NUR 104 / NUR104 HESI – Foundations of Nursing Review
V2: (Latest 2026/2027 Update) Verified Questions &
Answers with Detailed Rationales | Grade A
SUBTITLE:
50 Exam Questions with Answers & Detailed Rationales
PREPARED FOR:
NUR 104 Foundations of Nursing HESI Review - Fortis College
DOCUMENT INCLUDES:
● HESI-style exam questions
● Correct answers
● Detailed rationales
● Key topics covered
TOPICS COVERED:
● Nursing Process (ADPIE) & Clinical Judgment
● Safety & Infection Control
● Vital Signs & Physical Assessment
● Medication Administration Fundamentals
● Basic Care & Comfort / Hygiene
● Mobility & Immobility
● Nutrition, Hydration & Elimination
● Communication, Documentation & Patient Teaching
● Legal, Ethical & Cultural Considerations
● Growth & Development, Pain Management & Special Populations
,SECTION 1: Nursing Process & Clinical Judgment
Question 1
A nurse is caring for a client who reports severe chest pain. The nurse immediately
obtains vital signs and auscultates heart sounds. Which step of the nursing process is
the nurse performing?
A. Analysis
B. Planning
C. Implementation
D. Assessment
Correct Answer: D
Rationale: Assessment is the first step of the nursing process (ADPIE) and involves the
systematic collection of subjective and objective data. The nurse is gathering data
through vital signs and physical assessment. Analysis (A) involves identifying patterns
and formulating nursing diagnoses. Planning (B) involves setting goals and expected
outcomes. Implementation (C) involves performing nursing interventions.
Question 2
Which statement best describes the difference between a medical diagnosis and a
nursing diagnosis?
A. A medical diagnosis identifies a disease process, while a nursing diagnosis identifies
a client's response to an illness.
B. A medical diagnosis is made by the nurse, while a nursing diagnosis is made by the
physician.
C. A medical diagnosis remains constant throughout hospitalization, while a nursing
diagnosis changes every shift.
, D. A medical diagnosis focuses on prevention, while a nursing diagnosis focuses on
cure.
Correct Answer: A
Rationale: A medical diagnosis identifies a specific disease or pathology (e.g.,
pneumonia), while a nursing diagnosis identifies the client's human response to health
conditions or life processes (e.g., impaired gas exchange). Option B is incorrect
because physicians make medical diagnoses and nurses make nursing diagnoses.
Option C is incorrect because both types of diagnoses can change based on the client's
condition. Option D is incorrect because nursing focuses on holistic care, not cure.
Question 3
A nurse is developing a care plan for a client with impaired mobility. Which goal is
written correctly using SMART criteria?
A. The client will walk.
B. The client will ambulate 50 feet using a walker without assistance by discharge.
C. The nurse will assist the client with walking daily.
D. The client will improve mobility.
Correct Answer: B
Rationale: SMART goals are Specific, Measurable, Achievable, Relevant, and
Time-bound. Option B specifies the exact action (ambulate 50 feet), method (using a
walker), level of assistance (without assistance), and timeframe (by discharge). Option
A is not measurable or time-bound. Option C focuses on the nurse's action rather than
the client's outcome. Option D is vague and not measurable.
Question 4
V2: (Latest 2026/2027 Update) Verified Questions &
Answers with Detailed Rationales | Grade A
SUBTITLE:
50 Exam Questions with Answers & Detailed Rationales
PREPARED FOR:
NUR 104 Foundations of Nursing HESI Review - Fortis College
DOCUMENT INCLUDES:
● HESI-style exam questions
● Correct answers
● Detailed rationales
● Key topics covered
TOPICS COVERED:
● Nursing Process (ADPIE) & Clinical Judgment
● Safety & Infection Control
● Vital Signs & Physical Assessment
● Medication Administration Fundamentals
● Basic Care & Comfort / Hygiene
● Mobility & Immobility
● Nutrition, Hydration & Elimination
● Communication, Documentation & Patient Teaching
● Legal, Ethical & Cultural Considerations
● Growth & Development, Pain Management & Special Populations
,SECTION 1: Nursing Process & Clinical Judgment
Question 1
A nurse is caring for a client who reports severe chest pain. The nurse immediately
obtains vital signs and auscultates heart sounds. Which step of the nursing process is
the nurse performing?
A. Analysis
B. Planning
C. Implementation
D. Assessment
Correct Answer: D
Rationale: Assessment is the first step of the nursing process (ADPIE) and involves the
systematic collection of subjective and objective data. The nurse is gathering data
through vital signs and physical assessment. Analysis (A) involves identifying patterns
and formulating nursing diagnoses. Planning (B) involves setting goals and expected
outcomes. Implementation (C) involves performing nursing interventions.
Question 2
Which statement best describes the difference between a medical diagnosis and a
nursing diagnosis?
A. A medical diagnosis identifies a disease process, while a nursing diagnosis identifies
a client's response to an illness.
B. A medical diagnosis is made by the nurse, while a nursing diagnosis is made by the
physician.
C. A medical diagnosis remains constant throughout hospitalization, while a nursing
diagnosis changes every shift.
, D. A medical diagnosis focuses on prevention, while a nursing diagnosis focuses on
cure.
Correct Answer: A
Rationale: A medical diagnosis identifies a specific disease or pathology (e.g.,
pneumonia), while a nursing diagnosis identifies the client's human response to health
conditions or life processes (e.g., impaired gas exchange). Option B is incorrect
because physicians make medical diagnoses and nurses make nursing diagnoses.
Option C is incorrect because both types of diagnoses can change based on the client's
condition. Option D is incorrect because nursing focuses on holistic care, not cure.
Question 3
A nurse is developing a care plan for a client with impaired mobility. Which goal is
written correctly using SMART criteria?
A. The client will walk.
B. The client will ambulate 50 feet using a walker without assistance by discharge.
C. The nurse will assist the client with walking daily.
D. The client will improve mobility.
Correct Answer: B
Rationale: SMART goals are Specific, Measurable, Achievable, Relevant, and
Time-bound. Option B specifies the exact action (ambulate 50 feet), method (using a
walker), level of assistance (without assistance), and timeframe (by discharge). Option
A is not measurable or time-bound. Option C focuses on the nurse's action rather than
the client's outcome. Option D is vague and not measurable.
Question 4
