BSN 225 HESI RN Specialty
Fundamentals of Nursing Exam
Study Guide
Nightingale College | 2026/2027 Academic Year
Verified Questions and Answers with Comprehensive Rationales
125 Questions | 7 Sections | 100% Correct | Grade A | Aligned with 2026-2027 Curriculum
Section 1: Nursing Process, Critical Thinking, and Prioritization
(Q1-Q25)
Q1: A nurse is caring for four patients. Which patient should the nurse assess first using the
ABC (Airway, Breathing, Circulation) prioritization framework?
A. A patient with a scheduled medication due in 30 minutes
B. A patient reporting pain at a level of 5 out of 10 after abdominal surgery
C. A patient with a tracheostomy who has thick, tenacious secretions and an SpO2 of 88%
[CORRECT]
D. A patient requesting assistance with ambulation to the bathroom
Correct Answer: C
Rationale: Using the ABC framework, the nurse must prioritize airway, breathing, and circulation before
addressing any other patient needs. The patient with a tracheostomy who has thick secretions and an
oxygen saturation of 88% has both an airway concern (secretions potentially obstructing the
tracheostomy tube) and a breathing concern (hypoxemia with SpO2 below the normal range of
95-100%). This patient requires immediate suctioning and respiratory assessment to prevent complete
airway obstruction and respiratory failure. The other patients have important but less time-sensitive
needs that can be addressed after stabilizing the airway and breathing of the first patient.
Q2: According to Maslow hierarchy of needs, which nursing intervention should the nurse
prioritize for a patient who is anxious about an upcoming surgery and has not eaten since
midnight?
A. Providing emotional support and reassurance about the surgical procedure
B. Administering prescribed intravenous fluids to address the NPO status and prevent
dehydration [CORRECT]
C. Teaching the patient about postoperative exercises and deep breathing
D. Encouraging the patient to express feelings about the hospital experience
Correct Answer: B
Rationale: According to Maslow hierarchy, physiological needs take priority over safety, love/belonging,
esteem, and self-actualization needs. The patient who has not eaten since midnight and is NPO for
surgery has a physiological need for fluid maintenance. Administering prescribed IV fluids addresses the
most fundamental level of Maslow hierarchy by maintaining hydration and electrolyte balance. While the
patient anxiety (safety/esteem needs) and emotional support are important, they cannot be effectively
addressed until the patient physiological needs are met. When physiological and higher-level needs
coexist, the nurse must always address physiological needs first according to both Maslow and the ABC
prioritization framework used in HESI examinations.
Q3: A nurse is developing a nursing care plan for a patient with a nursing diagnosis of
Impaired Gas Exchange related to altered oxygen supply. Which component of the nursing
process does this represent?
Page 1
, BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide - Nightingale College 2026
A. Assessment
B. Nursing Diagnosis [CORRECT]
C. Planning
D. Implementation
Correct Answer: B
Rationale: Identifying a nursing diagnosis based on analyzed patient data represents the Diagnosis step
of the nursing process (ADPIE). The nursing diagnosis of Impaired Gas Exchange related to altered
oxygen supply demonstrates the nurse ability to cluster assessment data (objective and subjective
findings) into a meaningful diagnostic statement that identifies the patient response to a health
condition. The Assessment phase involves collecting comprehensive data. Planning involves developing
goals and interventions. Implementation involves executing the planned interventions. Evaluation
determines whether the interventions were effective. The diagnostic step is critical because it provides
the foundation for all subsequent nursing care planning and intervention.
Q4: Which action by a nurse demonstrates the Evaluation step of the nursing process?
A. Measuring the patient blood pressure and comparing it to the previous reading
[CORRECT]
B. Administering a prescribed antihypertensive medication to the patient
C. Identifying that the patient is at risk for falls due to orthostatic hypotension
D. Developing a goal that the patient blood pressure will remain below 140/90 mmHg
Correct Answer: A
Rationale: The Evaluation step of the nursing process involves measuring patient outcomes against
established goals and determining the effectiveness of nursing interventions. Measuring blood pressure
and comparing it to the previous reading is an evaluation activity because the nurse is assessing whether
the interventions (such as antihypertensive medication administration) have achieved the desired
outcome. Administering the medication is Implementation. Identifying the risk for falls is Diagnosis.
