BSN 206 Hallmark Exam Actual Exam 2026/2027 | Foundations of
Nursing Fundamentals | Nightingale | 55 Questions with Verified
Answers | 100% Correct | Pass Guaranteed
Foundations of Nursing Practice & Safety (Questions 1–14)
Q1: A nurse enters a patient's room and notices the bed is in the highest position, the call light is out of
reach, and the floor is wet from a spilled water pitcher. Which action should the nurse take first?
A. Document the safety hazards in the chart
B. Lower the bed, place the call light within reach, and clean the spill [CORRECT]
C. Call housekeeping to clean the spill
D. Ask the patient to be more careful
Correct Answer: B
Rationale: Patient safety is the immediate priority, so correcting environmental hazards—lowering the
bed to prevent falls, ensuring the call light is accessible, and removing the slip hazard—takes precedence
over documentation or delegating to others.
Q2: A nurse is caring for a patient with Clostridioides difficile infection. Which infection control
precaution is required?
A. Standard precautions only
B. Contact precautions with gown and gloves [CORRECT]
C. Droplet precautions with a surgical mask
D. Airborne precautions with an N95 respirator
Correct Answer: B
Rationale: C. difficile is transmitted through contact with contaminated surfaces and fecal matter, so
contact precautions with gown and gloves are required, along with dedicated equipment and thorough
environmental cleaning with bleach-based products.
Q3: A nurse is preparing to administer medication to a patient who has a known latex allergy. Which
action is essential?
A. Wear latex gloves for medication administration
B. Use non-latex gloves and ensure all equipment is latex-free [CORRECT]
,C. Administer an antihistamine before giving the medication
D. Avoid giving oral medications
Correct Answer: B
Rationale: Latex allergies can cause severe reactions ranging from contact dermatitis to anaphylaxis, so
using latex-free gloves and verifying that all supplies, tourniquets, and equipment are latex-free is
essential for patient safety.
Q4: A patient with dementia is attempting to get out of bed unassisted and has fallen twice in the past
24 hours. The nurse is considering restraints. Which action should the nurse take first?
A. Apply wrist restraints immediately
B. Implement alternative safety measures such as bed alarms, frequent rounding, and distraction
techniques [CORRECT]
C. Sedate the patient to prevent movement
D. Move the patient to a room farther from the nurses' station
Correct Answer: B
Rationale: The least restrictive approach is required by regulation and ethical standards, so restraints
should only be used after less restrictive alternatives like bed alarms, environmental modifications, and
frequent observation have been attempted and documented.
Q5: A nurse is documenting care in a patient's electronic health record. Which documentation practice is
correct?
A. Document care before it is provided to save time
B. Document objective, factual information using quotes for significant patient statements [CORRECT]
C. Use abbreviations that are not approved by the facility
D. Document opinions about the patient's personality
Correct Answer: B
Rationale: Accurate documentation includes factual, objective observations and direct quotes for
significant statements, which creates a reliable legal record and supports continuity of care without
introducing bias or judgment.
Q6: A nurse is assigned four patients. Which patient should the nurse assess first?
, A. A patient requesting a bedtime snack
B. A patient with a new oxygen saturation of 88% and increased work of breathing [CORRECT]
C. A patient who needs discharge teaching
D. A patient asking for a pain medication that is due in 30 minutes
Correct Answer: B
Rationale: The ABCs of prioritization place airway and breathing at the highest priority, and an oxygen
saturation of 88% with increased respiratory effort indicates potential respiratory failure that requires
immediate assessment and intervention.
Q7: A nurse is delegating tasks to a UAP. Which task is appropriate to delegate?
A. Assessing a postoperative patient's incision
B. Assisting a stable patient with a bed bath [CORRECT]
C. Administering oral medications
D. Teaching a patient about wound care
Correct Answer: B
Rationale: UAPs are trained to assist with activities of daily living like bathing, toileting, and ambulation
for stable patients, while assessment, medication administration, and patient education require nursing
judgment and remain the RN's responsibility.
Q8: A patient is scheduled for surgery and states, "I don't want the surgery anymore. I'm afraid I won't
wake up." Which response by the nurse is most appropriate?
A. "You have to have the surgery or you could die."
B. "Tell me more about your concerns. It's normal to feel anxious before surgery, and we can discuss
your fears with the surgeon" [CORRECT]
C. "Don't worry, everything will be fine."
D. "I'll tell the surgeon you refuse so they can find another patient."
Correct Answer: B
Rationale: Therapeutic communication involves exploring the patient's concerns with empathy,
validating their feelings, and facilitating further discussion with the healthcare team, which respects
autonomy while ensuring the patient has the information needed to make an informed decision.
Q9: A nurse is caring for a patient who is a Jehovah's Witness and refuses a blood transfusion. The
patient's hemoglobin is 6.8 g/dL. Which action by the nurse is correct?
