BSN 225 HESI RN SPECIALTY FUNDAMENTALS OF NURSING
EXAM PREP
(LATEST UPDATE ) — QUESTIONS & ANSWERS
100% CORRECT | GRADE A | NIGHTINGALE COLLEGE
Instructions: This comprehensive 150-question examination is aligned with the Nightingale College BSN 225 Course
Syllabus, HESI RN Specialty Exam Blueprint, the NCLEX-RN Test Plan (2026/2027), and Fundamentals of Nursing
Competencies. Each question has four options (A–D); only ONE option is correct and is marked *[CORRECT]*. After
each question, the correct answer is given, followed by a 2–4-sentence rationale that cites the relevant BSN 225
curriculum, HESI RN Specialty blueprint, NCLEX-RN standards, and evidence-based fundamentals of nursing practice.
The exam contains 20 priority-setting questions, 15 pharmacology questions, 10 delegation questions, and 5 integrated
case studies (each with multiple related questions).
Section 1: Safe & Effective Care Environment — Management of Care
20 Questions | Client rights, advocacy, legal/ethical issues, informed consent, advance directives, delegation (RN vs.
LPN vs. UAP), prioritization (ABCs, Maslow), assignment, SBAR, documentation, HIPAA, ethical principles, torts,
malpractice, negligence.
Q1: The RN is caring for a client with heart failure and is preparing to delegate morning care. Which of the
following tasks is most appropriate to delegate to the Unlicensed Assistive Personnel (UAP)?
A. Teaching the client about a low-sodium diet prior to discharge
B. Ambulating a stable client who received morphine 30 minutes ago for chest pain
C. Obtaining vital signs on a stable post-operative client who is 24 hours post-op *[CORRECT]*
D. Performing a head-to-toe assessment on a newly admitted client with chest pain
Correct Answer: C
Rationale: UAP scope of practice includes basic care tasks such as taking vital signs on stable clients, ambulation of stable
clients, ADLs, and feeding. The RN retains assessment, teaching, and care of unstable clients (post-morphine, new
admission with chest pain). Per the ANA Principles of Delegation (2026) and the Nurse Practice Act, the Five Rights of
Delegation (right task, right circumstance, right person, right communication, right supervision) guide this decision. Vital
signs on a stable 24-hour post-op client meets all five rights.
Q2: An RN on a medical-surgical unit has five clients. Which client care task should the RN assign to a
Licensed Practical Nurse (LPN)?
A. Initial admission assessment of a client transferred from the ICU
B. Administering IV push morphine to a client with acute chest pain
C. Reinforcing discharge teaching about a new diagnosis of diabetes mellitus to a stable client
*[CORRECT]*
D. Developing the plan of care for a newly admitted client with sepsis
Correct Answer: C
Rationale: The LPN scope of practice includes reinforcing teaching (not initial teaching), caring for stable clients with
predictable outcomes, and administering oral and subcutaneous medications (depending on state Nurse Practice Act). Initial
admission assessment, IV push narcotics, and developing plans of care for unstable clients require RN-level knowledge and
judgment. According to the NCLEX-RN Test Plan and the NCSBN Decision Tree (2026), the LPN may reinforce teaching
already initiated by the RN, making option C the safest assignment.
© 2026/2027 BSN 225 — 150-Question Specialty Exam Page 1
,BSN 225 — HESI RN Specialty Fundamentals of Nursing Exam Prep () Nightingale College | Grade A
Q3: The RN delegates measurement of intake and output to the UAP for four clients. Which statement by
the UAP requires the RN to intervene immediately?
