BSN 225 HESI RN Specialty
Fundamentals of Nursing Final Exam
Nightingale College | 2026/2027 Latest Update
100 Questions & Answers | 100% Correct | Grade A
Examination Overview: This comprehensive assessment contains 100 questions aligned with the HESI RN Specialty
Fundamentals examination blueprint, NCLEX-RN test plan, and Nightingale College BSN 225 curriculum
competencies. Questions are organized across eight sections covering Safe and Effective Care Environment, Health
Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological and Parenteral
Therapies, Reduction of Risk Potential, Physiological Adaptation, and Integrated Clinical Scenarios. Cognitive level
distribution: approximately 30% recall, 50% application, 20% analysis. Question style: 75% scenario-based, 20% direct
recall, 5% clinical analysis. Each question includes the correct answer and a comprehensive nursing rationale with
priority-setting frameworks, evidence-based practice, and patient safety principles.
Legend: Each question shows four options (A-D). The correct option is highlighted in green with [CORRECT] marker, followed by a
'Correct Answer:' confirmation and a detailed rationale block.
Section 1: Safe, Effective Care Environment (Management of Care, Safety & Infection Control)
Q1: A registered nurse (RN) on a medical-surgical unit is planning client care for the shift. Which of the following
tasks is MOST appropriate to delegate to a licensed practical nurse (LPN)?
A. Performing a comprehensive admission assessment on a newly admitted client
B. Reinforcing teaching to a stable client with a new colostomy [CORRECT]
C. Developing a plan of care for a client with complex wounds
D. Evaluating the effectiveness of a new pain medication regimen
Correct Answer: B
Rationale:
Reinforcing teaching (NOT initial teaching, which is an RN responsibility) to a stable client with a new colostomy is within the
LPN scope of practice. The Five Rights of Delegation guide this decision: right task (reinforcing, not initiating, teaching), right
circumstance (stable client), right person (LPN), right direction (clear instructions), and right supervision. Comprehensive
admission assessment, developing the plan of care, and evaluating medication effectiveness all require RN-level nursing
judgment and cannot be delegated to an LPN. The RN retains accountability for assessment, diagnosis, planning, evaluation,
complex interventions, and initial client education per state nurse practice acts and Nightingale College BSN 225 curriculum
standards.
Q2: A nurse is caring for four clients. Using the ABC priority-setting framework, which client should the nurse
assess FIRST?
A. A client with a blood pressure of 160/90 mmHg reporting a headache
B. A client with a respiratory rate of 8 breaths per minute after opioid administration [CORRECT]
C. A client with a blood glucose of 250 mg/dL and polyuria
D. A client with a temperature of 38.5°C (101.3°F) and a productive cough
Correct Answer: B
Rationale:
A respiratory rate of 8 breaths/min indicates respiratory depression—a life-threatening airway/breathing emergency requiring
immediate intervention. The ABC framework (Airway, Breathing, Circulation) is the highest priority-setting framework in
BSN 225 HESI RN Fundamentals Final Exam Page 1 Nightingale College 2026/2027
, nursing. Opioid-induced respiratory depression requires naloxone (Narcan) and airway support immediately. Hypertension
with headache (circulation concern), hyperglycemia (metabolic concern), and fever with cough (infection) are all important but
lower priority than compromised breathing. This prioritization aligns with Maslow's hierarchy (physiological needs first) and
the NCLEX-RN test plan emphasis on airway and breathing as foundational to survival.
Q3: A client is scheduled for an elective cholecystectomy. The surgeon has explained the procedure, risks, and
alternatives, and the client has signed the consent form. After the surgeon leaves, the client asks the nurse, 'I'm
not really sure what they're going to do. Can you explain it again?' What is the nurse's BEST response?
A. Explain the surgical procedure in detail to ensure the client understands
B. Notify the surgeon that the client has questions about the procedure and requires further explanation
[CORRECT]
C. Reassure the client that the surgeon has already explained everything and the procedure will go smoothly
D. Document the client's question and proceed with preoperative preparation
Correct Answer: B
Rationale:
Informed consent is the provider's responsibility—the surgeon must explain the procedure, risks, benefits, and alternatives. The
nurse's role is to witness the signature, confirm the client's understanding, and notify the provider if the client has questions or
appears to lack understanding. If the client cannot explain the procedure, consent is not truly 'informed,' and the nurse must
notify the surgeon to return and re-explain. The nurse should NOT provide the detailed procedural explanation (scope issue),
should NOT provide false reassurance (non-therapeutic), and should NOT proceed without ensuring informed consent is valid.
