BSN 225 HESI RN SPECIALTY FUNDAMENTALS OF NURSING
EXAM V1
LATEST UPDATE | QUESTIONS & ANSWERS | 100% CORRECT | GRADE A
Nightingale College | BSN 225 Course Syllabus | HESI RN Specialty Exam Blueprint | NCLEX-RN Test Plan
Examination Overview: This comprehensive specialty examination contains 150 multiple-choice questions aligned
with the HESI RN Specialty Fundamentals of Nursing Exam Blueprint and NCLEX-RN Test Plan (2026/2027 edition).
Cognitive distribution: 20% recall, 50% application, 30% analysis. Question style: 75% scenario-based, 25% direct
knowledge. Special inclusions: 20 priority-setting questions, 15 pharmacology-focused questions, 10 delegation
questions, and 5 integrated case studies with multiple related questions. Each question includes a 2-4 sentence
rationale referencing the BSN 225 curriculum, HESI RN Specialty blueprint, NCLEX-RN standards, and
evidence-based fundamentals of nursing practice.
Section Distribution:
Section 1: Management of Care (Q1–Q20) — 20 questions
Section 2: Safety & Infection Control (Q21–Q40) — 20 questions
Section 3: Health Promotion & Maintenance (Q41–Q58) — 18 questions
Section 4: Psychosocial Integrity (Q59–Q73) — 15 questions
Section 5: Basic Care & Comfort (Q74–Q95) — 22 questions
Section 6: Pharmacological & Parenteral Therapies (Q96–Q115) — 20 questions
Section 7: Reduction of Risk Potential (Q116–Q135) — 20 questions
Section 8: Physiological Adaptation (Q136–Q150) — 15 questions
Total: 150 questions
Section 1: Safe & Effective Care Environment – Management of Care
Q1: A 78-year-old client with terminal cancer executes a valid advance directive requesting no
cardiopulmonary resuscitation (DNR). The client's adult daughter tells the nurse, "I am the
healthcare proxy and I want everything done if my mother stops breathing." Which action by the
nurse best respects the client's autonomy?
A. Activate the code team and begin resuscitation because the daughter is the designated proxy.
B. Notify the provider and request that the advance directive be revoked since the family disagrees.
C. Honor the client's signed advance directive and DNR order and explain this to the daughter.
[CORRECT]
D. Ask the daughter to sign a consent form before any further decisions are made.
Correct Answer: C
Rationale: An advance directive executed by a competent adult is legally binding and reflects the client's
autonomous wishes; the surrogate must follow the directive, not override it. The nurse's duty is to honor the
document and provide respectful explanation to the family, supporting the BSN 225 curriculum principle of patient
self-determination and the NCLEX-RN emphasis on advocacy. Activating the code team violates the DNR; revoking
the directive or asking the daughter to consent overrides the client's authority.
Q2: A nurse notices a colleague documenting medications as administered at 09:00 before
actually giving them at 09:45. The colleague states, "I always chart early so I do not fall behind."
Which ethical principle is most directly violated by this practice?
A. Autonomy
B. Beneficence
, C. Veracity [CORRECT]
D. Justice
Correct Answer: C
Rationale: Veracity is the ethical duty to tell the truth and document accurately; pre-charting medications that have
not yet been given is falsification of the medical record. This violates the Nurse Practice Act, may constitute fraud,
and risks patient harm if another nurse acts on incorrect information. Autonomy concerns self-determination,
beneficence is acting for the patient's good, and justice concerns fair distribution of resources.
Q3: At 07:00 the RN is assigned four clients. Which client should the RN assess first?
A. A client 24 hours postoperative total hip replacement reporting pain at 6/10 controlled by oral analgesic.
B. A client with heart failure whose pulse oximetry drops from 95% to 88% on room air. [CORRECT]
C. A client with type 2 diabetes mellitus awaiting a 07:30 fasting glucose result.
D. A client receiving IV antibiotics scheduled for 08:00 with the next dose due in 30 minutes.
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) priority-setting framework, the client whose oxygen
saturation has fallen to 88% is hypoxemic and at risk for cardiac and neurological compromise; this client must be
assessed first. The postoperative pain is controlled, the glucose result is routine, and the antibiotic timing is not yet
urgent. This reflects Maslow's physiological needs and the NCLEX-RN test plan's emphasis on acute physiological
instability.