Developing the blood pressure goal is Planning. Evaluation is a continuous process that may lead to
revision of the care plan if outcomes are not met. The HESI exam consistently tests the ability to
distinguish between the five steps of the nursing process using clinical scenarios.
Q5: A nurse is caring for a patient with the following nursing diagnosis: Risk for Impaired Skin
Integrity related to immobility. Which intervention is an example of an independent nursing
intervention?
A. Administering a prescribed topical antibiotic to the skin
B. Repositioning the patient every 2 hours using a turning schedule [CORRECT]
C. Ordering a pressure-redistribution mattress for the patient bed
D. Referring the patient to a wound care specialist for consultation
Correct Answer: B
Rationale: Independent nursing interventions are actions that the nurse initiates without a provider
order, based on the nursing diagnosis and professional judgment. Repositioning the patient every 2
hours using a turning schedule is an independent nursing intervention because it falls within the scope
of nursing practice and does not require a physician order. Administering a prescribed topical antibiotic
is a dependent intervention (requires a provider order). Ordering specialized equipment typically
requires a provider order. Referring to a specialist may require a provider order or collaborative
agreement. The HESI exam frequently tests the distinction between independent, dependent, and
interdependent interventions as part of the nursing process and scope of practice evaluation.
Q6: A nurse uses the National Council of State Boards of Nursing Clinical Judgment
Measurement Model (NCJMM) to guide clinical decision-making. Which cognitive skill in the
NCJMM involves recognizing cues and analyzing them to form hypotheses about patient
needs?
Page 2
, BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide - Nightingale College 2026
A. Recognize Cues
B. Analyze Cues [CORRECT]
C. Prioritize Hypotheses
D. Generate Solutions
Correct Answer: B
Rationale: The NCJMM consists of six cognitive skills: Recognize Cues, Analyze Cues, Prioritize
Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes. Analyze Cues involves the nurse
interpreting and clustering the recognized cues to understand their significance and form clinical
hypotheses about what may be happening with the patient. While Recognize Cues involves identifying
relevant patient data and deviations from expected findings, Analyze Cues goes further by connecting
those cues to potential problems. Prioritize Hypotheses involves ranking the hypotheses. Generate
Solutions involves developing interventions. This model is central to the Next Generation NCLEX and is
heavily tested on HESI examinations aligned with 2026-2027 curriculum standards.
Q7: A nurse is writing a patient goal using the SMART goal framework. Which of the following
is an example of a well-written SMART goal?
A. The patient will feel better about their condition soon
B. The patient will ambulate 50 feet with a rolling walker by the end of the second
postoperative day [CORRECT]
C. The patient will understand their medications before discharge
D. The patient will have improved nutritional intake during hospitalization
Correct Answer: B
Rationale: SMART goals are Specific, Measurable, Attainable, Realistic, and Timely. Ambulating 50 feet
with a rolling walker by the end of the second postoperative day is a well-written SMART goal because it
is specific (ambulating with a rolling walker), measurable (50 feet), attainable and realistic for a
postoperative patient, and timely (by the end of the second postoperative day). The other options are
vague and not measurable. Feeling better, understanding medications, and improved intake lack
specific, measurable criteria and timeframes, making it impossible to objectively evaluate whether the
outcome was achieved. The HESI exam tests the ability to write and identify properly formatted SMART
goals as part of the Planning step of the nursing process.
Q8: According to Benner model of clinical competence, which level of nursing experience is
characterized by the nurse having a holistic understanding of patient situations and the ability
to recognize patterns and anticipate patient needs?
