BSN 225 HESI RN SPECIALTY
FUNDAMENTALS OF NURSING
FINAL EXAMINATION
2026/2027 Edition
150 Questions with Comprehensive Detailed Rationales
Questions and Verified Answers | 100% Correct | Grade A
Aligned with 2026-2027 Nightingale College BSN 225 Curriculum Standards
and HESI Fundamentals Comprehensive Final Examination Blueprint
Total Questions: 150 Format: Multiple Choice (A-D)
25% Recall, 55% Application, 20%
Cognitive Levels: Answer Key: Included with Rationales
Analysis
Sections: 8 Core Nursing Concept Areas Institution: Nightingale College
Covers: Nursing Process and Critical Thinking | Safety and Infection Control |
Health Assessment and Vital Signs | Medication Administration and Dosage Calculations |
Basic Nursing Skills and Patient Care | Communication, Patient Education, Cultural/Spiritual Care |
Ethical/Legal Considerations and Professional Practice | Integrated Clinical Scenarios
,Section 1: Nursing Process and Critical Thinking
Assessment, Diagnosis, Planning, Implementation, Evaluation, Prioritization, Clinical Judgment, QSEN
Q1. A nurse is performing an initial assessment on a newly admitted patient with heart failure. The patient
reports feeling short of breath when lying flat and states, "I just feel so tired all the time." The nurse observes
2+ pitting edema in the bilateral lower extremities and jugular venous distention. Which of the following
correctly categorizes this data?
A. "I just feel so tired all the time" is objective data; shortness of breath when lying flat is subjective data
B. "Shortness of breath when lying flat" and 2+ pitting edema are both objective data collected during the assessment
C. "I just feel so tired all the time" is subjective data; 2+ pitting edema and jugular venous distention are
objective data [CORRECT] [CORRECT]
D. All findings are subjective data because they are reported by the patient during the health history
Correct Answer: C
Rationale: Subjective data is information perceived, felt, or reported by the patient (such as fatigue) that cannot be measured
or observed directly by the nurse. Objective data is measurable, observable, and verifiable through physical examination or
diagnostic tests (such as pitting edema and jugular venous distention). Recognizing the distinction is fundamental to accurate
documentation and clinical decision-making in the assessment phase of the nursing process.
Q2. A nurse is caring for a patient who is 2 days postoperative following a total abdominal hysterectomy. The
patient states, "I have not had a bowel movement since before surgery." The nurse palpates a distended, firm
abdomen with hypoactive bowel sounds. Which nursing diagnosis is most appropriate for this patient?
A. Risk for Constipation related to surgical anesthesia and immobility
B. Constipation related to decreased gastrointestinal motility secondary to surgery as evidenced by absence of
bowel movement, abdominal distension, and hypoactive bowel sounds [CORRECT] [CORRECT]
C. Impaired Gas Exchange related to abdominal distension
D. Acute Pain related to abdominal distension
Correct Answer: B
Rationale: An actual nursing diagnosis requires both the problem (Constipation) and the defining characteristics (evidence)
that are already present. Option A is a risk diagnosis, which is used when the problem has not yet occurred, but this patient
already has signs of constipation. Options C and D do not match the primary clinical picture; the patient is not demonstrating
impaired gas exchange, and pain is not the chief complaint described.
Q3. A nurse is developing a care plan for a patient with a new diagnosis of type 2 diabetes mellitus. Which of the
following is the most appropriate patient-centered goal using the SMART framework?
A. The patient will understand diabetes management by discharge
B. The patient will demonstrate proper blood glucose monitoring technique using a glucometer with 100%
accuracy by the end of the second teaching session within 48 hours [CORRECT] [CORRECT]
C. The patient will never experience a hypoglycemic episode after discharge
D. The patient will feel better about having diabetes within one week
Correct Answer: B
Rationale: SMART goals must be Specific, Measurable, Achievable, Relevant, and Time-bound. Option B specifies the exact
skill (blood glucose monitoring), includes a measurable outcome (100% accuracy), sets a realistic expectation, is relevant to
the diagnosis, and provides a clear time frame (within 48 hours). Option A uses the vague verb "understand," which is not
measurable. Option C uses "never," which is unrealistic and not achievable. Option D is subjective and not measurable.
Q4. A nurse is prioritizing care for four patients at the beginning of a shift. Which patient should the nurse
assess first?