Q4: A physician orders morphine 4 mg IV every 2 hours PRN for a postoperative client. The nurse
reviews the chart and sees the client received morphine 4 mg IV at 12:00, 14:00, 16:00, and 18:00.
At 19:30 the client rates pain at 8/10. Which action by the nurse is most appropriate?
A. Administer the morphine now because it is due at 20:00 and the client is in severe pain.
B. Withhold the morphine, notify the provider of cumulative dosing, and request a
pain-management consult. [CORRECT]
C. Administer a lower dose (2 mg IV) and reassess in 30 minutes.
D. Document the pain rating and reassess in 1 hour before intervening.
Correct Answer: B
Rationale: Repeated IV morphine every 2 hours around the clock places the client at high risk for opioid-induced
respiratory depression and accumulation; the nurse must exercise judgment and collaborate with the provider before
the next scheduled dose. The BSN 225 fundamentals curriculum and HESI RN Specialty blueprint emphasize
medication safety and the rights of medication administration, including the right to question an order. Simply giving
the next dose, giving a smaller dose without an order, or waiting an hour ignore the cumulative risk.
Q5: Which of the following tasks is most appropriate for the RN to delegate to a unlicensed
assistive personnel (UAP)?
A. Teaching a client newly diagnosed with diabetes how to perform foot care.
B. Measuring and recording vital signs on a stable postoperative client. [CORRECT]
C. Evaluating the effectiveness of a new IV antibiotic for a client with pneumonia.
D. Reassessing a stage 2 pressure injury and selecting a new dressing.
Correct Answer: B
Rationale: Measuring and recording vital signs on a stable client is a routine, standardized task within the UAP scope
and does not require nursing judgment, fitting the Five Rights of Delegation (right task, right circumstance, right
person, right direction, right supervision). Teaching, evaluating medication effectiveness, and wound assessment with
,dressing selection all require the knowledge and judgment of a licensed nurse. The NCLEX-RN test plan and Nurse
Practice Act distinguish delegable tasks from those that must remain with the RN.
Q6: A client is scheduled for an elective cholecystectomy. The surgeon explains the procedure,
risks, and alternatives and obtains the client's signature on the consent form. Thirty minutes later
the client tells the nurse, "I really do not understand what they are going to do to my gallbladder."
What is the nurse's best action?
A. Witness the consent form because it has already been signed by the client and surgeon.
B. Notify the surgeon so that informed consent can be re-obtained. [CORRECT]
C. Explain the procedure to the client using a medical-surgical textbook.
D. Document the client's statement in the chart and proceed with preoperative preparation.
Correct Answer: B
Rationale: Informed consent requires that the client actually understands the procedure, risks, benefits, and
alternatives; a signed form is not valid if understanding is absent. The nurse must notify the surgeon, who is
responsible for re-explaining and re-obtaining consent, and document the conversation. Simply witnessing the form,
providing detailed medical information outside the nurse's scope, or ignoring the statement violates the ethical
principle of autonomy and legal standards for informed consent.
Q7: An RN, an LPN, and a UAP are caring for a team of clients on a medical unit. Which client
should the RN assign to the LPN?
A. A newly admitted client with suspected acute myocardial infarction requiring frequent assessment.
B. A stable client three days post-stroke receiving enteral feedings via PEG tube and oral
medications. [CORRECT]
C. A client who needs initial teaching about a newly placed colostomy.
D. A client with acute GI bleeding who requires hemodynamic monitoring and vasopressor titration.
Correct Answer: B
Rationale: The LPN scope of practice includes caring for stable clients with predictable outcomes and administering
oral and enteral medications, making the stable post-stroke client an appropriate assignment. The client with a
suspected acute MI requires complex assessment, the colostomy teaching requires RN-level initial instruction, and
the unstable GI bleed requires continuous RN-level monitoring and titration. The NCLEX-RN delegation framework
requires the RN to match client acuity to licensee competency.