A. Novice
B. Advanced Beginner
C. Competent
D. Expert [CORRECT]
Correct Answer: D
Rationale: Patricia Benner From Novice to Expert model describes five levels of nursing experience. The
Expert level is characterized by a holistic, intuitive grasp of each situation, the ability to recognize
patterns effortlessly, and anticipation of patient needs before they become apparent. Experts have
extensive experience and deep clinical knowledge that allows them to respond fluidly and flexibly to
complex situations. Novices follow rules and lack experience. Advanced Beginners recognize recurring
patterns and need guidance. Competent nurses have mastery of organizational and planning skills but
lack the intuitive grasp of experts. Proficient nurses perceive situations as wholes and understand
long-range goals. The HESI exam tests knowledge of Benner model as part of professional development
and nursing theory content.
Q9: A nurse is caring for multiple patients on a medical-surgical unit. Using the ABCs and
Maslow hierarchy, which patient should the nurse see first?
Page 3
, BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide - Nightingale College 2026
A. A patient with constipation who needs a prescribed laxative
B. A patient with a new onset of confusion and a blood pressure of 84/52 mmHg
[CORRECT]
C. A patient who is 1 day postoperative and needs to ambulate for the first time
D. A patient with diabetes who needs blood glucose monitoring before lunch
Correct Answer: B
Rationale: The patient with new-onset confusion and hypotension (BP 84/52 mmHg) should be seen first.
This patient has both circulatory compromise (low blood pressure indicating potential shock) and altered
neurological status, which are life-threatening. Using the ABC prioritization framework, circulation is at
risk, and the confusion may indicate decreased cerebral perfusion. Using Maslow hierarchy, this patient
has the highest priority physiological need. The constipation, ambulation need, and glucose monitoring
are important but not immediately life-threatening. New-onset confusion with hypotension can indicate
sepsis, hemorrhage, or other critical conditions requiring immediate intervention. The HESI exam
frequently presents multiple-patient prioritization scenarios requiring application of ABC, Maslow, and
acute-versus-chronic frameworks.
Q10: A nurse is providing care based on QSEN competencies. Which nursing action best
demonstrates the QSEN competency of Patient-Centered Care?
A. Using a barcode scanning system before administering medications
B. Incorporating the patient cultural preferences and personal values into the care plan
[CORRECT]
C. Participating in a unit-based quality improvement project to reduce
catheter-associated UTIs
D. Using evidence-based guidelines from the latest nursing research to update a clinical
protocol
Correct Answer: B
Rationale: The QSEN competency of Patient-Centered Care involves recognizing the patient or designee
as the source of control and full partner in providing compassionate and coordinated care based on
respect for patient preferences, values, and needs. Incorporating the patient cultural preferences and
personal values into the care plan directly reflects this competency. Barcode scanning medication
administration reflects Safety and Informatics competencies. Participating in a quality improvement
project reflects Quality Improvement. Using evidence-based guidelines reflects Evidence-Based Practice.
The six QSEN competencies (Patient-Centered Care, Teamwork and Collaboration, Evidence-Based
Practice, Quality Improvement, Safety, and Informatics) are systematically tested on HESI examinations.
Q11: A nurse is applying critical thinking skills in patient care. Which of the following best
describes the critical thinking component of reflection and self-correction?
A. Following facility policies and procedures without questioning their appropriateness
B. Reviewing a patient outcome that did not meet the expected goal and modifying the
care plan accordingly [CORRECT]
C. Delegating all patient care tasks to unlicensed assistive personnel to focus on
documentation
D. Accepting physician orders without verifying their appropriateness for the individual
patient
Correct Answer: B
Rationale: Critical thinking in nursing is defined as purposeful, goal-directed thinking that is
evidence-based and involves reflection and self-correction. Reviewing a patient outcome that did not
meet the expected goal and modifying the care plan accordingly demonstrates reflection (analyzing what
happened and why) and self-correction (making changes to improve future outcomes). Critical thinking
requires the nurse to question assumptions, evaluate evidence, and adjust approaches based on results.
