/60 mmHg
Correct Answer: C
Rationale: Furosemide is a loop diuretic that promotes fluid excretion; increased urine output
indicates the medication is achieving its therapeutic effect of reducing fluid volume. Weight gain (A)
and increased crackles (B) indicate worsening fluid overload, not effectiveness. Hypotension (D) is a
potential adverse effect, not a therapeutic goal. The RN must "Evaluate Outcomes" per the CJMM by
monitoring expected therapeutic responses to pharmacologic interventions.
7. A client prescribed sertraline reports increased anxiety and insomnia during the first
week of therapy. What is the RN's most appropriate response?
A. Discontinue the medication immediately due to adverse effects
B. Reassure the client that these are common initial side effects that typically resolve
within 1-2 weeks, and encourage continued adherence
C. Increase the dose to achieve faster therapeutic effect
D. Switch to a different class of antidepressant immediately
Correct Answer: B
Rationale: SSRIs like sertraline commonly cause initial activation symptoms (anxiety, insomnia,
agitation) that typically resolve within 1-2 weeks as the client adapts. The RN should provide
anticipatory guidance and encourage adherence while monitoring for improvement. Discontinuing
(A), increasing the dose (C), or switching medications (D) prematurely may prevent the client from
achieving therapeutic benefit. Patient education about expected side effects and timeline for
improvement is essential for medication adherence and aligns with the "Generate Solutions" step of
the CJMM.
8. A client with type 1 diabetes receives 10 units of regular insulin and 20 units of NPH
insulin at 0700. At what time is the client at greatest risk for hypoglycemia?
A. 0900 (peak of regular insulin)
B. 1300 (peak of NPH insulin)
C. 1700 (duration of regular insulin)
D. 2300 (duration of NPH insulin)
Correct Answer: B
Rationale: Regular insulin peaks at 2-4 hours (0900-1100), while NPH insulin peaks at 4-10 hours
(1100-1700), with the highest hypoglycemia risk at the NPH peak around 1300. The RN must
"Recognize Cues" and "Prioritize Hypotheses" regarding timing of hypoglycemia risk based on
insulin pharmacokinetics. Understanding onset, peak, and duration of insulin types is essential for
patient education, meal planning, and hypoglycemia prevention strategies.
9. A client is prescribed vancomycin IV for MRSA pneumonia. Which monitoring
parameter is most critical to prevent toxicity?
A. Liver function tests (AST/ALT)
B. Trough vancomycin level before the fourth dose
C. Serum potassium level
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HESI PHARMACOLOGY EVOLVE TEST BANK NGN QUESTION
SET WITH CLINICAL SOLUTIONS
HESI PHARMACOLOGY EVOLVE TEST BANK (NGN)
2026/2027 Academic Year
Comprehensive NGN-Style Pharmacotherapeutics Competency Assessment for Registered
Nursing
Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment
Abstract
This examination assesses proficiency in foundational and advanced
pharmacotherapeutic principles for pre-licensure registered nursing students aligned
with the HESI Pharmacology Evolve testing standards and the NCSBN Clinical
Judgment Measurement Model (CJMM). The assessment comprises 100 multiple-
choice questions spanning 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, and NGN case study application. All items are designed to
measure knowledge essential for safe, effective, and evidence-based medication
management practice, consistent with the current NCSBN NCLEX-RN Test Plan,
Elsevier HESI test blueprints, and institutional RN program learning outcomes.
Keywords: HESI Pharmacology, NGN, Clinical Judgment Measurement Model,
NCLEX-RN, high-alert medications, pharmacokinetics, pharmacotherapy,
antimicrobial stewardship, medication safety, dosage calculation
Total Questions 100 MCQ
Testing Time 120 Minutes
Passing Score 850 HESI Score / 75–80%
Format Computer-Based, Proctored (Elsevier
Evolve)
Alignment NCSBN CJMM / NCLEX-RN / HESI
Downloaded by: Want to earn $1,500
Distribution of this document is illegal extra per year?