A. "I will record all oral intake in milliliters and document it in the chart."
B. "I will empty the urinary catheter bag and record the total output for the shift."
C. "I noticed the client's urine is dark amber and smells strong, so I'll encourage more fluids."
*[CORRECT]*
D. "I will report any client whose urine output is less than 30 mL per hour to you right away."
Correct Answer: C
Rationale: The UAP's statement in option C crosses scope-of-practice boundaries by interpreting clinical findings (dark
amber, strong-smelling urine) and initiating independent nursing interventions (encouraging fluids). The UAP may observe
and report findings, but interpretation, analysis, and clinical decision-making remain RN responsibilities. The NCSBN
Delegation Model (2026) requires the RN to retain assessment, evaluation, and clinical judgment. Options A, B, and D
describe appropriate UAP roles within their scope.
Q4: A newly graduated RN is working with an experienced UAP. Which task should the new RN perform
personally rather than delegate?
A. Ambulating a stable client two days post appendectomy
B. Evaluating the effectiveness of a newly administered analgesic *[CORRECT]*
C. Assisting a stable client with feeding who has weakness on the left side
D. Taking routine vital signs on a stable client admitted for observation
Correct Answer: B
Rationale: Evaluation of medication effectiveness requires RN-level knowledge, clinical judgment, and assessment skills;
per the Five Rights of Delegation, evaluation cannot be delegated. The NCLEX-RN Test Plan (2026) classifies evaluation
as an RN-only activity. Options A, C, and D are appropriate to delegate to UAP because they involve routine tasks for
stable clients with predictable outcomes and do not require clinical judgment.
Q5: The charge nurse is making assignments for the shift. Which client should be assigned to the RN rather
than the LPN?
A. A stable client three days post colon resection receiving oral antibiotics
B. A client admitted six hours ago with acute GI bleeding, receiving IV fluids and a blood transfusion
*[CORRECT]*
C. A client with a stage III pressure ulcer requiring wet-to-dry dressing changes
D. A client with chronic obstructive pulmonary disease receiving nebulizer treatments
Correct Answer: B
Rationale: The client with acute GI bleeding and an active blood transfusion is unstable and requires ongoing assessment,
frequent monitoring, and complex clinical decision-making — all RN-level responsibilities. The NCSBN (2026) classifies
blood product administration as an RN-only task in most states. Options A, C, and D describe stable clients with
predictable care needs within the LPN scope. The RN must always retain care of unstable, complex, or rapidly changing
clients.
© 2026/2027 BSN 225 — 150-Question Specialty Exam Page 2
,BSN 225 — HESI RN Specialty Fundamentals of Nursing Exam Prep () Nightingale College | Grade A
Q6: An RN is supervising a UAP who is performing postural blood pressure measurements on a client with
a recent medication change. The UAP reports the blood pressure is significantly lower than baseline. What
is the RN's most appropriate action?
A. Tell the UAP to retake the measurement and document it in the chart
B. Personally assess the client, including vital signs and orthostatic measurements, before deciding on
further action *[CORRECT]*
C. Instruct the UAP to notify the healthcare provider of the change
D. Document the UAP's finding and reassess the client at the next scheduled vital signs check
Correct Answer: B
Rationale: When delegated data suggest a change in client status, the RN must independently verify the finding through
direct assessment before making clinical decisions. The RN retains accountability for assessment, interpretation, and
intervention. Per the ANA Principles of Delegation (2026), the RN must validate delegated data when findings fall outside
expected parameters. Options A, C, and D bypass the RN's professional responsibility to assess and analyze clinical data.
Q7: The RN is preparing to delegate the task of feeding a client who has dysphagia following a stroke.
Which factor is most important for the RN to consider before delegating this task to the UAP?
A. Whether the UAP has been trained in the use of thickened liquids and supervised swallowing precautions
*[CORRECT]*
B. Whether the client prefers to be fed by the UAP rather than the RN
C. Whether the UAP has cared for this client on previous shifts
D. Whether the feeding is scheduled during the UAP's regular break time
Correct Answer: A
Rationale: The most critical factor is whether the UAP has the competency (knowledge, skill, and training) to safely
perform the task, especially with a high-risk client (dysphagia post-CVA carries aspiration risk). The Five Rights of
Delegation require 'right person' — the delegatee must have demonstrated competence. Per the Nurse Practice Act and
NCLEX-RN Test Plan, competency verification is the RN's non-delegable duty. The other options are logistical or
preference-based and do not address safety.