The incorrect options represent non-critical thinking: blindly following policies, inappropriate
delegation, and unquestioning acceptance of orders all represent the opposite of critical thinking. The
Page 4
Fundamentals of Nursing Exam
Study Guide
Nightingale College | 2026/2027 Academic Year
Verified Questions and Answers with Comprehensive Rationales
125 Questions | 7 Sections | 100% Correct | Grade A | Aligned with 2026-2027 Curriculum
Section 1: Nursing Process, Critical Thinking, and Prioritization
(Q1-Q25)
Q1: A nurse is caring for four patients. Which patient should the nurse assess first using the
ABC (Airway, Breathing, Circulation) prioritization framework?
A. A patient with a scheduled medication due in 30 minutes
B. A patient reporting pain at a level of 5 out of 10 after abdominal surgery
C. A patient with a tracheostomy who has thick, tenacious secretions and an SpO2 of 88%
[CORRECT]
D. A patient requesting assistance with ambulation to the bathroom
Correct Answer: C
Rationale: Using the ABC framework, the nurse must prioritize airway, breathing, and circulation before
addressing any other patient needs. The patient with a tracheostomy who has thick secretions and an
oxygen saturation of 88% has both an airway concern (secretions potentially obstructing the
tracheostomy tube) and a breathing concern (hypoxemia with SpO2 below the normal range of
95-100%). This patient requires immediate suctioning and respiratory assessment to prevent complete
airway obstruction and respiratory failure. The other patients have important but less time-sensitive
needs that can be addressed after stabilizing the airway and breathing of the first patient.
Q2: According to Maslow hierarchy of needs, which nursing intervention should the nurse
prioritize for a patient who is anxious about an upcoming surgery and has not eaten since
midnight?
A. Providing emotional support and reassurance about the surgical procedure
B. Administering prescribed intravenous fluids to address the NPO status and prevent
dehydration [CORRECT]
C. Teaching the patient about postoperative exercises and deep breathing
D. Encouraging the patient to express feelings about the hospital experience
Correct Answer: B
Rationale: According to Maslow hierarchy, physiological needs take priority over safety, love/belonging,
esteem, and self-actualization needs. The patient who has not eaten since midnight and is NPO for
surgery has a physiological need for fluid maintenance. Administering prescribed IV fluids addresses the
most fundamental level of Maslow hierarchy by maintaining hydration and electrolyte balance. While the
patient anxiety (safety/esteem needs) and emotional support are important, they cannot be effectively
addressed until the patient physiological needs are met. When physiological and higher-level needs
coexist, the nurse must always address physiological needs first according to both Maslow and the ABC
prioritization framework used in HESI examinations.
Q3: A nurse is developing a nursing care plan for a patient with a nursing diagnosis of
Impaired Gas Exchange related to altered oxygen supply. Which component of the nursing
process does this represent?
Page 1
, BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide - Nightingale College 2026
A. Assessment
B. Nursing Diagnosis [CORRECT]
C. Planning
D. Implementation
Correct Answer: B
Rationale: Identifying a nursing diagnosis based on analyzed patient data represents the Diagnosis step
of the nursing process (ADPIE). The nursing diagnosis of Impaired Gas Exchange related to altered
oxygen supply demonstrates the nurse ability to cluster assessment data (objective and subjective
findings) into a meaningful diagnostic statement that identifies the patient response to a health
condition. The Assessment phase involves collecting comprehensive data. Planning involves developing
goals and interventions. Implementation involves executing the planned interventions. Evaluation
determines whether the interventions were effective. The diagnostic step is critical because it provides
the foundation for all subsequent nursing care planning and intervention.
Q4: Which action by a nurse demonstrates the Evaluation step of the nursing process?
A. Measuring the patient blood pressure and comparing it to the previous reading
[CORRECT]
B. Administering a prescribed antihypertensive medication to the patient
C. Identifying that the patient is at risk for falls due to orthostatic hypotension
D. Developing a goal that the patient blood pressure will remain below 140/90 mmHg
Correct Answer: A
Rationale: The Evaluation step of the nursing process involves measuring patient outcomes against
established goals and determining the effectiveness of nursing interventions. Measuring blood pressure
and comparing it to the previous reading is an evaluation activity because the nurse is assessing whether
the interventions (such as antihypertensive medication administration) have achieved the desired
outcome. Administering the medication is Implementation. Identifying the risk for falls is Diagnosis.