Q8: A UAP reports to the nurse that a client with pneumonia is "breathing funny." The nurse is
preparing an IV antibiotic for another client. What is the nurse's best initial action?
A. Finish preparing the antibiotic, administer it, and then assess the client with pneumonia.
B. Stop the antibiotic preparation and immediately assess the client with pneumonia. [CORRECT]
C. Ask the UAP to obtain full vital signs on the client while the nurse finishes the antibiotic.
D. Instruct the charge nurse to assess the client with pneumonia.
Correct Answer: B
Rationale: An acute change in respiratory status is potentially life-threatening; the nurse must stop the current task
and immediately assess the client using the ABC priority framework. Delegating assessment to a UAP is outside their
scope, and delaying assessment to finish another task ignores a potentially deteriorating patient. The NCLEX-RN test
plan and HESI blueprint emphasize rapid response to clinical deterioration as an RN responsibility that cannot be
delegated.
, Q9: A client with end-stage COPD tells the nurse, "I do not want to be intubated again. I want to go
home on hospice." The client's spouse insists the client be transferred to the ICU if breathing
worsens. Which nursing action best demonstrates advocacy?
A. Agree with the spouse because family preferences usually guide care decisions.
B. Schedule a family meeting to discuss the client's wishes and explore hospice options.
[CORRECT]
C. Document the client's statement and continue current treatments until a code status is signed.
D. Remind the spouse that the physician will make the final decision about ICU transfer.
Correct Answer: B
Rationale: Nursing advocacy requires the nurse to support the client's expressed wishes, facilitate communication
among the client, family, and interdisciplinary team, and arrange a goals-of-care discussion. The BSN 225 curriculum
identifies advocacy as a core RN role; scheduling a structured family meeting with the healthcare team validates the
client's autonomy while engaging the spouse. Deferring to the spouse, ignoring the statement, or handing the
decision to the physician alone all fail the advocacy role.
Q10: A nurse accidentally administers 10 units of regular insulin instead of the ordered 5 units.
The client is alert and asymptomatic. After assessing the client, what should the nurse do next?
A. Wait to see if symptoms develop before taking further action.
B. Complete an incident report, notify the provider, and monitor blood glucose closely. [CORRECT]
C. Document the error in the client's chart only and continue monitoring.
D. Ask a colleague to give the next scheduled insulin to share responsibility.
Correct Answer: B
Rationale: A medication error requires immediate provider notification, completion of an incident/variance report for
quality improvement, monitoring for hypoglycemia, and transparent documentation in the medical record. The
incident report is an internal quality tool, not part of the medical record; both are required. Waiting, documenting only
in the chart, or transferring responsibility to a colleague are unsafe and violate professional accountability.
Q11: The night shift RN is caring for four clients. Which client should the nurse assess first?
A. A client 4 hours post-colonoscopy reporting mild abdominal cramping.
B. A client with cirrhosis who has become increasingly confused in the last hour. [CORRECT]
C. A client receiving continuous IV heparin with an aPTT due at 06:00.
D. A client scheduled for a 06:00 fasting blood glucose and prescribed oral hypoglycemic.
Correct Answer: B
Rationale: Acute confusion in a client with cirrhosis suggests hepatic encephalopathy from rising ammonia levels, a
potentially reversible but life-threatening complication requiring immediate assessment and intervention. Mild
cramping after colonoscopy is expected, the heparin and glucose lab draws are routine scheduled tasks. Using the
ABC and acute-versus-chronic prioritization framework, the new neurological change takes precedence.
Q12: Which action by the RN demonstrates appropriate delegation to a LPN?
