BSN 225 - HESI RN Specialty Fundamentals of Nursing Nightingale College | 2026-2027
BSN 225 - HESI RN Specialty Fundamentals of
Nursing
Comprehensive Exam Prep | 100 Questions with A+ Graded Rationales
Nightingale College BSN Program | Academic Year | Grade A
Course BSN 225 - HESI RN Specialty Fundamentals Total Q 100
Institution Nightingale College Format Multiple Choice (A-D), One Correct
30% Recall | 50% Application | 20%
Term Academic Year Cognitive Mix
Analysis
75% Scenario | 20% Recall | 5% Clinical
Exam HESI Fundamentals Comprehensive Style
Analysis
This comprehensive examination is aligned with the Nightingale College BSN 225 curriculum, the 2026-2027 HESI RN
Specialty Fundamentals exam blueprint, and the current NCLEX-RN test plan. The exam covers eight core content domains
reflecting the NCLEX-RN Client Needs framework: 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 reasoning. Each question includes a detailed rationale explaining the
correct answer and why distractors are incorrect, providing a complete review tool for HESI Fundamentals examination
preparation.
Section 1: Safe, Effective Care Environment
Management of Care | Safety & Infection Control
Q1. A patient scheduled for an elective cholecystectomy signs the surgical consent form in the presence of
the nurse. The patient then asks the nurse, "Can you explain again what they are going to do during the
surgery?" Which action by the nurse is most appropriate?
A. Explain the surgical procedure in detail using a medical textbook
B. Witness the signature and notify the surgeon that the patient has questions about the procedure [CORRECT]
C. Tell the patient to sign the form now and ask the surgeon questions later
D. Cancel the surgery because the patient does not understand the procedure
Correct Answer: B
Rationale
The provider (surgeon) is responsible for explaining the procedure, risks, benefits, and alternatives and obtaining informed
consent. The nurse's role is to witness the signature, confirm that the patient understands, and notify the provider if the
patient has unanswered questions. The nurse should not provide the detailed surgical explanation because that exceeds
nursing scope and could create legal liability. Canceling surgery is premature and not within the nurse's authority. The
correct action protects patient autonomy and ensures true informed consent.
HESI Fundamentals Exam100
Prep
Questions
| 100% Correct
| Cognitive
| Grade
Levels:
A Recall 30%, Application 50%, Analysis 20% Page 1
,BSN 225 - HESI RN Specialty Fundamentals of Nursing Nightingale College | 2026-2027
Q2. A 78-year-old patient is being admitted to a long-term care facility. The nurse asks the patient whether
he has an advance directive. The patient asks why this is being asked. Which response by the nurse is most
accurate?
A. Advance directives are required for admission to all healthcare facilities
B. The Patient Self-Determination Act requires facilities to inform patients of their rights to make decisions about
their care, including advance directives [CORRECT]
C. Advance directives are only needed for patients with terminal illnesses
D. The facility needs this information for billing purposes
Correct Answer: B
Rationale
The Patient Self-Determination Act (PSDA) of 1990 requires all healthcare facilities receiving Medicare or Medicaid
funding to inform patients of their rights to make decisions about their care, including the right to accept or refuse treatment
and the right to formulate advance directives. Advance directives are not required for admission but patients must be
informed of their rights. They are appropriate for all adults, not only those with terminal illness, and have nothing to do with
billing. Documenting whether the patient has an advance directive is part of the admission process.
Q3. A nurse is caring for a patient diagnosed with HIV. The patient's employer calls the unit and asks for
the patient's diagnosis and treatment plan. Which response by the nurse is most appropriate?
A. Provide the information because the employer is concerned about workplace safety
B. Explain that HIPAA protects the patient's health information and that disclosure requires the patient's written
authorization unless it falls under treatment, payment, or healthcare operations [CORRECT]
C. Provide only the diagnosis without the treatment plan
D. Transfer the call to the patient's room so the patient can decide what to share
Correct Answer: B
Rationale
HIPAA protects Protected Health Information (PHI) from unauthorized disclosure. Permitted disclosures without patient
authorization are limited to Treatment, Payment, or Healthcare Operations (TPO). Disclosure to an employer does not fall
under TPO and would require the patient's written authorization. HIV status is particularly protected under additional
regulations. Providing any portion of the diagnosis without authorization is a HIPAA violation. Transferring the call may be
appropriate later but the nurse must first establish that the employer has no right to the information. Violations can result in
fines, civil liability, and termination.