Developing the blood pressure goal is Planning. Evaluation is a continuous process that may lead to
revision of the care plan if outcomes are not met. The HESI exam consistently tests the ability to
distinguish between the five steps of the nursing process using clinical scenarios.
Q5: A nurse is caring for a patient with the following nursing diagnosis: Risk for Impaired Skin
Integrity related to immobility. Which intervention is an example of an independent nursing
intervention?
A. Administering a prescribed topical antibiotic to the skin
B. Repositioning the patient every 2 hours using a turning schedule [CORRECT]
C. Ordering a pressure-redistribution mattress for the patient bed
D. Referring the patient to a wound care specialist for consultation
Correct Answer: B
Rationale: Independent nursing interventions are actions that the nurse initiates without a provider
order, based on the nursing diagnosis and professional judgment. Repositioning the patient every 2
hours using a turning schedule is an independent nursing intervention because it falls within the scope
of nursing practice and does not require a physician order. Administering a prescribed topical antibiotic
is a dependent intervention (requires a provider order). Ordering specialized equipment typically
requires a provider order. Referring to a specialist may require a provider order or collaborative
agreement. The HESI exam frequently tests the distinction between independent, dependent, and
interdependent interventions as part of the nursing process and scope of practice evaluation.
Q6: A nurse uses the National Council of State Boards of Nursing Clinical Judgment
Measurement Model (NCJMM) to guide clinical decision-making. Which cognitive skill in the
NCJMM involves recognizing cues and analyzing them to form hypotheses about patient
needs?
Page 2
, BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide - Nightingale College 2026
A. Recognize Cues
B. Analyze Cues [CORRECT]
C. Prioritize Hypotheses
D. Generate Solutions
Correct Answer: B
Rationale: The NCJMM consists of six cognitive skills: Recognize Cues, Analyze Cues, Prioritize
Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes. Analyze Cues involves the nurse
interpreting and clustering the recognized cues to understand their significance and form clinical
hypotheses about what may be happening with the patient. While Recognize Cues involves identifying
relevant patient data and deviations from expected findings, Analyze Cues goes further by connecting
those cues to potential problems. Prioritize Hypotheses involves ranking the hypotheses. Generate
Solutions involves developing interventions. This model is central to the Next Generation NCLEX and is
heavily tested on HESI examinations aligned with 2026-2027 curriculum standards.
Q7: A nurse is writing a patient goal using the SMART goal framework. Which of the following
is an example of a well-written SMART goal?
A. The patient will feel better about their condition soon
B. The patient will ambulate 50 feet with a rolling walker by the end of the second
postoperative day [CORRECT]
C. The patient will understand their medications before discharge
D. The patient will have improved nutritional intake during hospitalization
Correct Answer: B
Rationale: SMART goals are Specific, Measurable, Attainable, Realistic, and Timely. Ambulating 50 feet
with a rolling walker by the end of the second postoperative day is a well-written SMART goal because it
is specific (ambulating with a rolling walker), measurable (50 feet), attainable and realistic for a
postoperative patient, and timely (by the end of the second postoperative day). The other options are
vague and not measurable. Feeling better, understanding medications, and improved intake lack
specific, measurable criteria and timeframes, making it impossible to objectively evaluate whether the
outcome was achieved. The HESI exam tests the ability to write and identify properly formatted SMART
goals as part of the Planning step of the nursing process.
Q8: According to Benner model of clinical competence, which level of nursing experience is
characterized by the nurse having a holistic understanding of patient situations and the ability
to recognize patterns and anticipate patient needs?
