BSN 225 NIGHTINGALE COLLEGE
S P E C I A LT Y P R A C T I C E E X A M I N AT I O N W I T H R AT I O N A L E S
HESI RN Specialty
Fundamentals of Nursing
A 150-question comprehensive practice exam aligned with the
BSN 225 syllabus, HESI RN Specialty Exam Blueprint, NCLEX-
RN Test Plan, and Fundamentals of Nursing Competencies.
150 8 20 100%
T O TA L NCLEX CONTENT P R I O R I T Y- WITH CLINICAL
QUESTIONS DOMAINS SETTING R AT I O N A L E S
ITEMS
EXAM BLUEPRINT
Q1–20 Management of Care Q21–40 Safety & Infection Control
Q41–58 Health Promotion & Maintenance Q59–73 Psychosocial Integrity
Q74–95 Basic Care & Comfort Q96–115 Pharmacological & Parenteral
Q116–135 Reduction of Risk Potential Q136–150 Physiological Adaptation
NIGHTINGALE LATEST UPDATE EDITION | GRADE A PREPARATION
,BSN 225 — HESI RN Specialty Fundamentals of Nursing Practice Exam with Rationales · Edition
BSN 225 HESI RN Specialty Fundamentals of
Nursing
Exam Prep Practice Questions with Rationales · Latest Update Edition · 100% Correct · Grade A ·
Nightingale
Total Questions 150 Cognitive Mix 20% Recall · 50% Application · 30% Analysis
Content Domains 8 Question Style 75% Scenario-Based · 25% Direct Knowledge
Priority-Setting Items 20 Delegation Items 10
Pharmacology Items 15 Integrated Case Studies 5
This specialty practice examination was developed to mirror the HESI RN Specialty Exam Blueprint and the NCLEX-RN Test
Plan, mapped to the BSN 225 Fundamentals of Nursing course competencies. Each question is followed by the correct option
(clearly marked) and a 2–4 sentence rationale that links the correct response — and the incorrect distractors — to current
evidence-based nursing practice, national patient-safety standards, and the foundational nursing curriculum. The exam covers
eight NCLEX Client Needs domains: Management of Care; Safety & Infection Control; Health Promotion & Maintenance;
Psychosocial Integrity; Basic Care & Comfort; Pharmacological & Parenteral Therapies; Reduction of Risk Potential; and
Physiological Adaptation.
Section 1 — Safe & Effective Care Environment:
Q1 – Q20 · 20 items
Management of Care
Q1: A registered nurse (RN) on a medical-surgical unit is caring for five clients. Which of the following tasks
is most appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Teaching a newly diagnosed diabetic client about foot care
B. Assessing a stage 2 pressure injury on a bedbound client
C. Ambulating a stable postoperative client who is 24 hours post total knee replacement [CORRECT]
D. Administering an oral analgesic to a client with chronic osteoarthritis
Correct Answer: C
Rationale: Ambulation of a stable postoperative client is within the UAP scope of practice because it involves routine,
standardized care with predictable outcomes. Teaching (option A) and assessment (option B) cannot be delegated — they require
nursing judgment and are the RN's legal responsibility per the Nurse Practice Act and the ANA Principles of Delegation (Five
Rights of Delegation: right task, right circumstance, right person, right direction/communication, right supervision/evaluation).
Medication administration (option D) is reserved for licensed nurses and cannot be delegated to UAP.
Q2: The RN receives shift report on four clients. Which client should the nurse assess first?
A. A client with type 2 diabetes mellitus whose morning blood glucose is 220 mg/dL
B. A client admitted with pneumonia who has an oxygen saturation of 88% on room air [CORRECT]
C. A client 2 days post colonoscopy reporting mild abdominal bloating
D. A client with chronic kidney disease whose most recent potassium is 5.1 mEq/L
Correct Answer: B
© Nightingale College · BSN 225 Specialty Exam Preparation Page 1
,BSN 225 — HESI RN Specialty Fundamentals of Nursing Practice Exam with Rationales · Edition
Rationale: Using the ABC priority-setting framework (Airway, Breathing, Circulation), the client with pneumonia and an SpO2
of 88% on room air is hypoxic and represents the greatest immediate threat to life. Airway and breathing always take precedence
over circulation and metabolic concerns. The diabetic client (A) has hyperglycemia that is concerning but not immediately
life-threatening. Mild bloating post-colonoscopy (C) is an expected finding. A potassium of 5.1 mEq/L (D) requires monitoring
but is just above the upper limit of normal and is not an acute emergency compared with hypoxia.