HESI Fundamentals Exam100
Prep
Questions
| 100% Correct
| Cognitive
| Grade
Levels:
A Recall 30%, Application 50%, Analysis 20% Page 2
,BSN 225 - HESI RN Specialty Fundamentals of Nursing Nightingale College | 2026-2027
Q4. A 65-year-old competent patient with pneumonia refuses a prescribed antibiotic, stating, "I do not
want to take any more medications; I want to let nature take its course." Which action by the nurse is most
appropriate?
A. Administer the medication anyway because the patient has a treatable infection
B. Respect the patient's right to refuse, document the refusal and the patient's understanding of the consequences,
and notify the provider [CORRECT]
C. Have the family sign a consent form overriding the patient's decision
D. Obtain a court order to administer the medication
Correct Answer: B
Rationale
Competent adults have the legal and ethical right to refuse any treatment, even if the refusal may result in harm or death. The
nurse must respect this autonomy, document the refusal and the patient's demonstrated understanding of the consequences,
notify the provider so alternative options can be discussed, and continue to provide supportive care. Administering
medication against a competent patient's wishes constitutes battery. Family cannot override a competent adult's decision, and
a court order is inappropriate when the patient has decision-making capacity. The nurse should explore the patient's reasons
for refusal and provide education without coercion.
Q5. A patient tells the nurse, "I want my daughter to make medical decisions for me if I ever cannot make
them myself." Which document should the nurse recommend the patient complete?
A. A living will
B. A durable power of attorney for health care (DPOA-HC) [CORRECT]
C. An informed consent form
D. A do-not-resuscitate order
Correct Answer: B
Rationale
A durable power of attorney for health care (DPOA-HC) is a legal document that designates a surrogate decision-maker
(proxy) to make healthcare decisions on the patient's behalf if the patient becomes unable to do so. A living will specifies the
patient's wishes regarding life-sustaining treatment in specific situations but does not designate a decision-maker. Informed
consent is procedure-specific and not an advance directive. A DNR order addresses only resuscitation efforts. The
DPOA-HC is the appropriate document for designating a healthcare proxy and provides broader coverage than a living will.
HESI Fundamentals Exam100
Prep
Questions
| 100% Correct
| Cognitive
| Grade
Levels:
A Recall 30%, Application 50%, Analysis 20% Page 3
, BSN 225 - HESI RN Specialty Fundamentals of Nursing Nightingale College | 2026-2027
Q6. A charge nurse is delegating tasks to the nursing team. The nurse ensures that the right task is
assigned under the right circumstance to the right person with the right direction and communication.
Which element of the Five Rights of Delegation is the nurse demonstrating when she later observes the
LPN performing the task and provides feedback?
A. Right Task
B. Right Circumstance
C. Right Person
D. Right Supervision and Evaluation [CORRECT]
Correct Answer: D
Rationale
The Five Rights of Delegation are Right Task, Right Circumstance, Right Person, Right Direction/Communication, and
Right Supervision/Evaluation. Observation of the delegated task being performed and provision of feedback represent Right
Supervision and Evaluation, which requires the RN to monitor performance, evaluate outcomes, and intervene or provide
guidance as needed. Right Task refers to selecting an appropriate task to delegate, Right Circumstance considers patient
condition and setting, and Right Person ensures the delegatee has the appropriate scope and competency. Supervision is
ongoing, not a one-time event, and the RN retains accountability for delegated tasks.
Q7. Which of the following nursing actions must be performed by the RN and cannot be delegated to an
LPN/LVN or unlicensed assistive personnel (UAP)?
A. Administering oral medications to stable patients
B. Performing initial comprehensive patient assessment and formulating the nursing care plan [CORRECT]
C. Assisting patients with ambulation and hygiene
D. Reinforcing teaching previously provided by the RN
Correct Answer: B
Rationale
Initial comprehensive assessment, nursing diagnosis, care planning, evaluation, complex interventions, and initial client
education are within the RN scope and cannot be delegated. LPNs may perform focused assessments and reinforce teaching
but cannot perform the initial comprehensive assessment or develop the plan of care. Administering oral medications to
stable patients is within LPN scope (excluding IV medications). Assisting with ambulation and hygiene is UAP scope.
Reinforcing teaching is appropriate for LPNs. The RN retains accountability for the overall plan of care and must perform
functions requiring nursing judgment.