, classmerit.com — The Marketplace to Buy and Sell Study Materials
Examination Overview
Domain Questions Key Topics Weight
Clinical Judgment & 15 Rights of Medication Administration, 15%
Medication BCMA, Patient Education, Assessment
Administration Pre/Post Administration
Safety & High-Alert 18 Insulin/Heparin/Opioids/Anticoagulants 18%
Medication Protocols Safety, Double-Checks, Error Prevention,
ISMP Guidelines
Pharmacokinetics & 12 ADME Processes, Half-Life, Therapeutic 12%
Pharmacodynamics Range, Drug Interactions, Receptor
Theory
Cardiovascular & 15 Antihypertensives, Antianginals, 15%
Respiratory Anticoagulants, Bronchodilators,
Pharmacotherapy Corticosteroids, Monitoring Parameters
Neurologic & 12 Antidepressants, Antipsychotics, 12%
Psychiatric Anticonvulsants, Anxiolytics, Opioids,
Pharmacology Side Effect Monitoring
Endocrine & 10 Insulin Types, Oral Antidiabetics, 10%
Metabolic Thyroid Medications, Corticosteroids,
Pharmacotherapy Hypoglycemia Management
Anti-Infectives & 10 Antibiotics, Antivirals, Antifungals, 10%
Antimicrobial Resistance Prevention, Allergy
Stewardship Assessment, Culture-Guided Therapy
NGN Case Study 8 Bow-Tie Items, Trend Recognition, 8%
Application Matrix MCQs, Multi-Dose Safety, Clinical
Prioritization
Name: ________________________ Date: _______________ Score: ____ / 100
Instructions: Select the single best answer for each question unless marked as Select-All-That-Apply
(SATA). Total time: 120 minutes | Passing score: 850 HESI Score or 75–80%
Section I: Clinical Judgment & Medication Administration
1. The RN is preparing to administer metoprolol 50 mg PO to a client with hypertension.
Which assessment finding requires the RN to hold the dose and notify the provider?
A. Blood pressure of 138/82 mmHg
B. Apical pulse of 54 beats per minute
C. Respiratory rate of 18 breaths per minute
D. Blood glucose of 110 mg/dL
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that decreases heart rate; an apical pulse below 60 bpm is
a common parameter for holding the dose due to risk of severe bradycardia and hypotension. Blood
pressure of 138/82 (A) is acceptable. Respiratory rate (C) and blood glucose (D) are within normal
limits and not contraindications. The RN must know medication-specific parameters for holding
doses and when to escalate concerns, aligning with safe medication administration standards and
the "Recognize Cues" step of the CJMM.
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2. Select All That Apply: Which actions should the RN take when administering insulin to a
client with type 1 diabetes? [SATA]
A. Verify the insulin type and dose with another licensed nurse per facility policy for
high-alert medications
B. Rotate injection sites within the same anatomical area to prevent lipohypertrophy
C. Administer rapid-acting insulin 30 minutes before a meal
D. Mix NPH and regular insulin in the same syringe by drawing up NPH first
Correct Answer: A, B
Rationale: Appropriate RN actions include: verifying high-alert medications like insulin with
another licensed nurse (A) per ISMP safety protocols, and rotating injection sites within the same
anatomical area (B) to prevent tissue damage. Rapid-acting insulin (C) should be administered 0-15
minutes before a meal, not 30 minutes. When mixing NPH and regular insulin (D), regular (clear)
insulin should be drawn up first, then NPH (cloudy) to prevent contaminating the regular insulin
vial with NPH. These actions align with the "Take Action" step of the Clinical Judgment
Measurement Model.
3. A client is receiving a continuous IV heparin infusion. The aPTT is 98 seconds
(therapeutic range 60-80 seconds). What is the RN'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 provider
D. Administer vitamin K as an antidote
Correct Answer: C
Rationale: An aPTT of 98 seconds exceeds the therapeutic range (60-80 seconds), indicating over-
anticoagulation and increased bleeding risk. The appropriate action is to hold the infusion per
protocol and notify the provider for dose adjustment. Continuing the infusion (A) or increasing the
rate (B) would worsen over-anticoagulation. Vitamin K (D) is the antidote for warfarin, not heparin;
protamine sulfate reverses heparin. This scenario tests the RN's ability to "Analyze Cues" and "Take
Action" per the CJMM framework for high-alert medication management.
4. The RN is preparing to administer morphine 4 mg IV push for postoperative pain. Which
action is essential to prevent respiratory depression?