Q3: A client is scheduled for an elective cholecystectomy. The surgeon explains the procedure, risks, and
alternatives, and the client signs the consent form. Thirty minutes later, the client tells the nurse, "I'm not
really sure what they're going to do." What is the nurse's best action?
A. Reassure the client that the surgeon has explained everything and proceed with preoperative preparation
B. Notify the surgeon so that the surgeon can return to clarify and re-obtain informed consent [CORRECT]
C. Explain the procedure to the client using a standardized patient-education handout
D. Document the client's statement in the chart and continue preoperative care
Correct Answer: B
Rationale: Informed consent is the responsibility of the provider performing the procedure, not the nurse. When a client
expresses confusion or uncertainty about a procedure after signing consent, the nurse must notify the surgeon so that consent can
be re-clarified and re-obtained if necessary. Valid consent requires comprehension, voluntariness, and disclosure of risks,
benefits, and alternatives. Proceeding without clarifying (A, D) violates the ethical principle of autonomy and creates legal
liability for battery. The nurse may reinforce teaching (C) but cannot substitute for the provider's duty to obtain consent.
Q4: A nurse is caring for a public figure admitted under a pseudonym. A reporter calls the nursing station
and asks whether the client is a patient on the unit. Which response by the nurse best demonstrates
compliance with HIPAA?
A. "I cannot confirm or deny that the client is a patient here." [CORRECT]
B. "The client is here, but I cannot share any clinical information."
C. "You will need to speak with the hospital's public relations office."
D. "I'll have the charge nurse call you back with that information."
Correct Answer: A
Rationale: Under the HIPAA Privacy Rule, healthcare workers may not even acknowledge that an individual is a patient at the
facility without the client's authorization. The correct response is to neither confirm nor deny the presence of the client. Option B
confirms client presence, which is itself a disclosure of protected health information (PHI). Options C and D delay action but fail
to address the immediate privacy obligation. Confidentiality is a fundamental patient right under the Patient's Bill of Rights and
HIPAA (45 CFR Part 164).
Q5: An RN delegates morning vital signs and intake/output measurement to a UAP for four stable clients.
Which of the following represents the "right direction and communication" component of the Five Rights of
Delegation?
A. Selecting only stable clients whose vital signs follow predictable patterns
B. Telling the UAP, "Let me know if anyone looks worse, and report any systolic BP under 90 or over 180
immediately" [CORRECT]
C. Confirming the UAP has completed the unit's competency checklist for vital signs
D. Reviewing the UAP's documentation at the end of the shift
Correct Answer: B
Rationale: The Five Rights of Delegation are: right task, right circumstance, right person, right direction and communication, and
right supervision and evaluation. Right direction and communication requires the RN to give clear, specific instructions including
expected outcomes, timeframes, and parameters for reporting back. Option A is the right circumstance; option C is the right
person; option D is the right supervision and evaluation. Clear communication of specific reportable parameters (BP under 90 or
© Nightingale College · BSN 225 Specialty Exam Preparation Page 2
, BSN 225 — HESI RN Specialty Fundamentals of Nursing Practice Exam with Rationales · Edition
over 180) prevents failure to rescue and aligns with the NCSBN Delegation Decision-Making Process.
Q6: An 82-year-old client with end-stage heart failure is admitted with worsening dyspnea. The client has a
signed do-not-resuscitate (DNR) order in the chart but is now unresponsive and the family demands that the
nurse "do everything." What is the nurse's most appropriate action?
A. Call a code blue immediately to honor the family's wishes
B. Initiate CPR because the client is now unresponsive and family consent overrides the DNR
C. Honor the DNR order and provide comfort measures while notifying the provider [CORRECT]
D. Ask the family to leave the room and consult the ethics committee
Correct Answer: C
Rationale: The Patient Self-Determination Act (PSDA) of 1990 protects the client's right to make autonomous healthcare
decisions through advance directives, including DNR orders. A valid DNR reflects the client's autonomous wish and must be
honored even if family members object. Initiating CPR (A, B) would violate the client's autonomy and the nurse's ethical duty of
fidelity to the documented directive. The provider should be notified and the family offered psychosocial support and palliative
care consultation. Ethics consultation (D) may be appropriate if conflict persists, but does not override the documented DNR.