Nursing Fundamentals | Nightingale | 55 Questions with Verified
Answers | 100% Correct | Pass Guaranteed
Foundations of Nursing Practice & Safety (Questions 1–14)
Q1: A nurse enters a patient's room and notices the bed is in the highest position, the call light is out of
reach, and the floor is wet from a spilled water pitcher. Which action should the nurse take first?
A. Document the safety hazards in the chart
B. Lower the bed, place the call light within reach, and clean the spill [CORRECT]
C. Call housekeeping to clean the spill
D. Ask the patient to be more careful
Correct Answer: B
Rationale: Patient safety is the immediate priority, so correcting environmental hazards—lowering the
bed to prevent falls, ensuring the call light is accessible, and removing the slip hazard—takes precedence
over documentation or delegating to others.
Q2: A nurse is caring for a patient with Clostridioides difficile infection. Which infection control
precaution is required?
A. Standard precautions only
B. Contact precautions with gown and gloves [CORRECT]
C. Droplet precautions with a surgical mask
D. Airborne precautions with an N95 respirator
Correct Answer: B
Rationale: C. difficile is transmitted through contact with contaminated surfaces and fecal matter, so
contact precautions with gown and gloves are required, along with dedicated equipment and thorough
environmental cleaning with bleach-based products.
Q3: A nurse is preparing to administer medication to a patient who has a known latex allergy. Which
action is essential?
A. Wear latex gloves for medication administration
B. Use non-latex gloves and ensure all equipment is latex-free [CORRECT]
,C. Administer an antihistamine before giving the medication
D. Avoid giving oral medications
Correct Answer: B
Rationale: Latex allergies can cause severe reactions ranging from contact dermatitis to anaphylaxis, so
using latex-free gloves and verifying that all supplies, tourniquets, and equipment are latex-free is
essential for patient safety.
Q4: A patient with dementia is attempting to get out of bed unassisted and has fallen twice in the past
24 hours. The nurse is considering restraints. Which action should the nurse take first?
A. Apply wrist restraints immediately
B. Implement alternative safety measures such as bed alarms, frequent rounding, and distraction
techniques [CORRECT]
C. Sedate the patient to prevent movement
D. Move the patient to a room farther from the nurses' station
Correct Answer: B
Rationale: The least restrictive approach is required by regulation and ethical standards, so restraints
should only be used after less restrictive alternatives like bed alarms, environmental modifications, and
frequent observation have been attempted and documented.
Q5: A nurse is documenting care in a patient's electronic health record. Which documentation practice is
correct?
A. Document care before it is provided to save time
B. Document objective, factual information using quotes for significant patient statements [CORRECT]
C. Use abbreviations that are not approved by the facility
D. Document opinions about the patient's personality
Correct Answer: B
Rationale: Accurate documentation includes factual, objective observations and direct quotes for
significant statements, which creates a reliable legal record and supports continuity of care without
introducing bias or judgment.
Q6: A nurse is assigned four patients. Which patient should the nurse assess first?
, A. A patient requesting a bedtime snack
B. A patient with a new oxygen saturation of 88% and increased work of breathing [CORRECT]
C. A patient who needs discharge teaching
D. A patient asking for a pain medication that is due in 30 minutes
Correct Answer: B
Rationale: The ABCs of prioritization place airway and breathing at the highest priority, and an oxygen
saturation of 88% with increased respiratory effort indicates potential respiratory failure that requires
immediate assessment and intervention.
Q7: A nurse is delegating tasks to a UAP. Which task is appropriate to delegate?
A. Assessing a postoperative patient's incision
B. Assisting a stable patient with a bed bath [CORRECT]
C. Administering oral medications
D. Teaching a patient about wound care
Correct Answer: B
Rationale: UAPs are trained to assist with activities of daily living like bathing, toileting, and ambulation
for stable patients, while assessment, medication administration, and patient education require nursing
judgment and remain the RN's responsibility.
Q8: A patient is scheduled for surgery and states, "I don't want the surgery anymore. I'm afraid I won't
wake up." Which response by the nurse is most appropriate?
A. "You have to have the surgery or you could die."
B. "Tell me more about your concerns. It's normal to feel anxious before surgery, and we can discuss
your fears with the surgeon" [CORRECT]
C. "Don't worry, everything will be fine."
D. "I'll tell the surgeon you refuse so they can find another patient."
Correct Answer: B
Rationale: Therapeutic communication involves exploring the patient's concerns with empathy,
validating their feelings, and facilitating further discussion with the healthcare team, which respects
autonomy while ensuring the patient has the information needed to make an informed decision.
Q9: A nurse is caring for a patient who is a Jehovah's Witness and refuses a blood transfusion. The
patient's hemoglobin is 6.8 g/dL. Which action by the nurse is correct?
