NIGHTINGALE COLLEGE | BSN 225
BSN 225 HESI RN Specialty
Fundamentals of Nursing
Exam Study Guide
Latest Update | 100% Correct | Grade A
Total Questions 150 Multiple Choice
Cognitive Levels 20% Recall | 50% Application | 30% Analysis
Question Style 75% Scenario-Based | 25% Direct Knowledge
Aligned With HESI RN Specialty Blueprint
NCLEX-RN Test Plan
BSN 225 Course Syllabus
Special Inclusions 20 Priority-Setting | 15 Pharmacology
10 Delegation | 5 Integrated Case Studies
A Comprehensive Specialty Examination Study Guide
for BSN 225 HESI RN Specialty Fundamentals of Nursing Examination Preparation
Nightingale College | BSN Program | Department of Nursing Education
Aligned with Fundamentals of Nursing Competencies (2026/2027 Edition)
,BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide Edition | Grade A - Nightingale
Section 1: Safe & Effective Care Environment - Management of Care
Q1: A registered nurse (RN) on a medical-surgical unit is delegating care for the shift. Which of the
following tasks is most appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Teaching a newly diagnosed diabetic patient about foot care
B. Assessing a patient's surgical incision for signs of infection
C. Ambulating a stable postoperative patient who is 24 hours status post total knee replacement
*[CORRECT]*
D. Evaluating a patient's response to a newly administered IV analgesic
Correct Answer: C
Rationale: The RN retains tasks requiring nursing judgment (assessment, teaching, evaluation, and care planning) per the
Nurse Practice Act and ANA Principles of Delegation. UAP may perform activities of daily living, ambulation of stable
patients, and basic hygiene. Ambulating a stable postoperative patient is a routine, non-invasive task with predictable outcomes
that falls within the UAP scope. The other options involve assessment, teaching, and evaluation - the five rights of delegation
confirm that these require RN-level clinical judgment and cannot be delegated.
Q2: Which of the following clients should the RN assign to a licensed practical nurse (LPN) rather than to a
UAP?
A. A client who requires initial admission assessment and development of the plan of care
B. A stable client with a chronic pressure injury requiring a sterile dressing change *[CORRECT]*
C. A client newly admitted with acute exacerbation of heart failure requiring IV diuretics
D. A client who needs preoperative teaching about a coronary artery bypass graft
Correct Answer: B
Rationale: The LPN/VN scope of practice includes caring for stable clients with predictable outcomes, performing sterile
dressing changes, administering oral medications, and monitoring established care. Initial admission assessment (A), care of
unstable acute conditions requiring complex IV therapy (C), and preoperative teaching (D) require RN-level judgment.
Assigning a stable client with a chronic wound to the LPN aligns with the BSN 225 curriculum on differentiated practice and
the NCLEX-RN delegation framework using the Five Rights of Delegation.
Q3: The RN is caring for four clients and delegates obtaining routine vital signs to a UAP. Which statement
by the UAP requires the RN to intervene?
A. I will report any systolic blood pressure greater than 160 mmHg to you immediately.
B. I will re-measure the blood pressure on the client with the abnormal reading using the same arm.
C. I will skip obtaining vital signs on the client who just returned from a cardiac catheterization.
*[CORRECT]*
D. I will document all vital signs in the electronic health record after I finish my rounds.
Correct Answer: C
Rationale: Post-cardiac catheterization clients require vital sign monitoring per protocol to detect bleeding, hematoma, or
contrast-induced complications; the UAP cannot independently decide to skip vital signs. This represents a scope-of-practice
violation and a safety risk. Options A, B, and D demonstrate appropriate UAP judgment under RN supervision - reporting
critical values, repeating measurements to verify accuracy, and documenting routine data. The RN retains accountability for
delegation outcomes per the ANA Principles of Delegation and the BSN 225 curriculum on supervision.
Q4: An RN delegates fingerstick blood glucose monitoring to a UAP. Which component of the Five Rights
of Delegation is being demonstrated when the RN confirms the UAP has been competency-validated on the
glucometer?
