BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V1 |
Latest Update 2026/2027 | 200 Practice Questions and Verified
Answers | Nightingale College Complete Q&A Guide | A+
Graded
SECTION 1: SAFETY AND INFECTION CONTROL (Questions 1–40)
1. A nurse is preparing to administer a medication to a client. Which of the following actions should the
nurse take to verify the client's identity?
A) Ask the client to state their name and date of birth.
B) Check the client's room number against the MAR.
C) Verify the client's identification band matches the MAR.
D) Both A and C.
Answer: D – Both A and C.
Rationale: The twoidentifier method includes asking the client to state their name and DOB and
comparing the ID band to the MAR. Room number is not a reliable identifier.
2. A nurse is caring for a client with a new diagnosis of Clostridium difficile. Which of the following
infection control precautions should the nurse implement?
A) Airborne precautions
B) Droplet precautions
C) Contact precautions
D) Standard precautions only
Answer: C – Contact precautions.
Rationale: C. difficile is transmitted via spores on contaminated surfaces. Contact precautions (gown,
gloves, dedicated equipment) are required. Alcohol hand sanitizer is ineffective; soap and water must be
used.
,3. A nurse is preparing to insert an indwelling urinary catheter. Which of the following actions
demonstrates proper sterile technique?
A) Opening the outer package on the bedside table
B) Placing the sterile field at the edge of the table
C) Holding the catheter with sterile gloves and maintaining it within the sterile field
D) Using clean gloves to open the catheter package
Answer: C – Holding the catheter with sterile gloves and maintaining it within the sterile field.
Rationale: Sterile items must remain within the sterile field. The outer package is opened onto a clean
surface, but the inner wrap creates the sterile field. The edge of the table is considered unsterile.
4. A client is receiving continuous enteral feedings through a nasogastric tube. Which of the following
actions should the nurse take to reduce the risk of aspiration?
A) Elevate the head of the bed to 30–45 degrees.
B) Check gastric residual volume every 8 hours.
C) Flush the tube with 30 mL of water before and after feeding.
D) Both A and C.
Answer: D – Both A and C.
Rationale: Head elevation reduces aspiration risk; flushing maintains patency. Residual volumes should
be checked every 4–6 hours, not every 8.
5. A nurse is preparing to transfer a heavy, immobile patient from bed to chair. Which action best
protects the nurse's back?
A) Use proper body mechanics: keep back straight and bend knees while lifting
B) Lift the patient by herself slowly and carefully
C) Slide the patient down in bed, then lift from the knees
D) Obtain help or use a mechanical lifting device for the transfer
Answer: D – Obtain help or use a mechanical lifting device for the transfer.
,Rationale: Current guidelines emphasize that relying on body mechanics alone is insufficient to prevent
back injury when lifting heavy patients. Mechanical lift devices are recommended for patient transfers.
6. A nurse removes soiled gloves after providing care to a patient with diarrhea. Hands are visibly dirty.
According to CDC infectioncontrol guidelines, what should the nurse do next?
A) Apply alcoholbased hand rub immediately
B) Wash hands with soap and water
C) Rinse hands with warm water only
D) Skip hand hygiene since gloves were worn
Answer: B – Wash hands with soap and water.
Rationale: CDC guidelines specify that whenever hands are visibly soiled, hand hygiene must be done
with soap and water, not alcohol rub. Alcoholbased hand sanitizer is not effective at removing visible
soil and spores.
7. During a sterile dressing change, the nurse accidentally turns her back on the sterile field while
waiting for supplies. What is the implication?
A) This is acceptable because she has sterile gloves on
B) The sterile field may be contaminated because it must always be in view
C) Nothing changes; sterility is maintained even out of sight
D) The field stays sterile as long as nothing touched it
Answer: B – The sterile field may be contaminated because it must always be in view.
Rationale: Sterile fields must never be turned away from or left out of sight, as doing so breaks sterile
technique. Sterility cannot be guaranteed once it's out of view.
8. A patient hospitalized with confirmed tuberculosis is placed in an airborne infection isolation room.
What protective equipment should the nurse wear when entering the room?
A) Surgical mask
B) N95 respirator
C) Gloves only
, D) Gown and gloves
Answer: B – N95 respirator.
Rationale: Tuberculosis requires airborne precautions, which include an N95 respirator or higherlevel
respirator. A surgical mask is insufficient for airborne pathogens.
9. A nurse is caring for a client on contact precautions. Which of the following actions is correct?
A) Wear a mask when entering the room
B) Wear a gown and gloves when entering the room
C) Place the client in a negative pressure room
D) Keep the door closed at all times
Answer: B – Wear a gown and gloves when entering the room.
Rationale: Contact precautions require gown and gloves for all interactions. Masks are not required
unless there is risk of splash. Negative pressure is for airborne precautions.
10. Which of the following is the most effective way to prevent the spread of infection in healthcare
settings?
A) Wearing gloves at all times
B) Hand hygiene
C) Wearing a mask
D) Isolating all patients
Answer: B – Hand hygiene.
Rationale: Hand hygiene is the single most effective measure to prevent the spread of infection in
healthcare settings.
11. A nurse is preparing to administer an IV antibiotic. Which action is most important to prevent
infection?