A. Asking the LPN to develop the plan of care for a newly admitted client with heart failure.
B. Asking the LPN to administer scheduled oral medications and perform sterile dressing changes
for stable clients. [CORRECT]
C. Asking the LPN to provide discharge teaching for a client with newly diagnosed heart failure.
D. Asking the LPN to perform the initial admission assessment of a client transferred from the ICU.
EXAM V1
LATEST UPDATE | QUESTIONS & ANSWERS | 100% CORRECT | GRADE A
Nightingale College | BSN 225 Course Syllabus | HESI RN Specialty Exam Blueprint | NCLEX-RN Test Plan
Examination Overview: This comprehensive specialty examination contains 150 multiple-choice questions aligned
with the HESI RN Specialty Fundamentals of Nursing Exam Blueprint and NCLEX-RN Test Plan (2026/2027 edition).
Cognitive distribution: 20% recall, 50% application, 30% analysis. Question style: 75% scenario-based, 25% direct
knowledge. Special inclusions: 20 priority-setting questions, 15 pharmacology-focused questions, 10 delegation
questions, and 5 integrated case studies with multiple related questions. Each question includes a 2-4 sentence
rationale referencing the BSN 225 curriculum, HESI RN Specialty blueprint, NCLEX-RN standards, and
evidence-based fundamentals of nursing practice.
Section Distribution:
Section 1: Management of Care (Q1–Q20) — 20 questions
Section 2: Safety & Infection Control (Q21–Q40) — 20 questions
Section 3: Health Promotion & Maintenance (Q41–Q58) — 18 questions
Section 4: Psychosocial Integrity (Q59–Q73) — 15 questions
Section 5: Basic Care & Comfort (Q74–Q95) — 22 questions
Section 6: Pharmacological & Parenteral Therapies (Q96–Q115) — 20 questions
Section 7: Reduction of Risk Potential (Q116–Q135) — 20 questions
Section 8: Physiological Adaptation (Q136–Q150) — 15 questions
Total: 150 questions
Section 1: Safe & Effective Care Environment – Management of Care
Q1: A 78-year-old client with terminal cancer executes a valid advance directive requesting no
cardiopulmonary resuscitation (DNR). The client's adult daughter tells the nurse, "I am the
healthcare proxy and I want everything done if my mother stops breathing." Which action by the
nurse best respects the client's autonomy?
A. Activate the code team and begin resuscitation because the daughter is the designated proxy.
B. Notify the provider and request that the advance directive be revoked since the family disagrees.
C. Honor the client's signed advance directive and DNR order and explain this to the daughter.
[CORRECT]
D. Ask the daughter to sign a consent form before any further decisions are made.
Correct Answer: C
Rationale: An advance directive executed by a competent adult is legally binding and reflects the client's
autonomous wishes; the surrogate must follow the directive, not override it. The nurse's duty is to honor the
document and provide respectful explanation to the family, supporting the BSN 225 curriculum principle of patient
self-determination and the NCLEX-RN emphasis on advocacy. Activating the code team violates the DNR; revoking
the directive or asking the daughter to consent overrides the client's authority.
Q2: A nurse notices a colleague documenting medications as administered at 09:00 before
actually giving them at 09:45. The colleague states, "I always chart early so I do not fall behind."
Which ethical principle is most directly violated by this practice?
A. Autonomy
B. Beneficence
, C. Veracity [CORRECT]
D. Justice
Correct Answer: C
Rationale: Veracity is the ethical duty to tell the truth and document accurately; pre-charting medications that have
not yet been given is falsification of the medical record. This violates the Nurse Practice Act, may constitute fraud,
and risks patient harm if another nurse acts on incorrect information. Autonomy concerns self-determination,
beneficence is acting for the patient's good, and justice concerns fair distribution of resources.
Q3: At 07:00 the RN is assigned four clients. Which client should the RN assess first?
A. A client 24 hours postoperative total hip replacement reporting pain at 6/10 controlled by oral analgesic.
B. A client with heart failure whose pulse oximetry drops from 95% to 88% on room air. [CORRECT]
C. A client with type 2 diabetes mellitus awaiting a 07:30 fasting glucose result.
D. A client receiving IV antibiotics scheduled for 08:00 with the next dose due in 30 minutes.
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) priority-setting framework, the client whose oxygen
saturation has fallen to 88% is hypoxemic and at risk for cardiac and neurological compromise; this client must be
assessed first. The postoperative pain is controlled, the glucose result is routine, and the antibiotic timing is not yet
urgent. This reflects Maslow's physiological needs and the NCLEX-RN test plan's emphasis on acute physiological
instability.