A. Right task
B. Right circumstance
C. Right person *[CORRECT]*
D. Right direction and communication
Page 2
,BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide Edition | Grade A - Nightingale
Correct Answer: C
Rationale: The Five Rights of Delegation are: right task, right circumstance, right person, right direction/communication, and
right supervision/evaluation. The right person ensures the delegatee has the appropriate knowledge, skills, and demonstrated
competency to perform the task safely. Competency validation on the glucometer directly addresses the right person principle.
Right task involves matching the activity to the delegatee's scope, right circumstance considers the client's condition and setting,
and right direction/communication involves clear instructions - all are essential but do not address competency validation.
Q5: A UAP reports to the RN that a client's oral temperature is 39.2 C (102.6 F). The RN is in another
client's room administering IV morphine. What is the RN's best action?
A. Tell the UAP to recheck the temperature in 30 minutes and report back
B. Complete the medication administration, then assess the febrile client within 10 minutes *[CORRECT]*
C. Direct the UAP to administer acetaminophen 650 mg PO from the PRN drawer
D. Send another RN to assess the client while completing the current medication administration
Correct Answer: B
Rationale: Patient safety requires the RN to complete the current medication administration safely (avoiding a medication
error with a high-alert opioid) and then promptly assess the febrile client. The nurse cannot delegate assessment or PRN
medication administration to a UAP (option C is a scope-of-practice violation). Option A delays necessary intervention. The
most realistic NCLEX-RN answer prioritizes completing the immediate task safely while ensuring timely follow-up assessment
- this aligns with BSN 225 prioritization principles and safe medication administration. Note: In some agency policies, option D
would also be acceptable when another RN is immediately available.
Q6: The RN receives change-of-shift report on four clients. Which client should the nurse assess FIRST?
A. A client with diabetes mellitus who has a fasting blood glucose of 180 mg/dL
B. A client with chronic obstructive pulmonary disease who has an SpO2 of 88% on room air *[CORRECT]*
C. A client who is 2 days postoperative with a temperature of 38.1 C (100.6 F)
D. A client with heart failure who has gained 1 kg (2.2 lb) since yesterday
Correct Answer: B
Rationale: The ABC framework (Airway, Breathing, Circulation) is the highest-priority prioritization principle per the
NCLEX-RN Test Plan and HESI RN Specialty blueprint. An SpO2 of 88% on room air in a COPD client indicates significant
respiratory compromise requiring immediate assessment and possible oxygen titration. While the other clients need evaluation,
none represent acute physiological instability of the airway/breathing priority. The diabetic client (A) has mildly elevated
glucose, the postoperative client (C) has a low-grade fever needing evaluation, and the heart failure client (D) has slight weight
gain - all are lower priority than respiratory compromise.
Q7: Which of the following client needs should the nurse address FIRST according to Maslow's hierarchy
of needs?
A. A client who is anxious about an upcoming diagnostic procedure
B. A client who refuses to take prescribed antihypertensive medication
C. A client who reports new onset of shortness of breath and chest tightness *[CORRECT]*
D. A client who expresses feelings of isolation and lack of family support
Correct Answer: C
Rationale: Maslow's hierarchy prioritizes physiological needs (oxygen, circulation) above safety, love/belonging, esteem, and
self-actualization needs. New onset shortness of breath and chest tightness suggests a potential life-threatening cardiopulmonary
event requiring immediate intervention - this is a physiological priority. Anxiety (A) addresses safety/security, refusing
medication (B) addresses physiological stability but not acutely, and isolation (D) addresses love/belonging. BSN 225
curriculum integrates Maslow with the nursing process to triage client needs systematically. The ABC-Maslow framework is
foundational to NCLEX-RN prioritization.
Q8: At 0800, the RN has the following client care activities to complete. Which should the nurse do FIRST?