A) Clean the IV port with alcohol for 15 seconds
Latest Update 2026/2027 | 200 Practice Questions and Verified
Answers | Nightingale College Complete Q&A Guide | A+
Graded
SECTION 1: SAFETY AND INFECTION CONTROL (Questions 1–40)
1. A nurse is preparing to administer a medication to a client. Which of the following actions should the
nurse take to verify the client's identity?
A) Ask the client to state their name and date of birth.
B) Check the client's room number against the MAR.
C) Verify the client's identification band matches the MAR.
D) Both A and C.
Answer: D – Both A and C.
Rationale: The twoidentifier method includes asking the client to state their name and DOB and
comparing the ID band to the MAR. Room number is not a reliable identifier.
2. A nurse is caring for a client with a new diagnosis of Clostridium difficile. Which of the following
infection control precautions should the nurse implement?
A) Airborne precautions
B) Droplet precautions
C) Contact precautions
D) Standard precautions only
Answer: C – Contact precautions.
Rationale: C. difficile is transmitted via spores on contaminated surfaces. Contact precautions (gown,
gloves, dedicated equipment) are required. Alcohol hand sanitizer is ineffective; soap and water must be
used.
,3. A nurse is preparing to insert an indwelling urinary catheter. Which of the following actions
demonstrates proper sterile technique?
A) Opening the outer package on the bedside table
B) Placing the sterile field at the edge of the table
C) Holding the catheter with sterile gloves and maintaining it within the sterile field
D) Using clean gloves to open the catheter package
Answer: C – Holding the catheter with sterile gloves and maintaining it within the sterile field.
Rationale: Sterile items must remain within the sterile field. The outer package is opened onto a clean
surface, but the inner wrap creates the sterile field. The edge of the table is considered unsterile.
4. A client is receiving continuous enteral feedings through a nasogastric tube. Which of the following
actions should the nurse take to reduce the risk of aspiration?
A) Elevate the head of the bed to 30–45 degrees.
B) Check gastric residual volume every 8 hours.
C) Flush the tube with 30 mL of water before and after feeding.
D) Both A and C.
Answer: D – Both A and C.
Rationale: Head elevation reduces aspiration risk; flushing maintains patency. Residual volumes should
be checked every 4–6 hours, not every 8.
5. A nurse is preparing to transfer a heavy, immobile patient from bed to chair. Which action best
protects the nurse's back?
A) Use proper body mechanics: keep back straight and bend knees while lifting
B) Lift the patient by herself slowly and carefully
C) Slide the patient down in bed, then lift from the knees
D) Obtain help or use a mechanical lifting device for the transfer
Answer: D – Obtain help or use a mechanical lifting device for the transfer.
,Rationale: Current guidelines emphasize that relying on body mechanics alone is insufficient to prevent
back injury when lifting heavy patients. Mechanical lift devices are recommended for patient transfers.
6. A nurse removes soiled gloves after providing care to a patient with diarrhea. Hands are visibly dirty.
According to CDC infectioncontrol guidelines, what should the nurse do next?
A) Apply alcoholbased hand rub immediately
B) Wash hands with soap and water
C) Rinse hands with warm water only
D) Skip hand hygiene since gloves were worn
Answer: B – Wash hands with soap and water.
Rationale: CDC guidelines specify that whenever hands are visibly soiled, hand hygiene must be done
with soap and water, not alcohol rub. Alcoholbased hand sanitizer is not effective at removing visible
soil and spores.
7. During a sterile dressing change, the nurse accidentally turns her back on the sterile field while
waiting for supplies. What is the implication?
A) This is acceptable because she has sterile gloves on
B) The sterile field may be contaminated because it must always be in view
C) Nothing changes; sterility is maintained even out of sight
D) The field stays sterile as long as nothing touched it
Answer: B – The sterile field may be contaminated because it must always be in view.
Rationale: Sterile fields must never be turned away from or left out of sight, as doing so breaks sterile
technique. Sterility cannot be guaranteed once it's out of view.
8. A patient hospitalized with confirmed tuberculosis is placed in an airborne infection isolation room.
What protective equipment should the nurse wear when entering the room?
A) Surgical mask
B) N95 respirator
C) Gloves only
, D) Gown and gloves
Answer: B – N95 respirator.
Rationale: Tuberculosis requires airborne precautions, which include an N95 respirator or higherlevel
respirator. A surgical mask is insufficient for airborne pathogens.
9. A nurse is caring for a client on contact precautions. Which of the following actions is correct?
A) Wear a mask when entering the room
B) Wear a gown and gloves when entering the room
C) Place the client in a negative pressure room
D) Keep the door closed at all times
Answer: B – Wear a gown and gloves when entering the room.
Rationale: Contact precautions require gown and gloves for all interactions. Masks are not required
unless there is risk of splash. Negative pressure is for airborne precautions.
10. Which of the following is the most effective way to prevent the spread of infection in healthcare
settings?
A) Wearing gloves at all times
B) Hand hygiene
C) Wearing a mask
D) Isolating all patients
Answer: B – Hand hygiene.
Rationale: Hand hygiene is the single most effective measure to prevent the spread of infection in
healthcare settings.
11. A nurse is preparing to administer an IV antibiotic. Which action is most important to prevent
infection?
A) Clean the IV port with alcohol for 15 seconds