Q8: Which of the following clients should the RN assess first after receiving shift report?
A. A client with chronic kidney disease whose serum potassium is 5.2 mEq/L
B. A client with COPD whose oxygen saturation is 88% on room air and is experiencing dyspnea
*[CORRECT]*
C. A client with diabetes whose blood glucose is 220 mg/dL and is awaiting the morning dose of insulin
D. A client with heart failure whose weight has increased by 1 kg since yesterday
Correct Answer: B
Rationale: Using the ABC prioritization framework (Airway, Breathing, Circulation) and Maslow's hierarchy, the client
with COPD and 88% SpO2 with active dyspnea is the most acute and physiologically unstable. Respiratory compromise is
a life-threatening emergency that requires immediate assessment and intervention. The NCLEX-RN Test Plan (2026)
identifies acute respiratory distress as the highest priority. The other clients require timely care but are not in immediate
danger.
© 2026/2027 BSN 225 — 150-Question Specialty Exam Page 3
, BSN 225 — HESI RN Specialty Fundamentals of Nursing Exam Prep () Nightingale College | Grade A
Q9: The RN is caring for four clients. Which client should the RN see first?
A. A client with a new onset of atrial fibrillation and a heart rate of 110 bpm
B. A client who is 4 hours post thyroidectomy and reports throat pressure and difficulty swallowing
*[CORRECT]*
C. A client with type 1 diabetes who has not eaten breakfast and is awaiting insulin administration
D. A client with pneumonia whose temperature is 101.2°F (38.4°C) and is receiving IV antibiotics
Correct Answer: B
Rationale: Difficulty swallowing and throat pressure after thyroidectomy suggest possible hematoma formation or airway
compromise — a life-threatening emergency requiring immediate assessment. The ABC framework prioritizes airway
above all other concerns. The other clients require timely care but are not in immediate airway danger. NCLEX
prioritization focuses on the client at greatest risk for rapid deterioration.
Q10: An RN is assigned to four clients. Using Maslow's hierarchy, which client need should the RN address
first?
A. A client requesting to speak with the chaplain about an upcoming surgery
B. A client who is anxious about being discharged home with a new colostomy
C. A client who is complaining of severe incisional pain rated 8/10 that has not been relieved by
acetaminophen *[CORRECT]*
D. A client who would like clarification about an advance directive before signing
Correct Answer: C
Rationale: Maslow's hierarchy places physiological needs at the foundation and prioritizes them above safety,
love/belonging, esteem, and self-actualization needs. Severe unrelieved pain (8/10) is a physiological need that must be
addressed first. The other options reflect psychosocial or self-actualization needs, which sit higher in the hierarchy and can
be addressed after physiological stability is achieved. The NCLEX-RN Test Plan consistently applies Maslow when
triaging competing client needs.
Q11: A client is scheduled for an elective cardiac catheterization. The healthcare provider has explained the
procedure, risks, and alternatives, and the client has signed the consent form. The client then turns to the
nurse and asks, "Can you explain what they're going to do during the procedure?" What is the nurse's
most appropriate response?
A. Sign the form already; you can ask the doctor after the procedure.
B. Let me answer your questions, and then if you're still unsure, we can talk to the doctor again before you
sign. *[CORRECT]*
C. I'm not allowed to discuss the procedure with you; only the doctor can answer those questions.
D. Don't worry — the procedure is very common and usually goes smoothly.
Correct Answer: B
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives. If the
client still has questions, consent is not fully informed, and the nurse must act as advocate by contacting the provider for
re-explanation. Per the ANA Code of Ethics (2026) and the Patient Self-Determination Act, the nurse's role is to verify
understanding and facilitate re-education. Dismissing the question or minimizing the procedure violates the ethical
principle of autonomy.