Page 2
, A. A patient with a healing surgical wound who is due for a scheduled dressing change
B. A patient with pneumonia who has a new onset of confusion and oxygen saturation of 88% on room air
[CORRECT] [CORRECT]
C. A patient with type 2 diabetes who needs a blood glucose check before breakfast
D. A patient with hypertension who is requesting pain medication for a headache rated 4/10
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) priority-setting framework, the patient with an oxygen saturation
of 88% and new-onset confusion (a sign of hypoxia) takes highest priority because breathing is compromised. New-onset
confusion in a patient with pneumonia may indicate worsening respiratory status or impending respiratory failure, requiring
immediate intervention. The other patients have stable or non-urgent needs that can be addressed after the unstable patient is
assessed and stabilized.
Q5. A nurse is caring for a postoperative patient who has a PRN order for morphine sulfate 4 mg IV every 3
hours as needed for pain rated greater than 6/10. The patient reports pain as 3/10 and states, "I am comfortable
right now." Which type of nursing intervention is the nurse performing by choosing not to administer the
morphine at this time?
A. Dependent intervention
B. Interdependent intervention
C. Independent intervention [CORRECT] [CORRECT]
D. Collaborative intervention
Correct Answer: C
Rationale: An independent nursing intervention is an action the nurse performs without requiring a physician order, based on
clinical judgment and the nursing scope of practice. The decision not to administer a PRN medication when the patient does
not meet the specified criteria (pain greater than 6/10) is an independent nursing judgment. Dependent interventions require a
physician order; interdependent interventions involve collaboration with other healthcare providers; and collaborative
interventions are shared decisions among the healthcare team.
Q6. A nurse is evaluating the effectiveness of a nursing intervention for a patient with the nursing diagnosis of
Impaired Skin Integrity related to immobility. The nurse repositions the patient every 2 hours and applies a
moisture barrier cream to the sacral area. Which finding best indicates that the plan of care is effective?
A. The patient states that the cream feels cool on the skin
B. The sacral area remains intact with no redness, breakdown, or moisture accumulation after 5 days of care
[CORRECT] [CORRECT]
C. The nursing assistant reports that repositioning was completed on schedule
D. The patient’s dietary intake has increased since the intervention began
Correct Answer: B
Rationale: The evaluation phase of the nursing process involves comparing the patient’s current status with the expected
outcomes. Since the nursing diagnosis is Impaired Skin Integrity, the most direct indicator of effectiveness is the actual
condition of the skin. An intact sacral area without redness or breakdown demonstrates that the interventions (repositioning
and barrier cream) successfully prevented further skin breakdown. The other options address process measures or unrelated
outcomes rather than the patient’s skin integrity status.
Q7. A nurse receives a hand-off report on four patients. Patient A has a blood pressure of 190/110 mmHg and
reports a severe headache. Patient B has a blood glucose of 58 mg/dL and is diaphoretic. Patient C is requesting
assistance to ambulate to the bathroom. Patient D is due for a scheduled antibiotic in 30 minutes. Using
Maslow’s Hierarchy of Needs, which patient should the nurse see first?
A. Patient A, because the severe headache indicates a potential neurological emergency
Page 3
, B. Patient B, because hypoglycemia threatens physiological survival and requires immediate correction
[CORRECT] [CORRECT]
C. Patient C, because elimination is a basic physiological need
D. Patient D, because the antibiotic must be given on time to maintain therapeutic levels
Correct Answer: B
Rationale: Maslow’s Hierarchy prioritizes physiological needs first, with life-threatening conditions taking absolute
precedence. Patient B has hypoglycemia (blood glucose 58 mg/dL) with diaphoresis, which is an immediate, life-threatening
physiological crisis requiring rapid intervention such as administering a fast-acting carbohydrate. While Patient A also has a
concerning finding (hypertensive crisis), hypoglycemia can cause loss of consciousness and brain damage more rapidly.
Patient C has a non-urgent elimination need, and Patient D has a medication that can be given within a reasonable time
window.
Q8. A nursing student is caring for a patient with chronic obstructive pulmonary disease (COPD) and questions
why the provider ordered oxygen at 2 L/min via nasal cannula rather than a higher flow rate. The nursing
instructor explains that patients with COPD retain carbon dioxide due to chronic hypoventilation. Which
critical thinking skill is the nursing student demonstrating by questioning this order?