This protects patient autonomy and legal/ethical standards.
Q4: A nurse discovers a small fire in a client's wastebasket in a client's room. The client is on oxygen via nasal
cannula. Following the RACE protocol, what should the nurse do FIRST?
A. Extinguish the fire using a nearby fire extinguisher
B. Rescue the client by removing them from the room [CORRECT]
C. Activate the fire alarm and notify staff
D. Confine the fire by closing all doors and windows
Correct Answer: B
Rationale:
RACE stands for Rescue, Alarm, Confine, Extinguish/Evacuate—in that order. The first action is to RESCUE the client by
removing them from immediate danger, especially critical here because the client is on oxygen, which accelerates fire. After
the client is safe, the nurse activates the ALARM, then CONFINES the fire (close doors, turn off oxygen), and finally
EXTINGUISHES if it is safe to do so (using PASS: Pull, Aim, Squeeze, Sweep) or EVACUATES. Extinguishing first would
delay client rescue; activating the alarm first would leave the client in danger. RACE prioritizes human life over property,
consistent with the ABC and safety principles in the NCLEX-RN test plan.
Q5: A client with active pulmonary tuberculosis (TB) is admitted to the medical unit. Which infection control
precautions should the nurse implement?
A. Contact precautions with gown and gloves
B. Droplet precautions with a surgical mask
C. Airborne precautions with an N95 respirator and negative-pressure room [CORRECT]
D. Standard precautions only, since TB is not highly contagious
Correct Answer: C
Rationale:
BSN 225 HESI RN Fundamentals Final Exam Page 2 Nightingale College 2026/2027
, Pulmonary tuberculosis requires AIRBORNE precautions because Mycobacterium tuberculosis is transmitted via small
airborne droplet nuclei that remain suspended in air and travel long distances. Precautions include a private negative-pressure
room (AIIR), N95 respirator for personnel, and the door kept closed. Contact precautions (gown/gloves) are used for MRSA,
VRE, C. diff. Droplet precautions (surgical mask) are for influenza, meningitis, pertussis. Standard precautions alone are
insufficient for TB. The N95 respirator filters particles ≥0.3 microns and must be fit-tested annually. This distinction between
contact, droplet, and airborne is a high-yield HESI Fundamentals topic.
Q6: An older adult client is admitted with confusion and a history of falls at home. Which of the following is the
MOST appropriate fall prevention intervention?
A. Keep the bed in the highest position for easy nursing access
B. Keep the bed in the lowest position with the call bell within reach and use non-skid footwear
[CORRECT]
C. Apply bilateral wrist restraints to prevent the client from getting out of bed
D. Administer a PRN sedative at bedtime to keep the client calm and in bed
Correct Answer: B
Rationale:
The most appropriate fall prevention intervention is to keep the bed in the LOWEST position with wheels locked, place the call
bell within easy reach, ensure non-skid footwear, provide adequate lighting, and implement hourly rounding. These are
evidence-based fall prevention strategies per The Joint Commission and AHRQ guidelines. Keeping the bed in the highest
position increases fall risk from a greater height. Restraints are a last resort and require a physician order—they do not prevent
falls and can cause injury. Sedatives increase fall risk by impairing cognition and balance. Additional interventions include
bed/chair alarms, toileting schedules, and addressing underlying causes (medications, hypotension, vision, environment).
Q7: A nurse is preparing to administer medications to a client. Which of the following actions demonstrates
adherence to the 'Three Checks' of medication administration?