© 2026/2027 BSN 225 — 150-Question Specialty Exam Page 4
EXAM PREP
(LATEST UPDATE ) — QUESTIONS & ANSWERS
100% CORRECT | GRADE A | NIGHTINGALE COLLEGE
Instructions: This comprehensive 150-question examination is aligned with the Nightingale College BSN 225 Course
Syllabus, HESI RN Specialty Exam Blueprint, the NCLEX-RN Test Plan (2026/2027), and Fundamentals of Nursing
Competencies. Each question has four options (A–D); only ONE option is correct and is marked *[CORRECT]*. After
each question, the correct answer is given, followed by a 2–4-sentence rationale that cites the relevant BSN 225
curriculum, HESI RN Specialty blueprint, NCLEX-RN standards, and evidence-based fundamentals of nursing practice.
The exam contains 20 priority-setting questions, 15 pharmacology questions, 10 delegation questions, and 5 integrated
case studies (each with multiple related questions).
Section 1: Safe & Effective Care Environment — Management of Care
20 Questions | Client rights, advocacy, legal/ethical issues, informed consent, advance directives, delegation (RN vs.
LPN vs. UAP), prioritization (ABCs, Maslow), assignment, SBAR, documentation, HIPAA, ethical principles, torts,
malpractice, negligence.
Q1: The RN is caring for a client with heart failure and is preparing to delegate morning care. Which of the
following tasks is most appropriate to delegate to the Unlicensed Assistive Personnel (UAP)?
A. Teaching the client about a low-sodium diet prior to discharge
B. Ambulating a stable client who received morphine 30 minutes ago for chest pain
C. Obtaining vital signs on a stable post-operative client who is 24 hours post-op *[CORRECT]*
D. Performing a head-to-toe assessment on a newly admitted client with chest pain
Correct Answer: C
Rationale: UAP scope of practice includes basic care tasks such as taking vital signs on stable clients, ambulation of stable
clients, ADLs, and feeding. The RN retains assessment, teaching, and care of unstable clients (post-morphine, new
admission with chest pain). Per the ANA Principles of Delegation (2026) and the Nurse Practice Act, the Five Rights of
Delegation (right task, right circumstance, right person, right communication, right supervision) guide this decision. Vital
signs on a stable 24-hour post-op client meets all five rights.
Q2: An RN on a medical-surgical unit has five clients. Which client care task should the RN assign to a
Licensed Practical Nurse (LPN)?
A. Initial admission assessment of a client transferred from the ICU
B. Administering IV push morphine to a client with acute chest pain
C. Reinforcing discharge teaching about a new diagnosis of diabetes mellitus to a stable client
*[CORRECT]*
D. Developing the plan of care for a newly admitted client with sepsis
Correct Answer: C
Rationale: The LPN scope of practice includes reinforcing teaching (not initial teaching), caring for stable clients with
predictable outcomes, and administering oral and subcutaneous medications (depending on state Nurse Practice Act). Initial
admission assessment, IV push narcotics, and developing plans of care for unstable clients require RN-level knowledge and
judgment. According to the NCLEX-RN Test Plan and the NCSBN Decision Tree (2026), the LPN may reinforce teaching
already initiated by the RN, making option C the safest assignment.
© 2026/2027 BSN 225 — 150-Question Specialty Exam Page 1
,BSN 225 — HESI RN Specialty Fundamentals of Nursing Exam Prep () Nightingale College | Grade A
Q3: The RN delegates measurement of intake and output to the UAP for four clients. Which statement by
the UAP requires the RN to intervene immediately?
A. "I will record all oral intake in milliliters and document it in the chart."
B. "I will empty the urinary catheter bag and record the total output for the shift."
C. "I noticed the client's urine is dark amber and smells strong, so I'll encourage more fluids."
*[CORRECT]*
D. "I will report any client whose urine output is less than 30 mL per hour to you right away."
Correct Answer: C
Rationale: The UAP's statement in option C crosses scope-of-practice boundaries by interpreting clinical findings (dark
amber, strong-smelling urine) and initiating independent nursing interventions (encouraging fluids). The UAP may observe
and report findings, but interpretation, analysis, and clinical decision-making remain RN responsibilities. The NCSBN
Delegation Model (2026) requires the RN to retain assessment, evaluation, and clinical judgment. Options A, B, and D
describe appropriate UAP roles within their scope.