A. Administer scheduled morning insulin to a client with type 1 diabetes
B. Perform sterile dressing change on a client with a stage 3 pressure injury
Page 3
, BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide Edition | Grade A - Nightingale
C. Hang a new bag of total parenteral nutrition (TPN) for a client whose current bag is nearly empty
*[CORRECT]*
D. Administer prescribed IV antibiotic to a client with pneumonia scheduled for 0800
Correct Answer: C
Rationale: TPN must be infused on a continuous schedule to prevent rebound hypoglycemia and metabolic disturbances; if the
bag runs dry, the client is at risk for severe hypoglycemia and electrolyte shifts. While all options are time-sensitive, TPN
continuation represents an acute physiological threat if interrupted. Scheduled insulin (A) is important but typically has a 30-60
minute window. The dressing change (B) is important but not time-critical. The antibiotic (D) is scheduled but generally allows
a 30-minute window. The BSN 225 curriculum emphasizes anticipating and preventing complications through prioritization.
Q9: The charge nurse is making assignments for four newly admitted clients. Which client should be
assigned to the most experienced RN?
A. A 78-year-old client admitted with dehydration receiving IV fluids
B. A 45-year-old client admitted with acute pancreatitis requiring pain management
C. A 62-year-old client admitted with acute exacerbation of COPD on a non-rebreather mask *[CORRECT]*
D. A 28-year-old postoperative client 24 hours after appendectomy
Correct Answer: C
Rationale: The most experienced RN should be assigned the client with the highest acuity and most complex assessment needs.
The COPD client on a non-rebreather mask is critically ill and requires frequent respiratory assessment, titration of oxygen, and
anticipation of possible intubation. This represents the highest level of acuity and complexity. The other clients are more stable
and could be managed by less experienced staff with appropriate supervision. The BSN 225 curriculum and HESI blueprint
emphasize matching client acuity with staff competency to ensure safe, effective care.
Q10: While the RN is administering medications, a UAP runs to the medication room and reports that a
client has collapsed in the hallway and is unresponsive. What is the nurse's FIRST action?
A. Finish administering the medication, then respond to the emergency
B. Direct the UAP to call a rapid response team while the nurse assesses the client
C. Lock the medication cart and immediately assess the collapsed client's airway and pulse *[CORRECT]*
D. Call the healthcare provider for an order to leave the medication room
Correct Answer: C
Rationale: Patient safety in an emergent situation takes priority; the nurse must immediately assess the collapsed client's
airway, breathing, and circulation (ABC) and initiate CPR if needed. The medication cart must be secured (locked) to maintain
medication safety per Joint Commission standards, but securing the cart takes seconds. Activating the rapid response team (B)
is appropriate but the nurse must first assess the client. The BLS/ACLS algorithm and BSN 225 curriculum emphasize rapid
assessment and intervention in collapse situations - this aligns with the NCLEX-RN approach to emergent clinical scenarios.
Q11: A client is scheduled for an elective cholecystectomy in the morning. The surgeon has explained the
procedure, risks, and alternatives, and the client signs the consent form. The client later asks the nurse, "I
signed it, but I'm not really sure what they're going to do." What is the nurse's BEST response?
A. The surgeon already explained everything; just sign the form again to confirm you understand.
B. I will notify the surgeon that you have additional questions about the procedure. *[CORRECT]*
C. The surgery is elective, so you don't need to worry about understanding the details.
D. Let me explain the procedure to you since I witnessed your signature on the consent.
Correct Answer: B
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives - this is the
surgeon's legal and ethical responsibility. If the nurse identifies that the client does not understand, the nurse must notify the
surgeon so the surgeon can provide additional explanation. The nurse's role is to witness the signature and verify understanding,
not to obtain consent. Option A violates informed consent principles. Option C dismisses the client's right to information.
Option D is incorrect because explaining the procedure is the surgeon's responsibility - the nurse can reinforce teaching but
cannot substitute for the provider. This aligns with the BSN 225 curriculum on legal/ethical principles.
