BSN HESI 225 Practice Questions with correct answers with
rationales 2026/2027 version
1. A nurse is preparing to administer a prescribed medication. Before giving
the medication, the nurse notices the client's identification band is missing.
What action should the nurse take?
A. Ask the client to state their name and administer the medication.
B. Verify the client's identity with another nurse and administer the medication.
C. Obtain a new identification band before administering the medication.
D. Administer the medication because the client is familiar to the nurse.
Correct Answer: C. Obtain a new identification band before administering
the medication.
Rationale: The nurse must verify the client's identity using approved identifiers
before medication administration. A missing identification band requires
replacement before medications are given.
2. A postoperative client suddenly reports shortness of breath and chest pain.
Which action should the nurse perform first?
A. Notify the healthcare provider.
B. Administer prescribed pain medication.
C. Assess the client's oxygen saturation and vital signs.
D. Document the findings.
Correct Answer: C. Assess the client's oxygen saturation and vital signs.
Rationale: The nursing process requires assessment before intervention. Shortness
of breath and chest pain may indicate a pulmonary embolism or another
emergency.
3. Which client should the nurse assess first?
A. A client requesting assistance to the bathroom.
B. A client with a temperature of 101.2°F (38.4°C).
,C. A client with sudden confusion and slurred speech.
D. A client requesting a meal tray.
Correct Answer: C. A client with sudden confusion and slurred speech.
Rationale: Sudden neurological changes suggest a possible stroke and require
immediate assessment.
4. A nurse is teaching a client about preventing infection after surgery. Which
statement indicates correct understanding?
A. "I should keep my incision covered at all times."
B. "I will wash my hands before touching my incision."
C. "I can stop antibiotics once I feel better."
D. "Redness around the incision is always normal."
Correct Answer: B. I will wash my hands before touching my incision.
Rationale: Proper hand hygiene is the most effective method of preventing
infection.
5. Which assessment finding requires immediate nursing intervention?
A. Blood pressure 128/74 mmHg
B. Respiratory rate 10 breaths/minute after opioid administration
C. Pulse 88 beats/minute
D. Temperature 98.9°F (37.2°C)
Correct Answer: B. Respiratory rate 10 breaths/minute after opioid
administration
Rationale: Opioids may cause respiratory depression. A respiratory rate below 12
breaths/minute requires prompt assessment and intervention.
6. Which action demonstrates proper body mechanics when lifting a client?
,A. Bend at the waist.
B. Keep the feet together.
C. Lift using the leg muscles.
D. Twist while lifting.
Correct Answer: C. Lift using the leg muscles.
Rationale: Using the stronger leg muscles reduces the risk of musculoskeletal
injury.
7. A nurse is caring for a client receiving oxygen therapy. Which finding
requires immediate intervention?
A. Oxygen tubing is kinked.
B. Oxygen saturation is 96%.
C. Respiratory rate is 18 breaths/minute.
D. Client is sitting in high-Fowler's position.
Correct Answer: A. Oxygen tubing is kinked.
Rationale: Kinked tubing interrupts oxygen delivery and should be corrected
immediately.
8. Which client is at greatest risk for developing a pressure injury?
A. A healthy adult who walks daily.
B. A client on prolonged bed rest with poor nutrition.
C. A teenager recovering from influenza.
D. A client with seasonal allergies.
Correct Answer: B. A client on prolonged bed rest with poor nutrition.
Rationale: Immobility and poor nutrition significantly increase the risk for pressure
injuries.
, 9. Which action should the nurse perform first before inserting a nasogastric
tube?
A. Lubricate the tube.
B. Explain the procedure to the client.
C. Verify placement using x-ray.
D. Connect suction equipment.
Correct Answer: B. Explain the procedure to the client.
Rationale: Explaining the procedure reduces anxiety and supports informed
participation before the intervention begins.
10.Which finding indicates effective pain management?
A. Client sleeps continuously.
B. Client reports pain decreased from 8/10 to 3/10.
C. Client refuses to move.
D. Client requests additional pain medication every hour.
Correct Answer: B. Client reports pain decreased from 8/10 to 3/10.
Rationale: A reduction in reported pain accompanied by improved function
indicates effective pain management.
11.A nurse is preparing to administer insulin. Which action is appropriate?
A. Shake the vial vigorously.
B. Verify the client's blood glucose level before administration.
C. Massage the injection site afterward.
D. Inject insulin into scar tissue.
Correct Answer: B. Verify the client's blood glucose level before
administration.