Q4: A newly graduated RN is working with an experienced UAP. Which task should the new RN perform
personally rather than delegate?
A. Ambulating a stable client two days post appendectomy
B. Evaluating the effectiveness of a newly administered analgesic *[CORRECT]*
C. Assisting a stable client with feeding who has weakness on the left side
D. Taking routine vital signs on a stable client admitted for observation
Correct Answer: B
Rationale: Evaluation of medication effectiveness requires RN-level knowledge, clinical judgment, and assessment skills;
per the Five Rights of Delegation, evaluation cannot be delegated. The NCLEX-RN Test Plan (2026) classifies evaluation
as an RN-only activity. Options A, C, and D are appropriate to delegate to UAP because they involve routine tasks for
stable clients with predictable outcomes and do not require clinical judgment.
Q5: The charge nurse is making assignments for the shift. Which client should be assigned to the RN rather
than the LPN?
A. A stable client three days post colon resection receiving oral antibiotics
B. A client admitted six hours ago with acute GI bleeding, receiving IV fluids and a blood transfusion
*[CORRECT]*
C. A client with a stage III pressure ulcer requiring wet-to-dry dressing changes
D. A client with chronic obstructive pulmonary disease receiving nebulizer treatments
Correct Answer: B
Rationale: The client with acute GI bleeding and an active blood transfusion is unstable and requires ongoing assessment,
frequent monitoring, and complex clinical decision-making — all RN-level responsibilities. The NCSBN (2026) classifies
blood product administration as an RN-only task in most states. Options A, C, and D describe stable clients with
predictable care needs within the LPN scope. The RN must always retain care of unstable, complex, or rapidly changing
clients.
© 2026/2027 BSN 225 — 150-Question Specialty Exam Page 2
,BSN 225 — HESI RN Specialty Fundamentals of Nursing Exam Prep () Nightingale College | Grade A
Q6: An RN is supervising a UAP who is performing postural blood pressure measurements on a client with
a recent medication change. The UAP reports the blood pressure is significantly lower than baseline. What
is the RN's most appropriate action?
A. Tell the UAP to retake the measurement and document it in the chart
B. Personally assess the client, including vital signs and orthostatic measurements, before deciding on
further action *[CORRECT]*
C. Instruct the UAP to notify the healthcare provider of the change
D. Document the UAP's finding and reassess the client at the next scheduled vital signs check
Correct Answer: B
Rationale: When delegated data suggest a change in client status, the RN must independently verify the finding through
direct assessment before making clinical decisions. The RN retains accountability for assessment, interpretation, and
intervention. Per the ANA Principles of Delegation (2026), the RN must validate delegated data when findings fall outside
expected parameters. Options A, C, and D bypass the RN's professional responsibility to assess and analyze clinical data.
Q7: The RN is preparing to delegate the task of feeding a client who has dysphagia following a stroke.
Which factor is most important for the RN to consider before delegating this task to the UAP?
A. Whether the UAP has been trained in the use of thickened liquids and supervised swallowing precautions
*[CORRECT]*
B. Whether the client prefers to be fed by the UAP rather than the RN
C. Whether the UAP has cared for this client on previous shifts
D. Whether the feeding is scheduled during the UAP's regular break time
Correct Answer: A
Rationale: The most critical factor is whether the UAP has the competency (knowledge, skill, and training) to safely
perform the task, especially with a high-risk client (dysphagia post-CVA carries aspiration risk). The Five Rights of
Delegation require 'right person' — the delegatee must have demonstrated competence. Per the Nurse Practice Act and
NCLEX-RN Test Plan, competency verification is the RN's non-delegable duty. The other options are logistical or
preference-based and do not address safety.