A. Checking the medication label when retrieving it, when preparing it, and before administering it
[CORRECT]
B. Checking the medication label only at the time of administration
C. Checking the medication label at the beginning and end of the shift
D. Checking the medication label when retrieved and when returning it to storage
Correct Answer: A
Rationale:
The Three Checks of medication administration require the nurse to verify the medication label: (1) when retrieving it from
storage, (2) when preparing it (pouring, drawing up, etc.), and (3) before administering it to the client. Combined with the Six
Rights (right patient with 2 identifiers, right drug, right dose, right route, right time, right documentation), the Three Checks
form the foundation of safe medication administration and reduce error risk. Checking only at administration, at shift changes,
or at retrieval and storage is insufficient and increases medication error risk. These principles are core HESI Fundamentals
content and align with Nightingale College BSN 225 safety standards.
Q8: A client with Clostridium difficile infection is receiving contact precautions. The certified nursing assistant
(CNA) asks the nurse what type of hand hygiene to use after caring for this client. The nurse's BEST response is:
A. Use an alcohol-based hand rub because it is faster and more effective
B. Wash hands with soap and water for at least 20 seconds [CORRECT]
C. Use either method, as both are equally effective against C. diff
D. Wear gloves only; hand hygiene is not required if gloves are worn
Correct Answer: B
BSN 225 HESI RN Fundamentals Final Exam Page 3 Nightingale College 2026/2027
, Rationale:
Clostridium difficile produces spores that are NOT killed by alcohol-based hand rubs. Soap and water are required for
mechanical removal of spores. The CNA must wash hands with soap and water for at least 20 seconds after caring for a C. diff
patient, even if gloves were worn. Alcohol-based hand rubs are appropriate for routine hand hygiene when hands are not
visibly soiled and for most other pathogens, but C. diff is a critical exception. Gloves alone are insufficient—hand hygiene is
always required after glove removal. This exception is a frequent HESI exam point and is essential for preventing nosocomial
C. diff transmission.
Q9: A competent adult client refuses a prescribed blood transfusion due to religious beliefs. The physician insists
the transfusion is life-saving. What is the nurse's MOST appropriate action?
A. Administer the transfusion since it is life-saving and prescribed
B. Document the refusal, notify the physician, and respect the client's decision [CORRECT]
C. Have the client's family member sign the consent on the client's behalf
D. Administer the transfusion while the client is sedated for another procedure
Correct Answer: B
Rationale:
A competent adult has the legal and ethical right to refuse any treatment, even life-saving treatment, based on autonomy. The
nurse must respect the decision, document the refusal (including the client's understanding of consequences), notify the
physician, and continue to provide alternative care. Forcing treatment constitutes battery. A family member cannot consent for
a competent adult without a valid DPOA-HC. Administering treatment against the client's wishes—especially while
sedated—would be assault/battery and a violation of patient rights. The physician should be encouraged to discuss
consequences with the client, but the client's autonomous decision stands.
Q10: A nurse is caring for a client in wrist restraints following an episode of self-extubation. How often should the
nurse reassess the client and release the restraints for range of motion, toileting, and nutrition?
A. Reassess every 4 hours; release every 4 hours for adults
B. Reassess at least every 4 hours; release every 2 hours for adults [CORRECT]
C. Reassess every 2 hours; release every 4 hours for adults
D. Reassess and release every 1 hour for adults
Correct Answer: B
Rationale:
For adult clients in restraints, the nurse must reassess at least every 4 hours (more frequently if condition warrants), and release
the restraints every 2 hours for range of motion, toileting, nutrition, and hydration. For children, reassessment is every 2 hours
and release every 1-2 hours. Restraints require a physician order, face-to-face evaluation within 1 hour of application, and the
least restrictive device should be used. These standards from CMS and The Joint Commission protect client safety, circulation,
and dignity while preventing complications like contractures, skin breakdown, and psychological trauma. Restraints are a last
resort, used only when alternatives have failed.