A. Reflection
B. Self-correction
C. Purposeful inquiry and analysis of underlying rationale [CORRECT] [CORRECT]
D. Intuition
Correct Answer: C
Rationale: Critical thinking in nursing involves purposeful, goal-directed thinking that includes questioning assumptions,
analyzing rationales, and seeking to understand the "why" behind clinical decisions. By questioning why a specific oxygen flow
rate was chosen and seeking the pathophysiological basis for the order, the student demonstrates purposeful inquiry and
analysis. Reflection involves reviewing actions after the fact, self-correction involves recognizing and fixing one’s own errors,
and intuition is an unconscious pattern recognition that does not involve deliberate questioning.
Q9. A nurse is caring for an older adult patient who fell at home and was admitted with a hip fracture. The
patient has a history of hypertension, osteoarthritis, and mild cognitive impairment. The nurse identifies that
the patient is at risk for falls. Which of the following represents a collaborative problem rather than a nursing
diagnosis?
A. Risk for Falls related to impaired mobility and cognitive impairment
B. Acute Pain related to hip fracture as evidenced by patient report of pain 7/10 with movement
C. Potential Complication: Hypovolemic Shock related to postoperative blood loss from hip fracture repair
[CORRECT] [CORRECT]
D. Impaired Physical Mobility related to hip fracture and pain on movement
Correct Answer: C
Rationale: A collaborative problem is a physiological complication that requires both nursing and medical interventions to
manage or prevent. Potential Complication: Hypovolemic Shock requires medical interventions (such as fluid resuscitation,
blood transfusion, or surgical intervention) that are beyond the independent scope of nursing practice, though nurses monitor
for and report signs of this complication. Options A, B, and D are NANDA-I nursing diagnoses that nurses can independently
manage within their scope of practice.
Q10. A nurse is admitting a patient with community-acquired pneumonia. During the health history, the patient
reports a cough productive of yellow-green sputum for 5 days, fever, chills, and pleuritic chest pain. The
patient’s spouse adds that the patient seems more confused than usual. Which action by the nurse best
demonstrates the QSEN competency of Patient-Centered Care?
A. Asking the patient’s spouse to leave the room to maintain the patient’s privacy during the physical examination
Page 4
FUNDAMENTALS OF NURSING
FINAL EXAMINATION
2026/2027 Edition
150 Questions with Comprehensive Detailed Rationales
Questions and Verified Answers | 100% Correct | Grade A
Aligned with 2026-2027 Nightingale College BSN 225 Curriculum Standards
and HESI Fundamentals Comprehensive Final Examination Blueprint
Total Questions: 150 Format: Multiple Choice (A-D)
25% Recall, 55% Application, 20%
Cognitive Levels: Answer Key: Included with Rationales
Analysis
Sections: 8 Core Nursing Concept Areas Institution: Nightingale College
Covers: Nursing Process and Critical Thinking | Safety and Infection Control |
Health Assessment and Vital Signs | Medication Administration and Dosage Calculations |
Basic Nursing Skills and Patient Care | Communication, Patient Education, Cultural/Spiritual Care |
Ethical/Legal Considerations and Professional Practice | Integrated Clinical Scenarios
,Section 1: Nursing Process and Critical Thinking
Assessment, Diagnosis, Planning, Implementation, Evaluation, Prioritization, Clinical Judgment, QSEN
Q1. A nurse is performing an initial assessment on a newly admitted patient with heart failure. The patient
reports feeling short of breath when lying flat and states, "I just feel so tired all the time." The nurse observes
2+ pitting edema in the bilateral lower extremities and jugular venous distention. Which of the following
correctly categorizes this data?
A. "I just feel so tired all the time" is objective data; shortness of breath when lying flat is subjective data
B. "Shortness of breath when lying flat" and 2+ pitting edema are both objective data collected during the assessment
C. "I just feel so tired all the time" is subjective data; 2+ pitting edema and jugular venous distention are
objective data [CORRECT] [CORRECT]
D. All findings are subjective data because they are reported by the patient during the health history
Correct Answer: C
Rationale: Subjective data is information perceived, felt, or reported by the patient (such as fatigue) that cannot be measured
or observed directly by the nurse. Objective data is measurable, observable, and verifiable through physical examination or
diagnostic tests (such as pitting edema and jugular venous distention). Recognizing the distinction is fundamental to accurate
documentation and clinical decision-making in the assessment phase of the nursing process.