Q7: A nurse calls the on-call provider about a client whose heart rate has dropped from 88 to 42 beats/min
over the past hour and who is now lightheaded. Place the following SBAR components in the correct order: (1)
Recommendation, (2) Background, (3) Situation, (4) Assessment.
A. Situation, Background, Assessment, Recommendation [CORRECT]
B. Assessment, Situation, Background, Recommendation
C. Background, Situation, Recommendation, Assessment
D. Situation, Assessment, Background, Recommendation
Correct Answer: A
Rationale: The SBAR (Situation, Background, Assessment, Recommendation) framework is a standardized communication tool
endorsed by The Joint Commission and the Institute for Healthcare Improvement to improve handoffs and provider
communications. Situation is a brief statement of the current problem; Background provides relevant clinical history; Assessment
is the nurse's clinical analysis of the situation; Recommendation states what the nurse is requesting (e.g., evaluation, order change,
transfer). This structured format reduces communication errors that are a leading cause of sentinel events.
Q8: A home health nurse observes unexplained bruises on an 86-year-old client's upper arms, weight loss of 12
lb in 30 days, and the client's adult child repeatedly interrupts and refuses to leave the room during the visit.
What is the nurse's priority action?
A. Confront the adult child about the bruising and weight loss
B. Document the findings objectively and report suspected elder abuse to Adult Protective Services [CORRECT]
C. Wait until the next visit to see if the situation resolves
D. Tell the client to call the police if they feel unsafe
Correct Answer: B
Rationale: Nurses in all 50 U.S. states are mandated reporters of suspected elder abuse, neglect, and exploitation. The legal duty
is to report suspected abuse based on reasonable suspicion — actual proof is not required. Mandated reporting overrides HIPAA
privacy provisions. Documenting objectively (B) preserves evidence and supports the report. Confronting the caregiver (A) may
escalate danger. Waiting (C) places the client at continued risk. Telling the vulnerable client to act (D) shifts responsibility and
fails to meet the nurse's legal mandate under state elder abuse reporting statutes.
© Nightingale College · BSN 225 Specialty Exam Preparation Page 3
S P E C I A LT Y P R A C T I C E E X A M I N AT I O N W I T H R AT I O N A L E S
HESI RN Specialty
Fundamentals of Nursing
A 150-question comprehensive practice exam aligned with the
BSN 225 syllabus, HESI RN Specialty Exam Blueprint, NCLEX-
RN Test Plan, and Fundamentals of Nursing Competencies.
150 8 20 100%
T O TA L NCLEX CONTENT P R I O R I T Y- WITH CLINICAL
QUESTIONS DOMAINS SETTING R AT I O N A L E S
ITEMS
EXAM BLUEPRINT
Q1–20 Management of Care Q21–40 Safety & Infection Control
Q41–58 Health Promotion & Maintenance Q59–73 Psychosocial Integrity
Q74–95 Basic Care & Comfort Q96–115 Pharmacological & Parenteral
Q116–135 Reduction of Risk Potential Q136–150 Physiological Adaptation
NIGHTINGALE LATEST UPDATE EDITION | GRADE A PREPARATION
,BSN 225 — HESI RN Specialty Fundamentals of Nursing Practice Exam with Rationales · Edition
BSN 225 HESI RN Specialty Fundamentals of
Nursing
Exam Prep Practice Questions with Rationales · Latest Update Edition · 100% Correct · Grade A ·
Nightingale
Total Questions 150 Cognitive Mix 20% Recall · 50% Application · 30% Analysis
Content Domains 8 Question Style 75% Scenario-Based · 25% Direct Knowledge
Priority-Setting Items 20 Delegation Items 10
Pharmacology Items 15 Integrated Case Studies 5
This specialty practice examination was developed to mirror the HESI RN Specialty Exam Blueprint and the NCLEX-RN Test
Plan, mapped to the BSN 225 Fundamentals of Nursing course competencies. Each question is followed by the correct option
(clearly marked) and a 2–4 sentence rationale that links the correct response — and the incorrect distractors — to current
evidence-based nursing practice, national patient-safety standards, and the foundational nursing curriculum. The exam covers
eight NCLEX Client Needs domains: Management of Care; Safety & Infection Control; Health Promotion & Maintenance;
Psychosocial Integrity; Basic Care & Comfort; Pharmacological & Parenteral Therapies; Reduction of Risk Potential; and
Physiological Adaptation.