Q4: A physician orders morphine 4 mg IV every 2 hours PRN for a postoperative client. The nurse
reviews the chart and sees the client received morphine 4 mg IV at 12:00, 14:00, 16:00, and 18:00.
At 19:30 the client rates pain at 8/10. Which action by the nurse is most appropriate?
A. Administer the morphine now because it is due at 20:00 and the client is in severe pain.
B. Withhold the morphine, notify the provider of cumulative dosing, and request a
pain-management consult. [CORRECT]
C. Administer a lower dose (2 mg IV) and reassess in 30 minutes.
D. Document the pain rating and reassess in 1 hour before intervening.
Correct Answer: B
Rationale: Repeated IV morphine every 2 hours around the clock places the client at high risk for opioid-induced
respiratory depression and accumulation; the nurse must exercise judgment and collaborate with the provider before
the next scheduled dose. The BSN 225 fundamentals curriculum and HESI RN Specialty blueprint emphasize
medication safety and the rights of medication administration, including the right to question an order. Simply giving
the next dose, giving a smaller dose without an order, or waiting an hour ignore the cumulative risk.
Q5: Which of the following tasks is most appropriate for the RN to delegate to a unlicensed
assistive personnel (UAP)?
A. Teaching a client newly diagnosed with diabetes how to perform foot care.
B. Measuring and recording vital signs on a stable postoperative client. [CORRECT]
C. Evaluating the effectiveness of a new IV antibiotic for a client with pneumonia.
D. Reassessing a stage 2 pressure injury and selecting a new dressing.
Correct Answer: B
Rationale: Measuring and recording vital signs on a stable client is a routine, standardized task within the UAP scope
and does not require nursing judgment, fitting the Five Rights of Delegation (right task, right circumstance, right
person, right direction, right supervision). Teaching, evaluating medication effectiveness, and wound assessment with
,dressing selection all require the knowledge and judgment of a licensed nurse. The NCLEX-RN test plan and Nurse
Practice Act distinguish delegable tasks from those that must remain with the RN.
Q6: A client is scheduled for an elective cholecystectomy. The surgeon explains the procedure,
risks, and alternatives and obtains the client's signature on the consent form. Thirty minutes later
the client tells the nurse, "I really do not understand what they are going to do to my gallbladder."
What is the nurse's best action?
A. Witness the consent form because it has already been signed by the client and surgeon.
B. Notify the surgeon so that informed consent can be re-obtained. [CORRECT]
C. Explain the procedure to the client using a medical-surgical textbook.
D. Document the client's statement in the chart and proceed with preoperative preparation.
Correct Answer: B
Rationale: Informed consent requires that the client actually understands the procedure, risks, benefits, and
alternatives; a signed form is not valid if understanding is absent. The nurse must notify the surgeon, who is
responsible for re-explaining and re-obtaining consent, and document the conversation. Simply witnessing the form,
providing detailed medical information outside the nurse's scope, or ignoring the statement violates the ethical
principle of autonomy and legal standards for informed consent.
Q7: An RN, an LPN, and a UAP are caring for a team of clients on a medical unit. Which client
should the RN assign to the LPN?
A. A newly admitted client with suspected acute myocardial infarction requiring frequent assessment.
B. A stable client three days post-stroke receiving enteral feedings via PEG tube and oral
medications. [CORRECT]
C. A client who needs initial teaching about a newly placed colostomy.
D. A client with acute GI bleeding who requires hemodynamic monitoring and vasopressor titration.
Correct Answer: B
Rationale: The LPN scope of practice includes caring for stable clients with predictable outcomes and administering
oral and enteral medications, making the stable post-stroke client an appropriate assignment. The client with a
suspected acute MI requires complex assessment, the colostomy teaching requires RN-level initial instruction, and
the unstable GI bleed requires continuous RN-level monitoring and titration. The NCLEX-RN delegation framework
requires the RN to match client acuity to licensee competency.
