BSN 225 HESI RN SPECIALTY FUNDAMENTALS OF
NURSING EXAM V1 (LATEST UPDATE )
QUESTIONS & ANSWERS | 100% CORRECT | GRADE A
- NIGHTINGALE
BSN 225 HESI RN Specialty Fundamentals of Nursing
Comprehensive Practice Exam — Original HESI/NCLEX-Style Questions
Course: BSN 225
Course Name: Fundamentals of Nursing
Institution: Nightingale College
Exam Version: Original Practice Exam, 2026–2027 Study Edition
Format: 100 Questions with Answers and Detailed Rationales
Question Types: Multiple Choice and Short Answer
Important note: This is an original study/practice examination.
Table of Contents
1. Nursing Process, Assessment & Clinical Judgment — Questions 1–10
2. Safety, Infection Prevention & Control — Questions 11–20
3. Medication Administration — Questions 21–30
4. Cardiovascular System — Questions 31–40
5. Respiratory System — Questions 41–50
6. Neurologic System — Questions 51–60
7. Gastrointestinal & Nutritional Care — Questions 61–70
8. Renal & Urinary System — Questions 71–78
9. Musculoskeletal, Mobility & Skin Integrity — Questions 79–86
10. Fluid, Electrolyte & Acid-Base Balance — Questions 87–92
11. Pain, Psychosocial, Ethical & End-of-Life Care — Questions 93–100
12. Answer Review Summary
,Section 1 — Nursing Process, Assessment & Clinical Judgment
Question 1 — Multiple Choice
A nurse is beginning an admission assessment of a client who reports severe abdominal pain.
Which action should the nurse perform first?
A. Ask the client to rate the pain on a 0-to-10 scale.
B. Obtain a complete health history.
C. Assess the client's airway, breathing, and circulation.
D. Document the client's previous surgical history.
Correct Answer: C. Assess the client's airway, breathing, and circulation.
Rationale:
The nurse prioritizes immediate threats to life using the ABC framework: airway, breathing, and
circulation. Although pain assessment is important, the nurse must first determine whether the
client has an immediately life-threatening physiologic problem. A complete history and
documentation can follow stabilization.
Question 2 — Multiple Choice
Which finding requires the nurse's immediate attention?
A. Temperature of 37.4°C (99.3°F)
B. Heart rate of 104/min after ambulation
C. Respiratory rate of 8/min in a client receiving opioids
D. Blood pressure of 138/84 mm Hg
Correct Answer: C. Respiratory rate of 8/min in a client receiving opioids.
Rationale:
A respiratory rate of 8/min indicates respiratory depression, which is a potentially life-
threatening complication of opioid therapy. The nurse should immediately assess respiratory
status and follow emergency protocols. The other findings are less immediately concerning.
Question 3 — Short Answer
A nurse obtains a blood pressure of 86/50 mm Hg in a client who is pale and dizzy. What is the
nurse's priority response?
,Correct Answer: Assess the client's airway, breathing, circulation, mental status, and other signs
of hemodynamic instability; remain with the client and notify the appropriate provider/rapid-
response team according to facility protocol.
Rationale:
Hypotension accompanied by pallor and dizziness can indicate inadequate tissue perfusion or
shock. The nurse should not simply recheck the blood pressure later. Immediate assessment and
intervention are necessary to determine the cause and prevent deterioration.
Question 4 — Multiple Choice
Which nursing action best demonstrates use of the nursing process?
A. Administering medications exactly as prescribed without further assessment
B. Collecting assessment data before developing nursing interventions
C. Asking another nurse to determine the client's nursing diagnoses
D. Implementing interventions without evaluating their outcomes
Correct Answer: B. Collecting assessment data before developing nursing interventions.
Rationale:
Assessment is the first step of the nursing process. The nurse collects subjective and objective
information, analyzes the findings, identifies nursing problems, establishes goals, implements
interventions, and evaluates outcomes.
Question 5 — Multiple Choice
A client says, "I am frightened about my surgery tomorrow." Which response by the nurse is
most therapeutic?
A. "There is nothing to worry about."
B. "You should try to get some sleep."
C. "Tell me what concerns you most about the surgery."
D. "The surgeon performs this operation frequently."
Correct Answer: C. "Tell me what concerns you most about the surgery."
Rationale:
This response encourages the client to express feelings and identifies the source of anxiety.
Therapeutic communication involves active listening and open-ended questions rather than false
reassurance or changing the subject.
, Question 6 — Multiple Choice
Which information is considered subjective data?
A. Oxygen saturation is 91%.
B. The client reports feeling short of breath.
C. The client's respiratory rate is 24/min.
D. Bilateral crackles are heard on auscultation.
Correct Answer: B. The client reports feeling short of breath.
Rationale:
Subjective data are symptoms reported by the client. Objective data are measurable or observable
findings, such as respiratory rate, oxygen saturation, and auscultated lung sounds.
Question 7 — Multiple Choice
Which client should the nurse assess first?
A. A client requesting assistance with bathing
B. A client reporting new-onset chest pressure
C. A client waiting for discharge instructions
D. A client requesting a routine medication
Correct Answer: B. A client reporting new-onset chest pressure.
Rationale:
New chest pressure may indicate myocardial ischemia or another cardiovascular emergency. The
nurse should prioritize potentially life-threatening problems over routine needs.
Question 8 — Short Answer
What is the purpose of establishing measurable goals in a nursing care plan?
Correct Answer: To provide specific outcomes against which the nurse can evaluate whether
interventions are effective.
Rationale:
Measurable goals make evaluation objective. For example, "Client will maintain oxygen
saturation ≥94% within 2 hours" is more useful for evaluation than "Client will have improved
oxygenation."