HESI Fundamentals Exam100
Prep
Questions
| 100% Correct
| Cognitive
| Grade
Levels:
A Recall 30%, Application 50%, Analysis 20% Page 4
BSN 225 - HESI RN Specialty Fundamentals of
Nursing
Comprehensive Exam Prep | 100 Questions with A+ Graded Rationales
Nightingale College BSN Program | Academic Year | Grade A
Course BSN 225 - HESI RN Specialty Fundamentals Total Q 100
Institution Nightingale College Format Multiple Choice (A-D), One Correct
30% Recall | 50% Application | 20%
Term Academic Year Cognitive Mix
Analysis
75% Scenario | 20% Recall | 5% Clinical
Exam HESI Fundamentals Comprehensive Style
Analysis
This comprehensive examination is aligned with the Nightingale College BSN 225 curriculum, the 2026-2027 HESI RN
Specialty Fundamentals exam blueprint, and the current NCLEX-RN test plan. The exam covers eight core content domains
reflecting the NCLEX-RN Client Needs framework: 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 reasoning. Each question includes a detailed rationale explaining the
correct answer and why distractors are incorrect, providing a complete review tool for HESI Fundamentals examination
preparation.
Section 1: Safe, Effective Care Environment
Management of Care | Safety & Infection Control
Q1. A patient scheduled for an elective cholecystectomy signs the surgical consent form in the presence of
the nurse. The patient then asks the nurse, "Can you explain again what they are going to do during the
surgery?" Which action by the nurse is most appropriate?
A. Explain the surgical procedure in detail using a medical textbook
B. Witness the signature and notify the surgeon that the patient has questions about the procedure [CORRECT]
C. Tell the patient to sign the form now and ask the surgeon questions later
D. Cancel the surgery because the patient does not understand the procedure
Correct Answer: B
Rationale
The provider (surgeon) is responsible for explaining the procedure, risks, benefits, and alternatives and obtaining informed
consent. The nurse's role is to witness the signature, confirm that the patient understands, and notify the provider if the
patient has unanswered questions. The nurse should not provide the detailed surgical explanation because that exceeds
nursing scope and could create legal liability. Canceling surgery is premature and not within the nurse's authority. The
correct action protects patient autonomy and ensures true informed consent.
HESI Fundamentals Exam100
Prep
Questions
| 100% Correct
| Cognitive
| Grade
Levels:
A Recall 30%, Application 50%, Analysis 20% Page 1
,BSN 225 - HESI RN Specialty Fundamentals of Nursing Nightingale College | 2026-2027
Q2. A 78-year-old patient is being admitted to a long-term care facility. The nurse asks the patient whether
he has an advance directive. The patient asks why this is being asked. Which response by the nurse is most
accurate?
A. Advance directives are required for admission to all healthcare facilities
B. The Patient Self-Determination Act requires facilities to inform patients of their rights to make decisions about
their care, including advance directives [CORRECT]
C. Advance directives are only needed for patients with terminal illnesses
D. The facility needs this information for billing purposes
Correct Answer: B
Rationale
The Patient Self-Determination Act (PSDA) of 1990 requires all healthcare facilities receiving Medicare or Medicaid
funding to inform patients of their rights to make decisions about their care, including the right to accept or refuse treatment
and the right to formulate advance directives. Advance directives are not required for admission but patients must be
informed of their rights. They are appropriate for all adults, not only those with terminal illness, and have nothing to do with
billing. Documenting whether the patient has an advance directive is part of the admission process.
Q3. A nurse is caring for a patient diagnosed with HIV. The patient's employer calls the unit and asks for
the patient's diagnosis and treatment plan. Which response by the nurse is most appropriate?
A. Provide the information because the employer is concerned about workplace safety
B. Explain that HIPAA protects the patient's health information and that disclosure requires the patient's written
authorization unless it falls under treatment, payment, or healthcare operations [CORRECT]
C. Provide only the diagnosis without the treatment plan
D. Transfer the call to the patient's room so the patient can decide what to share
Correct Answer: B
Rationale
HIPAA protects Protected Health Information (PHI) from unauthorized disclosure. Permitted disclosures without patient
authorization are limited to Treatment, Payment, or Healthcare Operations (TPO). Disclosure to an employer does not fall
under TPO and would require the patient's written authorization. HIV status is particularly protected under additional
regulations. Providing any portion of the diagnosis without authorization is a HIPAA violation. Transferring the call may be
appropriate later but the nurse must first establish that the employer has no right to the information. Violations can result in
fines, civil liability, and termination.