Page 4
BSN 225 HESI RN Specialty
Fundamentals of Nursing
Exam Study Guide
Latest Update | 100% Correct | Grade A
Total Questions 150 Multiple Choice
Cognitive Levels 20% Recall | 50% Application | 30% Analysis
Question Style 75% Scenario-Based | 25% Direct Knowledge
Aligned With HESI RN Specialty Blueprint
NCLEX-RN Test Plan
BSN 225 Course Syllabus
Special Inclusions 20 Priority-Setting | 15 Pharmacology
10 Delegation | 5 Integrated Case Studies
A Comprehensive Specialty Examination Study Guide
for BSN 225 HESI RN Specialty Fundamentals of Nursing Examination Preparation
Nightingale College | BSN Program | Department of Nursing Education
Aligned with Fundamentals of Nursing Competencies (2026/2027 Edition)
,BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide Edition | Grade A - Nightingale
Section 1: Safe & Effective Care Environment - Management of Care
Q1: A registered nurse (RN) on a medical-surgical unit is delegating care for the shift. Which of the
following tasks is most appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Teaching a newly diagnosed diabetic patient about foot care
B. Assessing a patient's surgical incision for signs of infection
C. Ambulating a stable postoperative patient who is 24 hours status post total knee replacement
*[CORRECT]*
D. Evaluating a patient's response to a newly administered IV analgesic
Correct Answer: C
Rationale: The RN retains tasks requiring nursing judgment (assessment, teaching, evaluation, and care planning) per the
Nurse Practice Act and ANA Principles of Delegation. UAP may perform activities of daily living, ambulation of stable
patients, and basic hygiene. Ambulating a stable postoperative patient is a routine, non-invasive task with predictable outcomes
that falls within the UAP scope. The other options involve assessment, teaching, and evaluation - the five rights of delegation
confirm that these require RN-level clinical judgment and cannot be delegated.
Q2: Which of the following clients should the RN assign to a licensed practical nurse (LPN) rather than to a
UAP?
A. A client who requires initial admission assessment and development of the plan of care
B. A stable client with a chronic pressure injury requiring a sterile dressing change *[CORRECT]*
C. A client newly admitted with acute exacerbation of heart failure requiring IV diuretics
D. A client who needs preoperative teaching about a coronary artery bypass graft
Correct Answer: B
Rationale: The LPN/VN scope of practice includes caring for stable clients with predictable outcomes, performing sterile
dressing changes, administering oral medications, and monitoring established care. Initial admission assessment (A), care of
unstable acute conditions requiring complex IV therapy (C), and preoperative teaching (D) require RN-level judgment.
Assigning a stable client with a chronic wound to the LPN aligns with the BSN 225 curriculum on differentiated practice and
the NCLEX-RN delegation framework using the Five Rights of Delegation.
Q3: The RN is caring for four clients and delegates obtaining routine vital signs to a UAP. Which statement
by the UAP requires the RN to intervene?
A. I will report any systolic blood pressure greater than 160 mmHg to you immediately.
B. I will re-measure the blood pressure on the client with the abnormal reading using the same arm.
C. I will skip obtaining vital signs on the client who just returned from a cardiac catheterization.
*[CORRECT]*
D. I will document all vital signs in the electronic health record after I finish my rounds.
Correct Answer: C
Rationale: Post-cardiac catheterization clients require vital sign monitoring per protocol to detect bleeding, hematoma, or
contrast-induced complications; the UAP cannot independently decide to skip vital signs. This represents a scope-of-practice
violation and a safety risk. Options A, B, and D demonstrate appropriate UAP judgment under RN supervision - reporting
critical values, repeating measurements to verify accuracy, and documenting routine data. The RN retains accountability for
delegation outcomes per the ANA Principles of Delegation and the BSN 225 curriculum on supervision.
Q4: An RN delegates fingerstick blood glucose monitoring to a UAP. Which component of the Five Rights
of Delegation is being demonstrated when the RN confirms the UAP has been competency-validated on the
glucometer?