Section 1 — Safe & Effective Care Environment:
Q1 – Q20 · 20 items
Management of Care
Q1: A registered nurse (RN) on a medical-surgical unit is caring for five clients. Which of the following tasks
is most appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Teaching a newly diagnosed diabetic client about foot care
B. Assessing a stage 2 pressure injury on a bedbound client
C. Ambulating a stable postoperative client who is 24 hours post total knee replacement [CORRECT]
D. Administering an oral analgesic to a client with chronic osteoarthritis
Correct Answer: C
Rationale: Ambulation of a stable postoperative client is within the UAP scope of practice because it involves routine,
standardized care with predictable outcomes. Teaching (option A) and assessment (option B) cannot be delegated — they require
nursing judgment and are the RN's legal responsibility per the Nurse Practice Act and the ANA Principles of Delegation (Five
Rights of Delegation: right task, right circumstance, right person, right direction/communication, right supervision/evaluation).
Medication administration (option D) is reserved for licensed nurses and cannot be delegated to UAP.
Q2: The RN receives shift report on four clients. Which client should the nurse assess first?
A. A client with type 2 diabetes mellitus whose morning blood glucose is 220 mg/dL
B. A client admitted with pneumonia who has an oxygen saturation of 88% on room air [CORRECT]
C. A client 2 days post colonoscopy reporting mild abdominal bloating
D. A client with chronic kidney disease whose most recent potassium is 5.1 mEq/L
Correct Answer: B
© Nightingale College · BSN 225 Specialty Exam Preparation Page 1
,BSN 225 — HESI RN Specialty Fundamentals of Nursing Practice Exam with Rationales · Edition
Rationale: Using the ABC priority-setting framework (Airway, Breathing, Circulation), the client with pneumonia and an SpO2
of 88% on room air is hypoxic and represents the greatest immediate threat to life. Airway and breathing always take precedence
over circulation and metabolic concerns. The diabetic client (A) has hyperglycemia that is concerning but not immediately
life-threatening. Mild bloating post-colonoscopy (C) is an expected finding. A potassium of 5.1 mEq/L (D) requires monitoring
but is just above the upper limit of normal and is not an acute emergency compared with hypoxia.
Q3: A client is scheduled for an elective cholecystectomy. The surgeon explains the procedure, risks, and
alternatives, and the client signs the consent form. Thirty minutes later, the client tells the nurse, "I'm not
really sure what they're going to do." What is the nurse's best action?
A. Reassure the client that the surgeon has explained everything and proceed with preoperative preparation
B. Notify the surgeon so that the surgeon can return to clarify and re-obtain informed consent [CORRECT]
C. Explain the procedure to the client using a standardized patient-education handout
D. Document the client's statement in the chart and continue preoperative care
Correct Answer: B
Rationale: Informed consent is the responsibility of the provider performing the procedure, not the nurse. When a client
expresses confusion or uncertainty about a procedure after signing consent, the nurse must notify the surgeon so that consent can
be re-clarified and re-obtained if necessary. Valid consent requires comprehension, voluntariness, and disclosure of risks,
benefits, and alternatives. Proceeding without clarifying (A, D) violates the ethical principle of autonomy and creates legal
liability for battery. The nurse may reinforce teaching (C) but cannot substitute for the provider's duty to obtain consent.
Q4: A nurse is caring for a public figure admitted under a pseudonym. A reporter calls the nursing station
and asks whether the client is a patient on the unit. Which response by the nurse best demonstrates
compliance with HIPAA?
A. "I cannot confirm or deny that the client is a patient here." [CORRECT]
B. "The client is here, but I cannot share any clinical information."
C. "You will need to speak with the hospital's public relations office."
D. "I'll have the charge nurse call you back with that information."
Correct Answer: A
Rationale: Under the HIPAA Privacy Rule, healthcare workers may not even acknowledge that an individual is a patient at the
facility without the client's authorization. The correct response is to neither confirm nor deny the presence of the client. Option B
confirms client presence, which is itself a disclosure of protected health information (PHI). Options C and D delay action but fail
to address the immediate privacy obligation. Confidentiality is a fundamental patient right under the Patient's Bill of Rights and
HIPAA (45 CFR Part 164).