Q2. A nurse is caring for a patient who is 2 days postoperative following a total abdominal hysterectomy. The
patient states, "I have not had a bowel movement since before surgery." The nurse palpates a distended, firm
abdomen with hypoactive bowel sounds. Which nursing diagnosis is most appropriate for this patient?
A. Risk for Constipation related to surgical anesthesia and immobility
B. Constipation related to decreased gastrointestinal motility secondary to surgery as evidenced by absence of
bowel movement, abdominal distension, and hypoactive bowel sounds [CORRECT] [CORRECT]
C. Impaired Gas Exchange related to abdominal distension
D. Acute Pain related to abdominal distension
Correct Answer: B
Rationale: An actual nursing diagnosis requires both the problem (Constipation) and the defining characteristics (evidence)
that are already present. Option A is a risk diagnosis, which is used when the problem has not yet occurred, but this patient
already has signs of constipation. Options C and D do not match the primary clinical picture; the patient is not demonstrating
impaired gas exchange, and pain is not the chief complaint described.
Q3. A nurse is developing a care plan for a patient with a new diagnosis of type 2 diabetes mellitus. Which of the
following is the most appropriate patient-centered goal using the SMART framework?
A. The patient will understand diabetes management by discharge
B. The patient will demonstrate proper blood glucose monitoring technique using a glucometer with 100%
accuracy by the end of the second teaching session within 48 hours [CORRECT] [CORRECT]
C. The patient will never experience a hypoglycemic episode after discharge
D. The patient will feel better about having diabetes within one week
Correct Answer: B
Rationale: SMART goals must be Specific, Measurable, Achievable, Relevant, and Time-bound. Option B specifies the exact
skill (blood glucose monitoring), includes a measurable outcome (100% accuracy), sets a realistic expectation, is relevant to
the diagnosis, and provides a clear time frame (within 48 hours). Option A uses the vague verb "understand," which is not
measurable. Option C uses "never," which is unrealistic and not achievable. Option D is subjective and not measurable.
Q4. A nurse is prioritizing care for four patients at the beginning of a shift. Which patient should the nurse
assess first?
Page 2
, A. A patient with a healing surgical wound who is due for a scheduled dressing change
B. A patient with pneumonia who has a new onset of confusion and oxygen saturation of 88% on room air
[CORRECT] [CORRECT]
C. A patient with type 2 diabetes who needs a blood glucose check before breakfast
D. A patient with hypertension who is requesting pain medication for a headache rated 4/10
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) priority-setting framework, the patient with an oxygen saturation
of 88% and new-onset confusion (a sign of hypoxia) takes highest priority because breathing is compromised. New-onset
confusion in a patient with pneumonia may indicate worsening respiratory status or impending respiratory failure, requiring
immediate intervention. The other patients have stable or non-urgent needs that can be addressed after the unstable patient is
assessed and stabilized.
Q5. A nurse is caring for a postoperative patient who has a PRN order for morphine sulfate 4 mg IV every 3
hours as needed for pain rated greater than 6/10. The patient reports pain as 3/10 and states, "I am comfortable
right now." Which type of nursing intervention is the nurse performing by choosing not to administer the
morphine at this time?
A. Dependent intervention
B. Interdependent intervention
C. Independent intervention [CORRECT] [CORRECT]
D. Collaborative intervention
Correct Answer: C
Rationale: An independent nursing intervention is an action the nurse performs without requiring a physician order, based on
clinical judgment and the nursing scope of practice. The decision not to administer a PRN medication when the patient does
not meet the specified criteria (pain greater than 6/10) is an independent nursing judgment. Dependent interventions require a
physician order; interdependent interventions involve collaboration with other healthcare providers; and collaborative
interventions are shared decisions among the healthcare team.
Q6. A nurse is evaluating the effectiveness of a nursing intervention for a patient with the nursing diagnosis of
Impaired Skin Integrity related to immobility. The nurse repositions the patient every 2 hours and applies a
moisture barrier cream to the sacral area. Which finding best indicates that the plan of care is effective?
