BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V2 (Latest Update 2026/2027) Questions & Answers | 100% Correct | Grade A -
Nightingale 2026/2027
OBJECTIVE ASSESSMENT - EXAM
BSN 225 HESI RN Specialty
Fundamentals of Nursing Exam V2
(Latest Update 2026/2027)
Questions & Answers | 100%
Correct | Grade A - Nightingale
2026/2027
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Vital Signs & Physical Assessment Fluid & Electrolyte Management
Infection Control & Asepsis Client Rights & Ethical Practice
Patient Safety & Fall Prevention Nutrition & Wound Care
COVER PAGE - 1
, SECTION 1 | Basic Nursing Concepts & Skills | Q1-Q18
BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V2 (Latest Update 2026/2027) Questions & Answers | 100% Correct | Grade A - Nightingale
2026/2027
Q1 Question 1 of 75
A 68-year-old patient admitted for dehydration has an oral temperature reading of 37.9 degrees C
taken by the nursing student. The patient complains of feeling warm and appears flushed. Which
action by the nurse is most appropriate at this point?
A. Reposition the thermometer under the tongue and wait an additional 3 minutes before
rechecking
B. Document the reading and continue to monitor the patient for other signs of infection
C. Switch to a tympanic membrane thermometer to obtain a more accurate core temperature
D. Apply a cooling blanket immediately to reduce the patient's body temperature
Correct Answer: A
Rationale:
The oral temperature of 37.9 degrees C is borderline elevated, and the patient's symptoms suggest the reading may be
inaccurately low. Repositioning the thermometer into the posterior sublingual pocket ensures proper placement for an
accurate measurement. Documenting without verifying would risk missing a developing fever requiring prompt clinical
intervention.
Q2 Question 2 of 75
A 45-year-old postoperative patient who had abdominal surgery 6 hours ago is positioned supine with
the head of the bed flat. The nurse notes the patient is becoming increasingly restless and has a
weak, productive cough. Which position should the nurse implement first?
A. Place the patient in high Fowler's position with pillows behind the back and knees slightly flexed
B. Turn the patient to the left lateral position with a pillow between the knees
C. Position the patient prone with a small pillow under the abdomen for comfort
D. Lower the head of the bed below the level of the heart to promote venous return
Correct Answer: B
Rationale:
The left lateral position helps drain secretions from the bronchial tree by gravity and prevents aspiration of any oral
secretions in a postoperative patient with a weak cough. While high Fowler's maximizes lung expansion, the patient's
productive cough suggests secretions need to be mobilized and drained first, making lateral positioning the safer
immediate choice.
Q3 Question 3 of 75
A nurse is preparing to transfer a 185-pound patient from the bed to a wheelchair using a mechanical
lift. The patient has limited mobility in the right leg following a total knee replacement. Which
technique should the nurse use to protect both the patient and staff during this transfer?
BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V2 (Latest Update 2026/20... | 2026/2027 | Passing Score: 80% | Page 2 of 37
, A. Position the sling under the patient's axillae and behind the knees, then elevate vertically before
swinging to the wheelchair
B. Apply the sling with the patient seated upright on the edge of the bed, ensuring the affected leg is
supported with a pillow during the swing
C. Roll the patient to the side to place the sling, then use the lift to raise and position the patient
directly over the wheelchair seat
D. Have the patient bear partial weight on the unaffected leg while the lift provides support during the
transfer to the wheelchair
Correct Answer: C
Rationale:
Rolling the patient to properly place the sling distributes weight evenly across the sling surface, reducing shear and
friction. The mechanical lift then bears the entire load, protecting both the nurse's back and the patient's surgical knee
from stress. Elevating the patient directly over the wheelchair minimizes lateral movement during transfer.
Q4 Question 4 of 75
A nurse is performing a sterile dressing change on a 4-inch abdominal incision for a 55-year-old
patient. After removing the old dressing, the nurse notes a small area of dehiscence with pink
granulation tissue visible. Which action should the nurse take before applying the new sterile
dressing?