A. Administer the dose rapidly over 10 seconds for rapid pain relief
B. Dilute the morphine in 10 mL normal saline and administer slowly over 4-5 minutes,
monitoring respiratory status before, during, and after administration
C. Administer the dose without monitoring because the client has tolerated morphine previously
D. Give naloxone prophylactically before administering morphine
Correct Answer: B
Rationale: IV push opioids should be diluted and administered slowly (over 4-5 minutes for
morphine) with continuous respiratory monitoring to prevent respiratory depression, the most
serious opioid adverse effect. Rapid administration (A) increases respiratory depression risk.
Assuming tolerance (C) ignores individual variability and cumulative dosing effects. Prophylactic
naloxone (D) is not standard practice and may precipitate withdrawal or reduce analgesic efficacy.
This action aligns with ISMP high-alert medication safety protocols and the "Take Action" step of the
CJMM.
5. A medication has a half-life of 6 hours. If a dose is administered at 0800, approximately
what time will the plasma concentration reach steady state?
A. 1400 (6 hours later)
B. 2000 (12 hours later)
C. 0200 the next day (18 hours later)
D. 0800 the next day (24 hours later)
Correct Answer: D
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Rationale: Steady state is typically reached after 4-5 half-lives of a medication. With a half-life of 6
hours: 6 hours x 4 = 24 hours. Therefore, steady state would be reached approximately at 0800 the
next day. Understanding half-life and steady state is essential for predicting when therapeutic effects
will be achieved and for timing therapeutic drug monitoring. This pharmacokinetic principle guides
dosing interval decisions and patient education about medication onset.
6. A client with heart failure is prescribed furosemide 40 mg IV daily. Which assessment
finding indicates the medication is effective?
A. Weight gain of 2 kg in 24 hours
B. Increased crackles in lung bases
C. Urine output of 200 mL in the past hour
D. Blood pressure of 90/60 mmHg
Correct Answer: C
Rationale: Furosemide is a loop diuretic that promotes fluid excretion; increased urine output
indicates the medication is achieving its therapeutic effect of reducing fluid volume. Weight gain (A)
and increased crackles (B) indicate worsening fluid overload, not effectiveness. Hypotension (D) is a
potential adverse effect, not a therapeutic goal. The RN must "Evaluate Outcomes" per the CJMM by
monitoring expected therapeutic responses to pharmacologic interventions.
7. A client prescribed sertraline reports increased anxiety and insomnia during the first
week of therapy. What is the RN's most appropriate response?
A. Discontinue the medication immediately due to adverse effects
B. Reassure the client that these are common initial side effects that typically resolve
within 1-2 weeks, and encourage continued adherence
C. Increase the dose to achieve faster therapeutic effect
D. Switch to a different class of antidepressant immediately
Correct Answer: B
Rationale: SSRIs like sertraline commonly cause initial activation symptoms (anxiety, insomnia,
agitation) that typically resolve within 1-2 weeks as the client adapts. The RN should provide
anticipatory guidance and encourage adherence while monitoring for improvement. Discontinuing
(A), increasing the dose (C), or switching medications (D) prematurely may prevent the client from
achieving therapeutic benefit. Patient education about expected side effects and timeline for
improvement is essential for medication adherence and aligns with the "Generate Solutions" step of
the CJMM.
8. A client with type 1 diabetes receives 10 units of regular insulin and 20 units of NPH
insulin at 0700. At what time is the client at greatest risk for hypoglycemia?
A. 0900 (peak of regular insulin)
B. 1300 (peak of NPH insulin)
C. 1700 (duration of regular insulin)
D. 2300 (duration of NPH insulin)
Correct Answer: B
Rationale: Regular insulin peaks at 2-4 hours (0900-1100), while NPH insulin peaks at 4-10 hours
(1100-1700), with the highest hypoglycemia risk at the NPH peak around 1300. The RN must
"Recognize Cues" and "Prioritize Hypotheses" regarding timing of hypoglycemia risk based on
insulin pharmacokinetics. Understanding onset, peak, and duration of insulin types is essential for
patient education, meal planning, and hypoglycemia prevention strategies.
9. A client is prescribed vancomycin IV for MRSA pneumonia. Which monitoring
parameter is most critical to prevent toxicity?
A. Liver function tests (AST/ALT)
B. Trough vancomycin level before the fourth dose
C. Serum potassium level
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