A. The patient states that the cream feels cool on the skin
B. The sacral area remains intact with no redness, breakdown, or moisture accumulation after 5 days of care
[CORRECT] [CORRECT]
C. The nursing assistant reports that repositioning was completed on schedule
D. The patient’s dietary intake has increased since the intervention began
Correct Answer: B
Rationale: The evaluation phase of the nursing process involves comparing the patient’s current status with the expected
outcomes. Since the nursing diagnosis is Impaired Skin Integrity, the most direct indicator of effectiveness is the actual
condition of the skin. An intact sacral area without redness or breakdown demonstrates that the interventions (repositioning
and barrier cream) successfully prevented further skin breakdown. The other options address process measures or unrelated
outcomes rather than the patient’s skin integrity status.
Q7. A nurse receives a hand-off report on four patients. Patient A has a blood pressure of 190/110 mmHg and
reports a severe headache. Patient B has a blood glucose of 58 mg/dL and is diaphoretic. Patient C is requesting
assistance to ambulate to the bathroom. Patient D is due for a scheduled antibiotic in 30 minutes. Using
Maslow’s Hierarchy of Needs, which patient should the nurse see first?
A. Patient A, because the severe headache indicates a potential neurological emergency
Page 3
, B. Patient B, because hypoglycemia threatens physiological survival and requires immediate correction
[CORRECT] [CORRECT]
C. Patient C, because elimination is a basic physiological need
D. Patient D, because the antibiotic must be given on time to maintain therapeutic levels
Correct Answer: B
Rationale: Maslow’s Hierarchy prioritizes physiological needs first, with life-threatening conditions taking absolute
precedence. Patient B has hypoglycemia (blood glucose 58 mg/dL) with diaphoresis, which is an immediate, life-threatening
physiological crisis requiring rapid intervention such as administering a fast-acting carbohydrate. While Patient A also has a
concerning finding (hypertensive crisis), hypoglycemia can cause loss of consciousness and brain damage more rapidly.
Patient C has a non-urgent elimination need, and Patient D has a medication that can be given within a reasonable time
window.
Q8. A nursing student is caring for a patient with chronic obstructive pulmonary disease (COPD) and questions
why the provider ordered oxygen at 2 L/min via nasal cannula rather than a higher flow rate. The nursing
instructor explains that patients with COPD retain carbon dioxide due to chronic hypoventilation. Which
critical thinking skill is the nursing student demonstrating by questioning this order?
A. Reflection
B. Self-correction
C. Purposeful inquiry and analysis of underlying rationale [CORRECT] [CORRECT]
D. Intuition
Correct Answer: C
Rationale: Critical thinking in nursing involves purposeful, goal-directed thinking that includes questioning assumptions,
analyzing rationales, and seeking to understand the "why" behind clinical decisions. By questioning why a specific oxygen flow
rate was chosen and seeking the pathophysiological basis for the order, the student demonstrates purposeful inquiry and
analysis. Reflection involves reviewing actions after the fact, self-correction involves recognizing and fixing one’s own errors,
and intuition is an unconscious pattern recognition that does not involve deliberate questioning.
Q9. A nurse is caring for an older adult patient who fell at home and was admitted with a hip fracture. The
patient has a history of hypertension, osteoarthritis, and mild cognitive impairment. The nurse identifies that
the patient is at risk for falls. Which of the following represents a collaborative problem rather than a nursing
diagnosis?
A. Risk for Falls related to impaired mobility and cognitive impairment
B. Acute Pain related to hip fracture as evidenced by patient report of pain 7/10 with movement
C. Potential Complication: Hypovolemic Shock related to postoperative blood loss from hip fracture repair
[CORRECT] [CORRECT]
D. Impaired Physical Mobility related to hip fracture and pain on movement
Correct Answer: C
Rationale: A collaborative problem is a physiological complication that requires both nursing and medical interventions to
manage or prevent. Potential Complication: Hypovolemic Shock requires medical interventions (such as fluid resuscitation,
blood transfusion, or surgical intervention) that are beyond the independent scope of nursing practice, though nurses monitor
for and report signs of this complication. Options A, B, and D are NANDA-I nursing diagnoses that nurses can independently
manage within their scope of practice.
Q10. A nurse is admitting a patient with community-acquired pneumonia. During the health history, the patient
reports a cough productive of yellow-green sputum for 5 days, fever, chills, and pleuritic chest pain. The
patient’s spouse adds that the patient seems more confused than usual. Which action by the nurse best
demonstrates the QSEN competency of Patient-Centered Care?
A. Asking the patient’s spouse to leave the room to maintain the patient’s privacy during the physical examination
Page 4