A. Irrigate the wound bed with hydrogen peroxide to remove any residual debris from the dehisced area
B. Cleanse the wound from the center outward using sterile saline and gauze, maintaining sterile technique
throughout
C. Apply a topical antibiotic ointment directly to the granulation tissue before covering with a sterile gauze
pad
D. Pack the dehisced area loosely with sterile gauze soaked in povidone-iodine solution
Correct Answer: D
Rationale:
Povidone-iodine solution is antimicrobial and appropriate for a wound showing dehiscence where infection risk is
elevated. However, hydrogen peroxide is cytotoxic to granulation tissue, and plain saline may be insufficient given the
dehiscence. Packing the wound loosely with povidone-iodine gauze allows the antiseptic to reach the wound bed while
absorbing drainage.
Q5 Question 5 of 75
A 72-year-old patient with chronic obstructive pulmonary disease (COPD) requires supplemental
oxygen. The patient's current oxygen saturation is 88% on room air and the provider has ordered
oxygen therapy. Which oxygen delivery device is most appropriate for this patient?
A. Venturi mask set at 28% oxygen concentration
B. Simple face mask at 6 liters per minute
C. Non-rebreather mask at 10 liters per minute
D. Nasal cannula at 4 liters per minute
BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V2 (Latest Update 2026/20... | 2026/2027 | Passing Score: 80% | Page 3 of 37
, Correct Answer: A
Rationale:
The Venturi mask delivers a precise, fixed oxygen concentration, which is critical for COPD patients who rely on hypoxic
drive to maintain respiratory effort. A Venturi mask at 28% provides controlled oxygenation without suppressing the
patient's respiratory stimulus. High-flow devices like non-rebreather masks risk eliminating the hypoxic drive entirely.
Q6 Question 6 of 75
A nurse on the medical-surgical unit is calculating the 8-hour intake and output for a 60-year-old
patient receiving intravenous fluids. The patient received 500 mL of D5W at 0900, ate 240 mL of clear
liquids at noon, and had a 180 mL water pitcher refill at 1400. Urine output was 350 mL, and a
nasogastric tube drained 120 mL. What is the patient's net fluid balance for this 8-hour shift?
A. +250 mL
B. +450 mL
C. -50 mL
D. -120 mL
Correct Answer: B
Rationale:
Total intake is 500 mL (IV) plus 240 mL (oral) plus 180 mL (water) equals 920 mL. Total output is 350 mL (urine) plus
120 mL (NG drain) equals 470 mL. Net fluid balance is 920 minus 470 equals positive 450 mL. A negative balance
would indicate dehydration, which is not supported by these intake and output figures.
Q7 Question 7 of 75
A nurse is giving a complete bed bath to an 80-year-old patient who is bedridden following a stroke.
The patient's skin is cool and dry to the touch, and the room temperature is 72 degrees F. Which
intervention should the nurse include to maintain the patient's thermoregulation during the bath?
A. Increase the room temperature to 78 degrees F and use warm water at 110 degrees F for washing,
exposing only one body area at a time
B. Apply a heating pad to the patient's feet before beginning the bath and keep all bath linens pre-warmed
in a blanket warmer
C. Perform the bath quickly using cool water to stimulate circulation and cover the patient with a
thermal blanket immediately after
D. Administer an antipyretic medication prior to bathing and monitor the patient's temperature every 15
minutes throughout the procedure
Correct Answer: C
Rationale:
Using cool water during a bed bath provides a brief thermal stimulus that can improve peripheral circulation through
vasoconstriction and subsequent vasodilation. Covering the patient immediately after preserves body heat. Heating pads
pose a burn risk in patients with diminished sensation, and warm water combined with exposure still risks significant
heat loss in elderly patients.
BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V2 (Latest Update 2026/20... | 2026/2027 | Passing Score: 80% | Page 4 of 37
Nightingale 2026/2027
OBJECTIVE ASSESSMENT - EXAM
BSN 225 HESI RN Specialty
Fundamentals of Nursing Exam V2
(Latest Update 2026/2027)
Questions & Answers | 100%
Correct | Grade A - Nightingale
2026/2027
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Vital Signs & Physical Assessment Fluid & Electrolyte Management
Infection Control & Asepsis Client Rights & Ethical Practice
Patient Safety & Fall Prevention Nutrition & Wound Care
COVER PAGE - 1
, SECTION 1 | Basic Nursing Concepts & Skills | Q1-Q18
BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V2 (Latest Update 2026/2027) Questions & Answers | 100% Correct | Grade A - Nightingale
2026/2027
Q1 Question 1 of 75
A 68-year-old patient admitted for dehydration has an oral temperature reading of 37.9 degrees C
taken by the nursing student. The patient complains of feeling warm and appears flushed. Which
action by the nurse is most appropriate at this point?
A. Reposition the thermometer under the tongue and wait an additional 3 minutes before
rechecking
B. Document the reading and continue to monitor the patient for other signs of infection
C. Switch to a tympanic membrane thermometer to obtain a more accurate core temperature
D. Apply a cooling blanket immediately to reduce the patient's body temperature
Correct Answer: A
Rationale:
The oral temperature of 37.9 degrees C is borderline elevated, and the patient's symptoms suggest the reading may be
inaccurately low. Repositioning the thermometer into the posterior sublingual pocket ensures proper placement for an
accurate measurement. Documenting without verifying would risk missing a developing fever requiring prompt clinical
intervention.
Q2 Question 2 of 75
A 45-year-old postoperative patient who had abdominal surgery 6 hours ago is positioned supine with
the head of the bed flat. The nurse notes the patient is becoming increasingly restless and has a
weak, productive cough. Which position should the nurse implement first?
A. Place the patient in high Fowler's position with pillows behind the back and knees slightly flexed
B. Turn the patient to the left lateral position with a pillow between the knees
C. Position the patient prone with a small pillow under the abdomen for comfort
D. Lower the head of the bed below the level of the heart to promote venous return
Correct Answer: B
Rationale:
The left lateral position helps drain secretions from the bronchial tree by gravity and prevents aspiration of any oral
secretions in a postoperative patient with a weak cough. While high Fowler's maximizes lung expansion, the patient's
productive cough suggests secretions need to be mobilized and drained first, making lateral positioning the safer
immediate choice.
Q3 Question 3 of 75
A nurse is preparing to transfer a 185-pound patient from the bed to a wheelchair using a mechanical
lift. The patient has limited mobility in the right leg following a total knee replacement. Which
technique should the nurse use to protect both the patient and staff during this transfer?
BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V2 (Latest Update 2026/20... | 2026/2027 | Passing Score: 80% | Page 2 of 37
, A. Position the sling under the patient's axillae and behind the knees, then elevate vertically before
swinging to the wheelchair
B. Apply the sling with the patient seated upright on the edge of the bed, ensuring the affected leg is
supported with a pillow during the swing
C. Roll the patient to the side to place the sling, then use the lift to raise and position the patient
directly over the wheelchair seat
D. Have the patient bear partial weight on the unaffected leg while the lift provides support during the
transfer to the wheelchair
Correct Answer: C
Rationale:
Rolling the patient to properly place the sling distributes weight evenly across the sling surface, reducing shear and
friction. The mechanical lift then bears the entire load, protecting both the nurse's back and the patient's surgical knee
from stress. Elevating the patient directly over the wheelchair minimizes lateral movement during transfer.
Q4 Question 4 of 75
A nurse is performing a sterile dressing change on a 4-inch abdominal incision for a 55-year-old
patient. After removing the old dressing, the nurse notes a small area of dehiscence with pink
granulation tissue visible. Which action should the nurse take before applying the new sterile
dressing?