A. Right task
B. Right circumstance
C. Right person *[CORRECT]*
D. Right direction and communication
Page 2
,BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide Edition | Grade A - Nightingale
Correct Answer: C
Rationale: The Five Rights of Delegation are: right task, right circumstance, right person, right direction/communication, and
right supervision/evaluation. The right person ensures the delegatee has the appropriate knowledge, skills, and demonstrated
competency to perform the task safely. Competency validation on the glucometer directly addresses the right person principle.
Right task involves matching the activity to the delegatee's scope, right circumstance considers the client's condition and setting,
and right direction/communication involves clear instructions - all are essential but do not address competency validation.
Q5: A UAP reports to the RN that a client's oral temperature is 39.2 C (102.6 F). The RN is in another
client's room administering IV morphine. What is the RN's best action?
A. Tell the UAP to recheck the temperature in 30 minutes and report back
B. Complete the medication administration, then assess the febrile client within 10 minutes *[CORRECT]*
C. Direct the UAP to administer acetaminophen 650 mg PO from the PRN drawer
D. Send another RN to assess the client while completing the current medication administration
Correct Answer: B
Rationale: Patient safety requires the RN to complete the current medication administration safely (avoiding a medication
error with a high-alert opioid) and then promptly assess the febrile client. The nurse cannot delegate assessment or PRN
medication administration to a UAP (option C is a scope-of-practice violation). Option A delays necessary intervention. The
most realistic NCLEX-RN answer prioritizes completing the immediate task safely while ensuring timely follow-up assessment
- this aligns with BSN 225 prioritization principles and safe medication administration. Note: In some agency policies, option D
would also be acceptable when another RN is immediately available.
Q6: The RN receives change-of-shift report on four clients. Which client should the nurse assess FIRST?
A. A client with diabetes mellitus who has a fasting blood glucose of 180 mg/dL
B. A client with chronic obstructive pulmonary disease who has an SpO2 of 88% on room air *[CORRECT]*
C. A client who is 2 days postoperative with a temperature of 38.1 C (100.6 F)
D. A client with heart failure who has gained 1 kg (2.2 lb) since yesterday
Correct Answer: B
Rationale: The ABC framework (Airway, Breathing, Circulation) is the highest-priority prioritization principle per the
NCLEX-RN Test Plan and HESI RN Specialty blueprint. An SpO2 of 88% on room air in a COPD client indicates significant
respiratory compromise requiring immediate assessment and possible oxygen titration. While the other clients need evaluation,
none represent acute physiological instability of the airway/breathing priority. The diabetic client (A) has mildly elevated
glucose, the postoperative client (C) has a low-grade fever needing evaluation, and the heart failure client (D) has slight weight
gain - all are lower priority than respiratory compromise.
Q7: Which of the following client needs should the nurse address FIRST according to Maslow's hierarchy
of needs?
A. A client who is anxious about an upcoming diagnostic procedure
B. A client who refuses to take prescribed antihypertensive medication
C. A client who reports new onset of shortness of breath and chest tightness *[CORRECT]*
D. A client who expresses feelings of isolation and lack of family support
Correct Answer: C
Rationale: Maslow's hierarchy prioritizes physiological needs (oxygen, circulation) above safety, love/belonging, esteem, and
self-actualization needs. New onset shortness of breath and chest tightness suggests a potential life-threatening cardiopulmonary
event requiring immediate intervention - this is a physiological priority. Anxiety (A) addresses safety/security, refusing
medication (B) addresses physiological stability but not acutely, and isolation (D) addresses love/belonging. BSN 225
curriculum integrates Maslow with the nursing process to triage client needs systematically. The ABC-Maslow framework is
foundational to NCLEX-RN prioritization.
Q8: At 0800, the RN has the following client care activities to complete. Which should the nurse do FIRST?