Question 9 — Multiple Choice
NURSING EXAM V1 (LATEST UPDATE )
QUESTIONS & ANSWERS | 100% CORRECT | GRADE A
- NIGHTINGALE
BSN 225 HESI RN Specialty Fundamentals of Nursing
Comprehensive Practice Exam — Original HESI/NCLEX-Style Questions
Course: BSN 225
Course Name: Fundamentals of Nursing
Institution: Nightingale College
Exam Version: Original Practice Exam, 2026–2027 Study Edition
Format: 100 Questions with Answers and Detailed Rationales
Question Types: Multiple Choice and Short Answer
Important note: This is an original study/practice examination.
Table of Contents
1. Nursing Process, Assessment & Clinical Judgment — Questions 1–10
2. Safety, Infection Prevention & Control — Questions 11–20
3. Medication Administration — Questions 21–30
4. Cardiovascular System — Questions 31–40
5. Respiratory System — Questions 41–50
6. Neurologic System — Questions 51–60
7. Gastrointestinal & Nutritional Care — Questions 61–70
8. Renal & Urinary System — Questions 71–78
9. Musculoskeletal, Mobility & Skin Integrity — Questions 79–86
10. Fluid, Electrolyte & Acid-Base Balance — Questions 87–92
11. Pain, Psychosocial, Ethical & End-of-Life Care — Questions 93–100
12. Answer Review Summary
,Section 1 — Nursing Process, Assessment & Clinical Judgment
Question 1 — Multiple Choice
A nurse is beginning an admission assessment of a client who reports severe abdominal pain.
Which action should the nurse perform first?
A. Ask the client to rate the pain on a 0-to-10 scale.
B. Obtain a complete health history.
C. Assess the client's airway, breathing, and circulation.
D. Document the client's previous surgical history.
Correct Answer: C. Assess the client's airway, breathing, and circulation.
Rationale:
The nurse prioritizes immediate threats to life using the ABC framework: airway, breathing, and
circulation. Although pain assessment is important, the nurse must first determine whether the
client has an immediately life-threatening physiologic problem. A complete history and
documentation can follow stabilization.
Question 2 — Multiple Choice
Which finding requires the nurse's immediate attention?
A. Temperature of 37.4°C (99.3°F)
B. Heart rate of 104/min after ambulation
C. Respiratory rate of 8/min in a client receiving opioids
D. Blood pressure of 138/84 mm Hg
Correct Answer: C. Respiratory rate of 8/min in a client receiving opioids.
Rationale:
A respiratory rate of 8/min indicates respiratory depression, which is a potentially life-
threatening complication of opioid therapy. The nurse should immediately assess respiratory
status and follow emergency protocols. The other findings are less immediately concerning.
Question 3 — Short Answer
A nurse obtains a blood pressure of 86/50 mm Hg in a client who is pale and dizzy. What is the
nurse's priority response?
,Correct Answer: Assess the client's airway, breathing, circulation, mental status, and other signs
of hemodynamic instability; remain with the client and notify the appropriate provider/rapid-
response team according to facility protocol.
Rationale:
Hypotension accompanied by pallor and dizziness can indicate inadequate tissue perfusion or
shock. The nurse should not simply recheck the blood pressure later. Immediate assessment and
intervention are necessary to determine the cause and prevent deterioration.
Question 4 — Multiple Choice
Which nursing action best demonstrates use of the nursing process?
A. Administering medications exactly as prescribed without further assessment
B. Collecting assessment data before developing nursing interventions
C. Asking another nurse to determine the client's nursing diagnoses
D. Implementing interventions without evaluating their outcomes
Correct Answer: B. Collecting assessment data before developing nursing interventions.
Rationale:
Assessment is the first step of the nursing process. The nurse collects subjective and objective
information, analyzes the findings, identifies nursing problems, establishes goals, implements
interventions, and evaluates outcomes.
Question 5 — Multiple Choice
A client says, "I am frightened about my surgery tomorrow." Which response by the nurse is
most therapeutic?
A. "There is nothing to worry about."
B. "You should try to get some sleep."
C. "Tell me what concerns you most about the surgery."
D. "The surgeon performs this operation frequently."
Correct Answer: C. "Tell me what concerns you most about the surgery."
Rationale:
This response encourages the client to express feelings and identifies the source of anxiety.
Therapeutic communication involves active listening and open-ended questions rather than false
reassurance or changing the subject.
, Question 6 — Multiple Choice
Which information is considered subjective data?
A. Oxygen saturation is 91%.
B. The client reports feeling short of breath.
C. The client's respiratory rate is 24/min.
D. Bilateral crackles are heard on auscultation.
Correct Answer: B. The client reports feeling short of breath.
Rationale:
Subjective data are symptoms reported by the client. Objective data are measurable or observable
findings, such as respiratory rate, oxygen saturation, and auscultated lung sounds.
Question 7 — Multiple Choice
Which client should the nurse assess first?
A. A client requesting assistance with bathing
B. A client reporting new-onset chest pressure
C. A client waiting for discharge instructions
D. A client requesting a routine medication
Correct Answer: B. A client reporting new-onset chest pressure.
Rationale:
New chest pressure may indicate myocardial ischemia or another cardiovascular emergency. The
nurse should prioritize potentially life-threatening problems over routine needs.
Question 8 — Short Answer
What is the purpose of establishing measurable goals in a nursing care plan?
Correct Answer: To provide specific outcomes against which the nurse can evaluate whether
interventions are effective.
Rationale:
Measurable goals make evaluation objective. For example, "Client will maintain oxygen
saturation ≥94% within 2 hours" is more useful for evaluation than "Client will have improved
oxygenation."
Question 9 — Multiple Choice