Q11: A client asks the nurse, 'What is the difference between a living will and a durable power of attorney for
health care?' The nurse's BEST response is:
A. A living will designates a person to make decisions; a DPOA-HC specifies treatment preferences
B. A living will specifies treatment preferences in specific situations; a DPOA-HC designates a person to
make health care decisions when the client cannot [CORRECT]
C. Both documents are the same and serve identical purposes
D. A DPOA-HC is only for end-of-life care; a living will covers all medical decisions
Correct Answer: B
BSN 225 HESI RN Fundamentals Final Exam Page 4 Nightingale College 2026/2027
Fundamentals of Nursing Final Exam
Nightingale College | 2026/2027 Latest Update
100 Questions & Answers | 100% Correct | Grade A
Examination Overview: This comprehensive assessment contains 100 questions aligned with the HESI RN Specialty
Fundamentals examination blueprint, NCLEX-RN test plan, and Nightingale College BSN 225 curriculum
competencies. Questions are organized across eight sections covering Safe and Effective Care Environment, Health
Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort, Pharmacological and Parenteral
Therapies, Reduction of Risk Potential, Physiological Adaptation, and Integrated Clinical Scenarios. Cognitive level
distribution: approximately 30% recall, 50% application, 20% analysis. Question style: 75% scenario-based, 20% direct
recall, 5% clinical analysis. Each question includes the correct answer and a comprehensive nursing rationale with
priority-setting frameworks, evidence-based practice, and patient safety principles.
Legend: Each question shows four options (A-D). The correct option is highlighted in green with [CORRECT] marker, followed by a
'Correct Answer:' confirmation and a detailed rationale block.
Section 1: Safe, Effective Care Environment (Management of Care, Safety & Infection Control)
Q1: A registered nurse (RN) on a medical-surgical unit is planning client care for the shift. Which of the following
tasks is MOST appropriate to delegate to a licensed practical nurse (LPN)?
A. Performing a comprehensive admission assessment on a newly admitted client
B. Reinforcing teaching to a stable client with a new colostomy [CORRECT]
C. Developing a plan of care for a client with complex wounds
D. Evaluating the effectiveness of a new pain medication regimen
Correct Answer: B
Rationale:
Reinforcing teaching (NOT initial teaching, which is an RN responsibility) to a stable client with a new colostomy is within the
LPN scope of practice. The Five Rights of Delegation guide this decision: right task (reinforcing, not initiating, teaching), right
circumstance (stable client), right person (LPN), right direction (clear instructions), and right supervision. Comprehensive
admission assessment, developing the plan of care, and evaluating medication effectiveness all require RN-level nursing
judgment and cannot be delegated to an LPN. The RN retains accountability for assessment, diagnosis, planning, evaluation,
complex interventions, and initial client education per state nurse practice acts and Nightingale College BSN 225 curriculum
standards.
Q2: A nurse is caring for four clients. Using the ABC priority-setting framework, which client should the nurse
assess FIRST?
A. A client with a blood pressure of 160/90 mmHg reporting a headache
B. A client with a respiratory rate of 8 breaths per minute after opioid administration [CORRECT]
C. A client with a blood glucose of 250 mg/dL and polyuria
D. A client with a temperature of 38.5°C (101.3°F) and a productive cough
Correct Answer: B
Rationale:
A respiratory rate of 8 breaths/min indicates respiratory depression—a life-threatening airway/breathing emergency requiring
immediate intervention. The ABC framework (Airway, Breathing, Circulation) is the highest priority-setting framework in
BSN 225 HESI RN Fundamentals Final Exam Page 1 Nightingale College 2026/2027
, nursing. Opioid-induced respiratory depression requires naloxone (Narcan) and airway support immediately. Hypertension
with headache (circulation concern), hyperglycemia (metabolic concern), and fever with cough (infection) are all important but
lower priority than compromised breathing. This prioritization aligns with Maslow's hierarchy (physiological needs first) and
the NCLEX-RN test plan emphasis on airway and breathing as foundational to survival.
Q3: A client is scheduled for an elective cholecystectomy. The surgeon has explained the procedure, risks, and
alternatives, and the client has signed the consent form. After the surgeon leaves, the client asks the nurse, 'I'm
not really sure what they're going to do. Can you explain it again?' What is the nurse's BEST response?
A. Explain the surgical procedure in detail to ensure the client understands
B. Notify the surgeon that the client has questions about the procedure and requires further explanation
[CORRECT]
C. Reassure the client that the surgeon has already explained everything and the procedure will go smoothly
D. Document the client's question and proceed with preoperative preparation
Correct Answer: B
Rationale:
Informed consent is the provider's responsibility—the surgeon must explain the procedure, risks, benefits, and alternatives. The
nurse's role is to witness the signature, confirm the client's understanding, and notify the provider if the client has questions or
appears to lack understanding. If the client cannot explain the procedure, consent is not truly 'informed,' and the nurse must
notify the surgeon to return and re-explain. The nurse should NOT provide the detailed procedural explanation (scope issue),
should NOT provide false reassurance (non-therapeutic), and should NOT proceed without ensuring informed consent is valid.