A. Administer scheduled morning insulin to a client with type 1 diabetes
B. Perform sterile dressing change on a client with a stage 3 pressure injury
Page 3
, BSN 225 HESI RN Specialty Fundamentals of Nursing Exam Study Guide Edition | Grade A - Nightingale
C. Hang a new bag of total parenteral nutrition (TPN) for a client whose current bag is nearly empty
*[CORRECT]*
D. Administer prescribed IV antibiotic to a client with pneumonia scheduled for 0800
Correct Answer: C
Rationale: TPN must be infused on a continuous schedule to prevent rebound hypoglycemia and metabolic disturbances; if the
bag runs dry, the client is at risk for severe hypoglycemia and electrolyte shifts. While all options are time-sensitive, TPN
continuation represents an acute physiological threat if interrupted. Scheduled insulin (A) is important but typically has a 30-60
minute window. The dressing change (B) is important but not time-critical. The antibiotic (D) is scheduled but generally allows
a 30-minute window. The BSN 225 curriculum emphasizes anticipating and preventing complications through prioritization.
Q9: The charge nurse is making assignments for four newly admitted clients. Which client should be
assigned to the most experienced RN?
A. A 78-year-old client admitted with dehydration receiving IV fluids
B. A 45-year-old client admitted with acute pancreatitis requiring pain management
C. A 62-year-old client admitted with acute exacerbation of COPD on a non-rebreather mask *[CORRECT]*
D. A 28-year-old postoperative client 24 hours after appendectomy
Correct Answer: C
Rationale: The most experienced RN should be assigned the client with the highest acuity and most complex assessment needs.
The COPD client on a non-rebreather mask is critically ill and requires frequent respiratory assessment, titration of oxygen, and
anticipation of possible intubation. This represents the highest level of acuity and complexity. The other clients are more stable
and could be managed by less experienced staff with appropriate supervision. The BSN 225 curriculum and HESI blueprint
emphasize matching client acuity with staff competency to ensure safe, effective care.
Q10: While the RN is administering medications, a UAP runs to the medication room and reports that a
client has collapsed in the hallway and is unresponsive. What is the nurse's FIRST action?
A. Finish administering the medication, then respond to the emergency
B. Direct the UAP to call a rapid response team while the nurse assesses the client
C. Lock the medication cart and immediately assess the collapsed client's airway and pulse *[CORRECT]*
D. Call the healthcare provider for an order to leave the medication room
Correct Answer: C
Rationale: Patient safety in an emergent situation takes priority; the nurse must immediately assess the collapsed client's
airway, breathing, and circulation (ABC) and initiate CPR if needed. The medication cart must be secured (locked) to maintain
medication safety per Joint Commission standards, but securing the cart takes seconds. Activating the rapid response team (B)
is appropriate but the nurse must first assess the client. The BLS/ACLS algorithm and BSN 225 curriculum emphasize rapid
assessment and intervention in collapse situations - this aligns with the NCLEX-RN approach to emergent clinical scenarios.
Q11: A client is scheduled for an elective cholecystectomy in the morning. The surgeon has explained the
procedure, risks, and alternatives, and the client signs the consent form. The client later asks the nurse, "I
signed it, but I'm not really sure what they're going to do." What is the nurse's BEST response?
A. The surgeon already explained everything; just sign the form again to confirm you understand.
B. I will notify the surgeon that you have additional questions about the procedure. *[CORRECT]*
C. The surgery is elective, so you don't need to worry about understanding the details.
D. Let me explain the procedure to you since I witnessed your signature on the consent.
Correct Answer: B
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives - this is the
surgeon's legal and ethical responsibility. If the nurse identifies that the client does not understand, the nurse must notify the
surgeon so the surgeon can provide additional explanation. The nurse's role is to witness the signature and verify understanding,
not to obtain consent. Option A violates informed consent principles. Option C dismisses the client's right to information.
Option D is incorrect because explaining the procedure is the surgeon's responsibility - the nurse can reinforce teaching but
cannot substitute for the provider. This aligns with the BSN 225 curriculum on legal/ethical principles.
Page 4