A. Irrigate the wound bed with hydrogen peroxide to remove any residual debris from the dehisced area
B. Cleanse the wound from the center outward using sterile saline and gauze, maintaining sterile technique
throughout
C. Apply a topical antibiotic ointment directly to the granulation tissue before covering with a sterile gauze
pad
D. Pack the dehisced area loosely with sterile gauze soaked in povidone-iodine solution
Correct Answer: D
Rationale:
Povidone-iodine solution is antimicrobial and appropriate for a wound showing dehiscence where infection risk is
elevated. However, hydrogen peroxide is cytotoxic to granulation tissue, and plain saline may be insufficient given the
dehiscence. Packing the wound loosely with povidone-iodine gauze allows the antiseptic to reach the wound bed while
absorbing drainage.
Q5 Question 5 of 75
A 72-year-old patient with chronic obstructive pulmonary disease (COPD) requires supplemental
oxygen. The patient's current oxygen saturation is 88% on room air and the provider has ordered
oxygen therapy. Which oxygen delivery device is most appropriate for this patient?
A. Venturi mask set at 28% oxygen concentration
B. Simple face mask at 6 liters per minute
C. Non-rebreather mask at 10 liters per minute
D. Nasal cannula at 4 liters per minute
BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V2 (Latest Update 2026/20... | 2026/2027 | Passing Score: 80% | Page 3 of 37
, Correct Answer: A
Rationale:
The Venturi mask delivers a precise, fixed oxygen concentration, which is critical for COPD patients who rely on hypoxic
drive to maintain respiratory effort. A Venturi mask at 28% provides controlled oxygenation without suppressing the
patient's respiratory stimulus. High-flow devices like non-rebreather masks risk eliminating the hypoxic drive entirely.
Q6 Question 6 of 75
A nurse on the medical-surgical unit is calculating the 8-hour intake and output for a 60-year-old
patient receiving intravenous fluids. The patient received 500 mL of D5W at 0900, ate 240 mL of clear
liquids at noon, and had a 180 mL water pitcher refill at 1400. Urine output was 350 mL, and a
nasogastric tube drained 120 mL. What is the patient's net fluid balance for this 8-hour shift?
A. +250 mL
B. +450 mL
C. -50 mL
D. -120 mL
Correct Answer: B
Rationale:
Total intake is 500 mL (IV) plus 240 mL (oral) plus 180 mL (water) equals 920 mL. Total output is 350 mL (urine) plus
120 mL (NG drain) equals 470 mL. Net fluid balance is 920 minus 470 equals positive 450 mL. A negative balance
would indicate dehydration, which is not supported by these intake and output figures.
Q7 Question 7 of 75
A nurse is giving a complete bed bath to an 80-year-old patient who is bedridden following a stroke.
The patient's skin is cool and dry to the touch, and the room temperature is 72 degrees F. Which
intervention should the nurse include to maintain the patient's thermoregulation during the bath?
A. Increase the room temperature to 78 degrees F and use warm water at 110 degrees F for washing,
exposing only one body area at a time
B. Apply a heating pad to the patient's feet before beginning the bath and keep all bath linens pre-warmed
in a blanket warmer
C. Perform the bath quickly using cool water to stimulate circulation and cover the patient with a
thermal blanket immediately after
D. Administer an antipyretic medication prior to bathing and monitor the patient's temperature every 15
minutes throughout the procedure
Correct Answer: C
Rationale:
Using cool water during a bed bath provides a brief thermal stimulus that can improve peripheral circulation through
vasoconstriction and subsequent vasodilation. Covering the patient immediately after preserves body heat. Heating pads
pose a burn risk in patients with diminished sensation, and warm water combined with exposure still risks significant
heat loss in elderly patients.
BSN 225 HESI RN Specialty Fundamentals of Nursing Exam V2 (Latest Update 2026/20... | 2026/2027 | Passing Score: 80% | Page 4 of 37