This protects patient autonomy and legal/ethical standards.
Q4: A nurse discovers a small fire in a client's wastebasket in a client's room. The client is on oxygen via nasal
cannula. Following the RACE protocol, what should the nurse do FIRST?
A. Extinguish the fire using a nearby fire extinguisher
B. Rescue the client by removing them from the room [CORRECT]
C. Activate the fire alarm and notify staff
D. Confine the fire by closing all doors and windows
Correct Answer: B
Rationale:
RACE stands for Rescue, Alarm, Confine, Extinguish/Evacuate—in that order. The first action is to RESCUE the client by
removing them from immediate danger, especially critical here because the client is on oxygen, which accelerates fire. After
the client is safe, the nurse activates the ALARM, then CONFINES the fire (close doors, turn off oxygen), and finally
EXTINGUISHES if it is safe to do so (using PASS: Pull, Aim, Squeeze, Sweep) or EVACUATES. Extinguishing first would
delay client rescue; activating the alarm first would leave the client in danger. RACE prioritizes human life over property,
consistent with the ABC and safety principles in the NCLEX-RN test plan.
Q5: A client with active pulmonary tuberculosis (TB) is admitted to the medical unit. Which infection control
precautions should the nurse implement?
A. Contact precautions with gown and gloves
B. Droplet precautions with a surgical mask
C. Airborne precautions with an N95 respirator and negative-pressure room [CORRECT]
D. Standard precautions only, since TB is not highly contagious
Correct Answer: C
Rationale:
BSN 225 HESI RN Fundamentals Final Exam Page 2 Nightingale College 2026/2027
, Pulmonary tuberculosis requires AIRBORNE precautions because Mycobacterium tuberculosis is transmitted via small
airborne droplet nuclei that remain suspended in air and travel long distances. Precautions include a private negative-pressure
room (AIIR), N95 respirator for personnel, and the door kept closed. Contact precautions (gown/gloves) are used for MRSA,
VRE, C. diff. Droplet precautions (surgical mask) are for influenza, meningitis, pertussis. Standard precautions alone are
insufficient for TB. The N95 respirator filters particles ≥0.3 microns and must be fit-tested annually. This distinction between
contact, droplet, and airborne is a high-yield HESI Fundamentals topic.
Q6: An older adult client is admitted with confusion and a history of falls at home. Which of the following is the
MOST appropriate fall prevention intervention?
A. Keep the bed in the highest position for easy nursing access
B. Keep the bed in the lowest position with the call bell within reach and use non-skid footwear
[CORRECT]
C. Apply bilateral wrist restraints to prevent the client from getting out of bed
D. Administer a PRN sedative at bedtime to keep the client calm and in bed
Correct Answer: B
Rationale:
The most appropriate fall prevention intervention is to keep the bed in the LOWEST position with wheels locked, place the call
bell within easy reach, ensure non-skid footwear, provide adequate lighting, and implement hourly rounding. These are
evidence-based fall prevention strategies per The Joint Commission and AHRQ guidelines. Keeping the bed in the highest
position increases fall risk from a greater height. Restraints are a last resort and require a physician order—they do not prevent
falls and can cause injury. Sedatives increase fall risk by impairing cognition and balance. Additional interventions include
bed/chair alarms, toileting schedules, and addressing underlying causes (medications, hypotension, vision, environment).
Q7: A nurse is preparing to administer medications to a client. Which of the following actions demonstrates
adherence to the 'Three Checks' of medication administration?