HESI Fundamentals Exam100
Prep
Questions
| 100% Correct
| Cognitive
| Grade
Levels:
A Recall 30%, Application 50%, Analysis 20% Page 2
,BSN 225 - HESI RN Specialty Fundamentals of Nursing Nightingale College | 2026-2027
Q4. A 65-year-old competent patient with pneumonia refuses a prescribed antibiotic, stating, "I do not
want to take any more medications; I want to let nature take its course." Which action by the nurse is most
appropriate?
A. Administer the medication anyway because the patient has a treatable infection
B. Respect the patient's right to refuse, document the refusal and the patient's understanding of the consequences,
and notify the provider [CORRECT]
C. Have the family sign a consent form overriding the patient's decision
D. Obtain a court order to administer the medication
Correct Answer: B
Rationale
Competent adults have the legal and ethical right to refuse any treatment, even if the refusal may result in harm or death. The
nurse must respect this autonomy, document the refusal and the patient's demonstrated understanding of the consequences,
notify the provider so alternative options can be discussed, and continue to provide supportive care. Administering
medication against a competent patient's wishes constitutes battery. Family cannot override a competent adult's decision, and
a court order is inappropriate when the patient has decision-making capacity. The nurse should explore the patient's reasons
for refusal and provide education without coercion.
Q5. A patient tells the nurse, "I want my daughter to make medical decisions for me if I ever cannot make
them myself." Which document should the nurse recommend the patient complete?
A. A living will
B. A durable power of attorney for health care (DPOA-HC) [CORRECT]
C. An informed consent form
D. A do-not-resuscitate order
Correct Answer: B
Rationale
A durable power of attorney for health care (DPOA-HC) is a legal document that designates a surrogate decision-maker
(proxy) to make healthcare decisions on the patient's behalf if the patient becomes unable to do so. A living will specifies the
patient's wishes regarding life-sustaining treatment in specific situations but does not designate a decision-maker. Informed
consent is procedure-specific and not an advance directive. A DNR order addresses only resuscitation efforts. The
DPOA-HC is the appropriate document for designating a healthcare proxy and provides broader coverage than a living will.
HESI Fundamentals Exam100
Prep
Questions
| 100% Correct
| Cognitive
| Grade
Levels:
A Recall 30%, Application 50%, Analysis 20% Page 3
, BSN 225 - HESI RN Specialty Fundamentals of Nursing Nightingale College | 2026-2027
Q6. A charge nurse is delegating tasks to the nursing team. The nurse ensures that the right task is
assigned under the right circumstance to the right person with the right direction and communication.
Which element of the Five Rights of Delegation is the nurse demonstrating when she later observes the
LPN performing the task and provides feedback?
A. Right Task
B. Right Circumstance
C. Right Person
D. Right Supervision and Evaluation [CORRECT]
Correct Answer: D
Rationale
The Five Rights of Delegation are Right Task, Right Circumstance, Right Person, Right Direction/Communication, and
Right Supervision/Evaluation. Observation of the delegated task being performed and provision of feedback represent Right
Supervision and Evaluation, which requires the RN to monitor performance, evaluate outcomes, and intervene or provide
guidance as needed. Right Task refers to selecting an appropriate task to delegate, Right Circumstance considers patient
condition and setting, and Right Person ensures the delegatee has the appropriate scope and competency. Supervision is
ongoing, not a one-time event, and the RN retains accountability for delegated tasks.
Q7. Which of the following nursing actions must be performed by the RN and cannot be delegated to an
LPN/LVN or unlicensed assistive personnel (UAP)?
A. Administering oral medications to stable patients
B. Performing initial comprehensive patient assessment and formulating the nursing care plan [CORRECT]
C. Assisting patients with ambulation and hygiene
D. Reinforcing teaching previously provided by the RN
Correct Answer: B
Rationale
Initial comprehensive assessment, nursing diagnosis, care planning, evaluation, complex interventions, and initial client
education are within the RN scope and cannot be delegated. LPNs may perform focused assessments and reinforce teaching
but cannot perform the initial comprehensive assessment or develop the plan of care. Administering oral medications to
stable patients is within LPN scope (excluding IV medications). Assisting with ambulation and hygiene is UAP scope.
Reinforcing teaching is appropriate for LPNs. The RN retains accountability for the overall plan of care and must perform
functions requiring nursing judgment.
HESI Fundamentals Exam100
Prep
Questions
| 100% Correct
| Cognitive
| Grade
Levels:
A Recall 30%, Application 50%, Analysis 20% Page 4