A. Novice
B. Advanced Beginner
C. Competent
D. Expert [CORRECT]
Correct Answer: D
Rationale: Patricia Benner From Novice to Expert model describes five levels of nursing experience. The
Expert level is characterized by a holistic, intuitive grasp of each situation, the ability to recognize
patterns effortlessly, and anticipation of patient needs before they become apparent. Experts have
extensive experience and deep clinical knowledge that allows them to respond fluidly and flexibly to
complex situations. Novices follow rules and lack experience. Advanced Beginners recognize recurring
patterns and need guidance. Competent nurses have mastery of organizational and planning skills but
lack the intuitive grasp of experts. Proficient nurses perceive situations as wholes and understand
long-range goals. The HESI exam tests knowledge of Benner model as part of professional development
and nursing theory content.
Q9: A nurse is caring for multiple patients on a medical-surgical unit. Using the ABCs and
Maslow hierarchy, which patient should the nurse see first?
Page 3
, BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide - Nightingale College 2026
A. A patient with constipation who needs a prescribed laxative
B. A patient with a new onset of confusion and a blood pressure of 84/52 mmHg
[CORRECT]
C. A patient who is 1 day postoperative and needs to ambulate for the first time
D. A patient with diabetes who needs blood glucose monitoring before lunch
Correct Answer: B
Rationale: The patient with new-onset confusion and hypotension (BP 84/52 mmHg) should be seen first.
This patient has both circulatory compromise (low blood pressure indicating potential shock) and altered
neurological status, which are life-threatening. Using the ABC prioritization framework, circulation is at
risk, and the confusion may indicate decreased cerebral perfusion. Using Maslow hierarchy, this patient
has the highest priority physiological need. The constipation, ambulation need, and glucose monitoring
are important but not immediately life-threatening. New-onset confusion with hypotension can indicate
sepsis, hemorrhage, or other critical conditions requiring immediate intervention. The HESI exam
frequently presents multiple-patient prioritization scenarios requiring application of ABC, Maslow, and
acute-versus-chronic frameworks.
Q10: A nurse is providing care based on QSEN competencies. Which nursing action best
demonstrates the QSEN competency of Patient-Centered Care?
A. Using a barcode scanning system before administering medications
B. Incorporating the patient cultural preferences and personal values into the care plan
[CORRECT]
C. Participating in a unit-based quality improvement project to reduce
catheter-associated UTIs
D. Using evidence-based guidelines from the latest nursing research to update a clinical
protocol
Correct Answer: B
Rationale: The QSEN competency of Patient-Centered Care involves recognizing the patient or designee
as the source of control and full partner in providing compassionate and coordinated care based on
respect for patient preferences, values, and needs. Incorporating the patient cultural preferences and
personal values into the care plan directly reflects this competency. Barcode scanning medication
administration reflects Safety and Informatics competencies. Participating in a quality improvement
project reflects Quality Improvement. Using evidence-based guidelines reflects Evidence-Based Practice.
The six QSEN competencies (Patient-Centered Care, Teamwork and Collaboration, Evidence-Based
Practice, Quality Improvement, Safety, and Informatics) are systematically tested on HESI examinations.
Q11: A nurse is applying critical thinking skills in patient care. Which of the following best
describes the critical thinking component of reflection and self-correction?
A. Following facility policies and procedures without questioning their appropriateness
B. Reviewing a patient outcome that did not meet the expected goal and modifying the
care plan accordingly [CORRECT]
C. Delegating all patient care tasks to unlicensed assistive personnel to focus on
documentation
D. Accepting physician orders without verifying their appropriateness for the individual
patient
Correct Answer: B
Rationale: Critical thinking in nursing is defined as purposeful, goal-directed thinking that is
evidence-based and involves reflection and self-correction. Reviewing a patient outcome that did not
meet the expected goal and modifying the care plan accordingly demonstrates reflection (analyzing what
happened and why) and self-correction (making changes to improve future outcomes). Critical thinking
requires the nurse to question assumptions, evaluate evidence, and adjust approaches based on results.
The incorrect options represent non-critical thinking: blindly following policies, inappropriate
delegation, and unquestioning acceptance of orders all represent the opposite of critical thinking. The
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