BSN HESI 225 Fundamentals of Nursing Exam Guide
Practice Test Actual 2025/2026 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: Foundations of Nursing Practice (Questions 1–12)
Q1: A nurse is caring for a patient with heart failure. The nurse notes the patient has
edema, dyspnea, and a 5-pound weight gain in 2 days. Which step of the nursing
process is the nurse performing when documenting these findings?
A. Planning
B. Implementation
C. Assessment
D. Evaluation
Correct Answer: C
Rationale: Documenting objective and subjective data including edema, dyspnea,
and weight gain represents the assessment phase of the nursing process; this data
collection forms the foundation for subsequent analysis and care planning.
Q2: A nurse is using critical thinking to analyze a patient's condition. Which
characteristic of critical thinking is the nurse demonstrating when questioning the
rationale for a prescribed medication?
A. Confidence
,B. Curiosity
C. Perseverance
D. Fair-mindedness
Correct Answer: B
Rationale: Curiosity drives the nurse to question, investigate, and seek deeper
understanding of clinical situations; questioning medication rationale demonstrates
intellectual curiosity, a foundational characteristic of critical thinking that promotes
patient safety.
Q3: A patient is prescribed morphine for pain. The nurse notes the patient has a
history of sleep apnea. Which clinical judgment should the nurse make?
A. Administer the morphine as prescribed without additional monitoring
B. Hold the morphine and notify the provider of the increased respiratory depression
risk
C. Administer a higher dose to overcome the patient's tolerance
D. Give the medication and place the patient in a prone position
Correct Answer: B
Rationale: Sleep apnea significantly increases the risk of opioid-induced respiratory
depression; the nurse must hold the dose, notify the provider to discuss alternative
analgesia or reduced dosing with continuous respiratory monitoring, and document
the clinical reasoning.
,Q4: A nurse is caring for a patient who refuses a blood transfusion based on
religious beliefs. The provider orders the transfusion as medically necessary. Which
ethical principle is the nurse upholding by supporting the patient's refusal?
A. Beneficence
B. Nonmaleficence
C. Autonomy
D. Justice
Correct Answer: C
Rationale: Autonomy is the ethical principle that respects the patient's right to
self-determination and informed refusal of treatment; supporting the patient's
decision upholds autonomy while requiring the nurse to notify the provider and
explore alternative treatments.
Q5: A nurse delegates the task of measuring vital signs to a nursing assistant. Which
task is most appropriate to delegate?
A. Assessing a postoperative patient's pain level
B. Obtaining blood pressure on a stable patient
C. Evaluating a patient's response to pain medication
D. Teaching a patient about wound care
Correct Answer: B
Rationale: Obtaining blood pressure on a stable patient is within the scope of nursing
assistant practice as a routine, standardized procedure; assessment, evaluation, and
, patient teaching require nursing judgment and remain the responsibility of the
registered nurse.
Q6: A nurse is caring for a patient with diabetes who has a blood glucose of 52
mg/dL. Which action demonstrates clinical judgment using the nursing process?
A. Administer insulin as scheduled
B. Recheck the blood glucose in 2 hours
C. Administer 15 grams of fast-acting carbohydrate and recheck in 15 minutes
D. Notify the provider and wait for further orders
Correct Answer: C
Rationale: A blood glucose of 52 mg/dL indicates hypoglycemia requiring immediate
intervention; administering 15 grams of fast-acting carbohydrate followed by
rechecking in 15 minutes follows evidence-based protocol for hypoglycemia
management without delaying treatment.
Q7: A nurse is caring for a patient who is confused and attempting to remove their IV
catheter. Which legal principle guides the nurse's decision to apply soft wrist
restraints?
A. Assault
B. Battery
C. False imprisonment
D. Duty to protect
Correct Answer: D
Practice Test Actual 2025/2026 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: Foundations of Nursing Practice (Questions 1–12)
Q1: A nurse is caring for a patient with heart failure. The nurse notes the patient has
edema, dyspnea, and a 5-pound weight gain in 2 days. Which step of the nursing
process is the nurse performing when documenting these findings?
A. Planning
B. Implementation
C. Assessment
D. Evaluation
Correct Answer: C
Rationale: Documenting objective and subjective data including edema, dyspnea,
and weight gain represents the assessment phase of the nursing process; this data
collection forms the foundation for subsequent analysis and care planning.
Q2: A nurse is using critical thinking to analyze a patient's condition. Which
characteristic of critical thinking is the nurse demonstrating when questioning the
rationale for a prescribed medication?
A. Confidence
,B. Curiosity
C. Perseverance
D. Fair-mindedness
Correct Answer: B
Rationale: Curiosity drives the nurse to question, investigate, and seek deeper
understanding of clinical situations; questioning medication rationale demonstrates
intellectual curiosity, a foundational characteristic of critical thinking that promotes
patient safety.
Q3: A patient is prescribed morphine for pain. The nurse notes the patient has a
history of sleep apnea. Which clinical judgment should the nurse make?
A. Administer the morphine as prescribed without additional monitoring
B. Hold the morphine and notify the provider of the increased respiratory depression
risk
C. Administer a higher dose to overcome the patient's tolerance
D. Give the medication and place the patient in a prone position
Correct Answer: B
Rationale: Sleep apnea significantly increases the risk of opioid-induced respiratory
depression; the nurse must hold the dose, notify the provider to discuss alternative
analgesia or reduced dosing with continuous respiratory monitoring, and document
the clinical reasoning.
,Q4: A nurse is caring for a patient who refuses a blood transfusion based on
religious beliefs. The provider orders the transfusion as medically necessary. Which
ethical principle is the nurse upholding by supporting the patient's refusal?
A. Beneficence
B. Nonmaleficence
C. Autonomy
D. Justice
Correct Answer: C
Rationale: Autonomy is the ethical principle that respects the patient's right to
self-determination and informed refusal of treatment; supporting the patient's
decision upholds autonomy while requiring the nurse to notify the provider and
explore alternative treatments.
Q5: A nurse delegates the task of measuring vital signs to a nursing assistant. Which
task is most appropriate to delegate?
A. Assessing a postoperative patient's pain level
B. Obtaining blood pressure on a stable patient
C. Evaluating a patient's response to pain medication
D. Teaching a patient about wound care
Correct Answer: B
Rationale: Obtaining blood pressure on a stable patient is within the scope of nursing
assistant practice as a routine, standardized procedure; assessment, evaluation, and
, patient teaching require nursing judgment and remain the responsibility of the
registered nurse.
Q6: A nurse is caring for a patient with diabetes who has a blood glucose of 52
mg/dL. Which action demonstrates clinical judgment using the nursing process?
A. Administer insulin as scheduled
B. Recheck the blood glucose in 2 hours
C. Administer 15 grams of fast-acting carbohydrate and recheck in 15 minutes
D. Notify the provider and wait for further orders
Correct Answer: C
Rationale: A blood glucose of 52 mg/dL indicates hypoglycemia requiring immediate
intervention; administering 15 grams of fast-acting carbohydrate followed by
rechecking in 15 minutes follows evidence-based protocol for hypoglycemia
management without delaying treatment.
Q7: A nurse is caring for a patient who is confused and attempting to remove their IV
catheter. Which legal principle guides the nurse's decision to apply soft wrist
restraints?
A. Assault
B. Battery
C. False imprisonment
D. Duty to protect
Correct Answer: D