Q8: Which of the following clients should the RN assess first after receiving shift report?
A. A client with chronic kidney disease whose serum potassium is 5.2 mEq/L
B. A client with COPD whose oxygen saturation is 88% on room air and is experiencing dyspnea
*[CORRECT]*
C. A client with diabetes whose blood glucose is 220 mg/dL and is awaiting the morning dose of insulin
D. A client with heart failure whose weight has increased by 1 kg since yesterday
Correct Answer: B
Rationale: Using the ABC prioritization framework (Airway, Breathing, Circulation) and Maslow's hierarchy, the client
with COPD and 88% SpO2 with active dyspnea is the most acute and physiologically unstable. Respiratory compromise is
a life-threatening emergency that requires immediate assessment and intervention. The NCLEX-RN Test Plan (2026)
identifies acute respiratory distress as the highest priority. The other clients require timely care but are not in immediate
danger.
© 2026/2027 BSN 225 — 150-Question Specialty Exam Page 3
, BSN 225 — HESI RN Specialty Fundamentals of Nursing Exam Prep () Nightingale College | Grade A
Q9: The RN is caring for four clients. Which client should the RN see first?
A. A client with a new onset of atrial fibrillation and a heart rate of 110 bpm
B. A client who is 4 hours post thyroidectomy and reports throat pressure and difficulty swallowing
*[CORRECT]*
C. A client with type 1 diabetes who has not eaten breakfast and is awaiting insulin administration
D. A client with pneumonia whose temperature is 101.2°F (38.4°C) and is receiving IV antibiotics
Correct Answer: B
Rationale: Difficulty swallowing and throat pressure after thyroidectomy suggest possible hematoma formation or airway
compromise — a life-threatening emergency requiring immediate assessment. The ABC framework prioritizes airway
above all other concerns. The other clients require timely care but are not in immediate airway danger. NCLEX
prioritization focuses on the client at greatest risk for rapid deterioration.
Q10: An RN is assigned to four clients. Using Maslow's hierarchy, which client need should the RN address
first?
A. A client requesting to speak with the chaplain about an upcoming surgery
B. A client who is anxious about being discharged home with a new colostomy
C. A client who is complaining of severe incisional pain rated 8/10 that has not been relieved by
acetaminophen *[CORRECT]*
D. A client who would like clarification about an advance directive before signing
Correct Answer: C
Rationale: Maslow's hierarchy places physiological needs at the foundation and prioritizes them above safety,
love/belonging, esteem, and self-actualization needs. Severe unrelieved pain (8/10) is a physiological need that must be
addressed first. The other options reflect psychosocial or self-actualization needs, which sit higher in the hierarchy and can
be addressed after physiological stability is achieved. The NCLEX-RN Test Plan consistently applies Maslow when
triaging competing client needs.
Q11: A client is scheduled for an elective cardiac catheterization. The healthcare provider has explained the
procedure, risks, and alternatives, and the client has signed the consent form. The client then turns to the
nurse and asks, "Can you explain what they're going to do during the procedure?" What is the nurse's
most appropriate response?
A. Sign the form already; you can ask the doctor after the procedure.
B. Let me answer your questions, and then if you're still unsure, we can talk to the doctor again before you
sign. *[CORRECT]*
C. I'm not allowed to discuss the procedure with you; only the doctor can answer those questions.
D. Don't worry — the procedure is very common and usually goes smoothly.
Correct Answer: B
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives. If the
client still has questions, consent is not fully informed, and the nurse must act as advocate by contacting the provider for
re-explanation. Per the ANA Code of Ethics (2026) and the Patient Self-Determination Act, the nurse's role is to verify
understanding and facilitate re-education. Dismissing the question or minimizing the procedure violates the ethical
principle of autonomy.
© 2026/2027 BSN 225 — 150-Question Specialty Exam Page 4