Rationale: Insulin dosing depends on the client's current blood glucose level and
prescribed regimen.
rationales 2026/2027 version
1. A nurse is preparing to administer a prescribed medication. Before giving
the medication, the nurse notices the client's identification band is missing.
What action should the nurse take?
A. Ask the client to state their name and administer the medication.
B. Verify the client's identity with another nurse and administer the medication.
C. Obtain a new identification band before administering the medication.
D. Administer the medication because the client is familiar to the nurse.
Correct Answer: C. Obtain a new identification band before administering
the medication.
Rationale: The nurse must verify the client's identity using approved identifiers
before medication administration. A missing identification band requires
replacement before medications are given.
2. A postoperative client suddenly reports shortness of breath and chest pain.
Which action should the nurse perform first?
A. Notify the healthcare provider.
B. Administer prescribed pain medication.
C. Assess the client's oxygen saturation and vital signs.
D. Document the findings.
Correct Answer: C. Assess the client's oxygen saturation and vital signs.
Rationale: The nursing process requires assessment before intervention. Shortness
of breath and chest pain may indicate a pulmonary embolism or another
emergency.
3. Which client should the nurse assess first?
A. A client requesting assistance to the bathroom.
B. A client with a temperature of 101.2°F (38.4°C).
,C. A client with sudden confusion and slurred speech.
D. A client requesting a meal tray.
Correct Answer: C. A client with sudden confusion and slurred speech.
Rationale: Sudden neurological changes suggest a possible stroke and require
immediate assessment.
4. A nurse is teaching a client about preventing infection after surgery. Which
statement indicates correct understanding?
A. "I should keep my incision covered at all times."
B. "I will wash my hands before touching my incision."
C. "I can stop antibiotics once I feel better."
D. "Redness around the incision is always normal."
Correct Answer: B. I will wash my hands before touching my incision.
Rationale: Proper hand hygiene is the most effective method of preventing
infection.
5. Which assessment finding requires immediate nursing intervention?
A. Blood pressure 128/74 mmHg
B. Respiratory rate 10 breaths/minute after opioid administration
C. Pulse 88 beats/minute
D. Temperature 98.9°F (37.2°C)
Correct Answer: B. Respiratory rate 10 breaths/minute after opioid
administration
Rationale: Opioids may cause respiratory depression. A respiratory rate below 12
breaths/minute requires prompt assessment and intervention.
6. Which action demonstrates proper body mechanics when lifting a client?
,A. Bend at the waist.
B. Keep the feet together.
C. Lift using the leg muscles.
D. Twist while lifting.
Correct Answer: C. Lift using the leg muscles.
Rationale: Using the stronger leg muscles reduces the risk of musculoskeletal
injury.
7. A nurse is caring for a client receiving oxygen therapy. Which finding
requires immediate intervention?
A. Oxygen tubing is kinked.
B. Oxygen saturation is 96%.
C. Respiratory rate is 18 breaths/minute.
D. Client is sitting in high-Fowler's position.
Correct Answer: A. Oxygen tubing is kinked.
Rationale: Kinked tubing interrupts oxygen delivery and should be corrected
immediately.
8. Which client is at greatest risk for developing a pressure injury?
A. A healthy adult who walks daily.
B. A client on prolonged bed rest with poor nutrition.
C. A teenager recovering from influenza.
D. A client with seasonal allergies.
Correct Answer: B. A client on prolonged bed rest with poor nutrition.
Rationale: Immobility and poor nutrition significantly increase the risk for pressure
injuries.
, 9. Which action should the nurse perform first before inserting a nasogastric
tube?
A. Lubricate the tube.
B. Explain the procedure to the client.
C. Verify placement using x-ray.
D. Connect suction equipment.
Correct Answer: B. Explain the procedure to the client.
Rationale: Explaining the procedure reduces anxiety and supports informed
participation before the intervention begins.
10.Which finding indicates effective pain management?
A. Client sleeps continuously.
B. Client reports pain decreased from 8/10 to 3/10.
C. Client refuses to move.
D. Client requests additional pain medication every hour.
Correct Answer: B. Client reports pain decreased from 8/10 to 3/10.
Rationale: A reduction in reported pain accompanied by improved function
indicates effective pain management.
11.A nurse is preparing to administer insulin. Which action is appropriate?
A. Shake the vial vigorously.
B. Verify the client's blood glucose level before administration.
C. Massage the injection site afterward.
D. Inject insulin into scar tissue.
Correct Answer: B. Verify the client's blood glucose level before
administration.
Rationale: Insulin dosing depends on the client's current blood glucose level and
prescribed regimen.