A. Checking the medication label when retrieving it, when preparing it, and before administering it
[CORRECT]
B. Checking the medication label only at the time of administration
C. Checking the medication label at the beginning and end of the shift
D. Checking the medication label when retrieved and when returning it to storage
Correct Answer: A
Rationale:
The Three Checks of medication administration require the nurse to verify the medication label: (1) when retrieving it from
storage, (2) when preparing it (pouring, drawing up, etc.), and (3) before administering it to the client. Combined with the Six
Rights (right patient with 2 identifiers, right drug, right dose, right route, right time, right documentation), the Three Checks
form the foundation of safe medication administration and reduce error risk. Checking only at administration, at shift changes,
or at retrieval and storage is insufficient and increases medication error risk. These principles are core HESI Fundamentals
content and align with Nightingale College BSN 225 safety standards.
Q8: A client with Clostridium difficile infection is receiving contact precautions. The certified nursing assistant
(CNA) asks the nurse what type of hand hygiene to use after caring for this client. The nurse's BEST response is:
A. Use an alcohol-based hand rub because it is faster and more effective
B. Wash hands with soap and water for at least 20 seconds [CORRECT]
C. Use either method, as both are equally effective against C. diff
D. Wear gloves only; hand hygiene is not required if gloves are worn
Correct Answer: B
BSN 225 HESI RN Fundamentals Final Exam Page 3 Nightingale College 2026/2027
, Rationale:
Clostridium difficile produces spores that are NOT killed by alcohol-based hand rubs. Soap and water are required for
mechanical removal of spores. The CNA must wash hands with soap and water for at least 20 seconds after caring for a C. diff
patient, even if gloves were worn. Alcohol-based hand rubs are appropriate for routine hand hygiene when hands are not
visibly soiled and for most other pathogens, but C. diff is a critical exception. Gloves alone are insufficient—hand hygiene is
always required after glove removal. This exception is a frequent HESI exam point and is essential for preventing nosocomial
C. diff transmission.
Q9: A competent adult client refuses a prescribed blood transfusion due to religious beliefs. The physician insists
the transfusion is life-saving. What is the nurse's MOST appropriate action?
A. Administer the transfusion since it is life-saving and prescribed
B. Document the refusal, notify the physician, and respect the client's decision [CORRECT]
C. Have the client's family member sign the consent on the client's behalf
D. Administer the transfusion while the client is sedated for another procedure
Correct Answer: B
Rationale:
A competent adult has the legal and ethical right to refuse any treatment, even life-saving treatment, based on autonomy. The
nurse must respect the decision, document the refusal (including the client's understanding of consequences), notify the
physician, and continue to provide alternative care. Forcing treatment constitutes battery. A family member cannot consent for
a competent adult without a valid DPOA-HC. Administering treatment against the client's wishes—especially while
sedated—would be assault/battery and a violation of patient rights. The physician should be encouraged to discuss
consequences with the client, but the client's autonomous decision stands.
Q10: A nurse is caring for a client in wrist restraints following an episode of self-extubation. How often should the
nurse reassess the client and release the restraints for range of motion, toileting, and nutrition?
A. Reassess every 4 hours; release every 4 hours for adults
B. Reassess at least every 4 hours; release every 2 hours for adults [CORRECT]
C. Reassess every 2 hours; release every 4 hours for adults
D. Reassess and release every 1 hour for adults
Correct Answer: B
Rationale:
For adult clients in restraints, the nurse must reassess at least every 4 hours (more frequently if condition warrants), and release
the restraints every 2 hours for range of motion, toileting, nutrition, and hydration. For children, reassessment is every 2 hours
and release every 1-2 hours. Restraints require a physician order, face-to-face evaluation within 1 hour of application, and the
least restrictive device should be used. These standards from CMS and The Joint Commission protect client safety, circulation,
and dignity while preventing complications like contractures, skin breakdown, and psychological trauma. Restraints are a last
resort, used only when alternatives have failed.
Q11: A client asks the nurse, 'What is the difference between a living will and a durable power of attorney for
health care?' The nurse's BEST response is:
A. A living will designates a person to make decisions; a DPOA-HC specifies treatment preferences
B. A living will specifies treatment preferences in specific situations; a DPOA-HC designates a person to
make health care decisions when the client cannot [CORRECT]
C. Both documents are the same and serve identical purposes
D. A DPOA-HC is only for end-of-life care; a living will covers all medical decisions
Correct Answer: B
BSN 225 HESI RN Fundamentals Final Exam Page 4 Nightingale College 2026/2027