Q8: A UAP reports to the nurse that a client with pneumonia is "breathing funny." The nurse is
preparing an IV antibiotic for another client. What is the nurse's best initial action?
A. Finish preparing the antibiotic, administer it, and then assess the client with pneumonia.
B. Stop the antibiotic preparation and immediately assess the client with pneumonia. [CORRECT]
C. Ask the UAP to obtain full vital signs on the client while the nurse finishes the antibiotic.
D. Instruct the charge nurse to assess the client with pneumonia.
Correct Answer: B
Rationale: An acute change in respiratory status is potentially life-threatening; the nurse must stop the current task
and immediately assess the client using the ABC priority framework. Delegating assessment to a UAP is outside their
scope, and delaying assessment to finish another task ignores a potentially deteriorating patient. The NCLEX-RN test
plan and HESI blueprint emphasize rapid response to clinical deterioration as an RN responsibility that cannot be
delegated.
, Q9: A client with end-stage COPD tells the nurse, "I do not want to be intubated again. I want to go
home on hospice." The client's spouse insists the client be transferred to the ICU if breathing
worsens. Which nursing action best demonstrates advocacy?
A. Agree with the spouse because family preferences usually guide care decisions.
B. Schedule a family meeting to discuss the client's wishes and explore hospice options.
[CORRECT]
C. Document the client's statement and continue current treatments until a code status is signed.
D. Remind the spouse that the physician will make the final decision about ICU transfer.
Correct Answer: B
Rationale: Nursing advocacy requires the nurse to support the client's expressed wishes, facilitate communication
among the client, family, and interdisciplinary team, and arrange a goals-of-care discussion. The BSN 225 curriculum
identifies advocacy as a core RN role; scheduling a structured family meeting with the healthcare team validates the
client's autonomy while engaging the spouse. Deferring to the spouse, ignoring the statement, or handing the
decision to the physician alone all fail the advocacy role.
Q10: A nurse accidentally administers 10 units of regular insulin instead of the ordered 5 units.
The client is alert and asymptomatic. After assessing the client, what should the nurse do next?
A. Wait to see if symptoms develop before taking further action.
B. Complete an incident report, notify the provider, and monitor blood glucose closely. [CORRECT]
C. Document the error in the client's chart only and continue monitoring.
D. Ask a colleague to give the next scheduled insulin to share responsibility.
Correct Answer: B
Rationale: A medication error requires immediate provider notification, completion of an incident/variance report for
quality improvement, monitoring for hypoglycemia, and transparent documentation in the medical record. The
incident report is an internal quality tool, not part of the medical record; both are required. Waiting, documenting only
in the chart, or transferring responsibility to a colleague are unsafe and violate professional accountability.
Q11: The night shift RN is caring for four clients. Which client should the nurse assess first?
A. A client 4 hours post-colonoscopy reporting mild abdominal cramping.
B. A client with cirrhosis who has become increasingly confused in the last hour. [CORRECT]
C. A client receiving continuous IV heparin with an aPTT due at 06:00.
D. A client scheduled for a 06:00 fasting blood glucose and prescribed oral hypoglycemic.
Correct Answer: B
Rationale: Acute confusion in a client with cirrhosis suggests hepatic encephalopathy from rising ammonia levels, a
potentially reversible but life-threatening complication requiring immediate assessment and intervention. Mild
cramping after colonoscopy is expected, the heparin and glucose lab draws are routine scheduled tasks. Using the
ABC and acute-versus-chronic prioritization framework, the new neurological change takes precedence.
Q12: Which action by the RN demonstrates appropriate delegation to a LPN?
A. Asking the LPN to develop the plan of care for a newly admitted client with heart failure.
B. Asking the LPN to administer scheduled oral medications and perform sterile dressing changes
for stable clients. [CORRECT]
C. Asking the LPN to provide discharge teaching for a client with newly diagnosed heart failure.
D. Asking the LPN to perform the initial admission assessment of a client transferred from the ICU.