Q5: An RN delegates morning vital signs and intake/output measurement to a UAP for four stable clients.
Which of the following represents the "right direction and communication" component of the Five Rights of
Delegation?
A. Selecting only stable clients whose vital signs follow predictable patterns
B. Telling the UAP, "Let me know if anyone looks worse, and report any systolic BP under 90 or over 180
immediately" [CORRECT]
C. Confirming the UAP has completed the unit's competency checklist for vital signs
D. Reviewing the UAP's documentation at the end of the shift
Correct Answer: B
Rationale: The Five Rights of Delegation are: right task, right circumstance, right person, right direction and communication, and
right supervision and evaluation. Right direction and communication requires the RN to give clear, specific instructions including
expected outcomes, timeframes, and parameters for reporting back. Option A is the right circumstance; option C is the right
person; option D is the right supervision and evaluation. Clear communication of specific reportable parameters (BP under 90 or
© Nightingale College · BSN 225 Specialty Exam Preparation Page 2
, BSN 225 — HESI RN Specialty Fundamentals of Nursing Practice Exam with Rationales · Edition
over 180) prevents failure to rescue and aligns with the NCSBN Delegation Decision-Making Process.
Q6: An 82-year-old client with end-stage heart failure is admitted with worsening dyspnea. The client has a
signed do-not-resuscitate (DNR) order in the chart but is now unresponsive and the family demands that the
nurse "do everything." What is the nurse's most appropriate action?
A. Call a code blue immediately to honor the family's wishes
B. Initiate CPR because the client is now unresponsive and family consent overrides the DNR
C. Honor the DNR order and provide comfort measures while notifying the provider [CORRECT]
D. Ask the family to leave the room and consult the ethics committee
Correct Answer: C
Rationale: The Patient Self-Determination Act (PSDA) of 1990 protects the client's right to make autonomous healthcare
decisions through advance directives, including DNR orders. A valid DNR reflects the client's autonomous wish and must be
honored even if family members object. Initiating CPR (A, B) would violate the client's autonomy and the nurse's ethical duty of
fidelity to the documented directive. The provider should be notified and the family offered psychosocial support and palliative
care consultation. Ethics consultation (D) may be appropriate if conflict persists, but does not override the documented DNR.
Q7: A nurse calls the on-call provider about a client whose heart rate has dropped from 88 to 42 beats/min
over the past hour and who is now lightheaded. Place the following SBAR components in the correct order: (1)
Recommendation, (2) Background, (3) Situation, (4) Assessment.
A. Situation, Background, Assessment, Recommendation [CORRECT]
B. Assessment, Situation, Background, Recommendation
C. Background, Situation, Recommendation, Assessment
D. Situation, Assessment, Background, Recommendation
Correct Answer: A
Rationale: The SBAR (Situation, Background, Assessment, Recommendation) framework is a standardized communication tool
endorsed by The Joint Commission and the Institute for Healthcare Improvement to improve handoffs and provider
communications. Situation is a brief statement of the current problem; Background provides relevant clinical history; Assessment
is the nurse's clinical analysis of the situation; Recommendation states what the nurse is requesting (e.g., evaluation, order change,
transfer). This structured format reduces communication errors that are a leading cause of sentinel events.
Q8: A home health nurse observes unexplained bruises on an 86-year-old client's upper arms, weight loss of 12
lb in 30 days, and the client's adult child repeatedly interrupts and refuses to leave the room during the visit.
What is the nurse's priority action?
A. Confront the adult child about the bruising and weight loss
B. Document the findings objectively and report suspected elder abuse to Adult Protective Services [CORRECT]
C. Wait until the next visit to see if the situation resolves
D. Tell the client to call the police if they feel unsafe
Correct Answer: B
Rationale: Nurses in all 50 U.S. states are mandated reporters of suspected elder abuse, neglect, and exploitation. The legal duty
is to report suspected abuse based on reasonable suspicion — actual proof is not required. Mandated reporting overrides HIPAA
privacy provisions. Documenting objectively (B) preserves evidence and supports the report. Confronting the caregiver (A) may
escalate danger. Waiting (C) places the client at continued risk. Telling the vulnerable client to act (D) shifts responsibility and
fails to meet the nurse's legal mandate under state elder abuse reporting statutes.
© Nightingale College · BSN 225 Specialty Exam Preparation Page 3
