HESI BSN Fundamentals Exam – 2026
Updated 300 NCLEX-Style Questions with
Answers & Rationales
1. A nurse is preparing to insert an indwelling urinary catheter for a
female client. Which action demonstrates proper sterile technique?
A. Open the sterile kit facing away from the body
B. Use sterile gloves and then open the inner wrap
C. Place the sterile drape with the shiny side up
D. Clean each labial fold with the same cotton ball
Answer: B
Rationale: Sterile gloves are required before handling sterile supplies.
Opening the inner wrap after gloving maintains sterility. Shiny side is
usually impermeable but should be down. Each fold requires a separate
cotton ball.
2. A client with chronic obstructive pulmonary disease (COPD) has an
oxygen saturation of 88%. The nurse should first:
A. Increase oxygen to 4 L/min via nasal cannula
B. Encourage deep breathing and coughing
C. Place client in high Fowler's position
D. Auscultate lung sounds
Answer: C
Rationale: Positioning to maximize lung expansion is the first
noninvasive intervention. Increasing O2 without assessment can
worsen CO2 retention in some COPD clients.
,3. A nurse is calculating intake for a client with heart failure. The client
drank 240 mL of water, 120 mL of coffee, and ate 180 mL of ice chips.
What is the total intake?
A. 420 mL
B. 450 mL
C. 540 mL
D. 620 mL
Answer: B
Rationale: Ice chips are counted as half volume (180 mL ice chips = 90
mL water). Total = 240 + 120 + 90 = 450 mL.
4. Which client is at highest risk for developing a pressure injury?
A. 35-year-old with a fractured tibia in a cast
B. 68-year-old with incontinence and immobility
C. 50-year-old with hypertension on a beta-blocker
D. 42-year-old with diabetes and normal skin turgor
Answer: B
Rationale: Incontinence (moisture) + immobility (pressure) + advanced
age are major risk factors for pressure injuries.
5. A nurse delegates vital signs to an unlicensed assistive personnel
(UAP). Which client should the nurse assign to the UAP?
A. Client 1 hour post-cardiac catheterization
B. Client on a patient-controlled analgesia (PCA) pump
C. Client with stable vital signs and ambulatory
D. Client with new-onset confusion
Answer: C
Rationale: Stable, predictable clients are appropriate for UAP
,delegation. Unstable or post-procedure clients require licensed nurse
assessment.
6. A client has a prescription for enoxaparin (Lovenox) subcutaneously.
Which technique is correct?
A. Aspirate before injection
B. Massage the site after injection
C. Inject into the deltoid muscle
D. Pinch skin fold and insert needle at 90 degrees
Answer: D
Rationale: Enoxaparin is given subcutaneously into the abdomen, 90-
degree angle with skin fold. No aspiration, no massage (prevents
bruising/hematoma).
7. A nurse is teaching a client with a new colostomy. Which statement
indicates understanding?
A. "I will change the pouch every day."
B. "I should eat more popcorn and nuts for fiber."
C. "I will cut the wafer opening 1/8 inch larger than my stoma."
D. "I can use soap and water to clean the stoma directly."
Answer: C
Rationale: Allows for stoma swelling without skin contact. Daily
changing causes skin breakdown; popcorn/nuts risk blockage; stoma
should be cleaned with water only.
8. A client's ABG results: pH 7.30, PaCO2 50 mm Hg, HCO3 24 mEq/L.
The nurse interprets this as:
A. Metabolic acidosis
B. Metabolic alkalosis
, C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: Low pH (acidosis) + high PaCO2 (respiratory cause) +
normal HCO3 (no renal compensation yet) = acute respiratory acidosis.
9. Which finding in a client with a new tracheostomy requires
immediate action?
A. Small amount of blood-tinged mucus
B. Crackles in bilateral lung bases
C. Tracheostomy ties that allow one finger underneath
D. Client unable to speak
Answer: D
Rationale: Sudden inability to speak may indicate tube obstruction or
displacement. This is an airway emergency.
10. A nurse is performing a sterile wound dressing change. After
opening the sterile kit, the nurse drops a sterile gauze onto the bedside
table. What should the nurse do?
A. Use the gauze since it fell on a clean surface
B. Discard the gauze and obtain a new one
C. Rinse the gauze with sterile saline
D. Flip the gauze over and use the other side
Answer: B
Rationale: Any sterile item that touches a nonsterile surface (including
bedside table) is contaminated and must be discarded.
11. A client with dementia repeatedly tries to get out of bed. Which
intervention is most appropriate?
Updated 300 NCLEX-Style Questions with
Answers & Rationales
1. A nurse is preparing to insert an indwelling urinary catheter for a
female client. Which action demonstrates proper sterile technique?
A. Open the sterile kit facing away from the body
B. Use sterile gloves and then open the inner wrap
C. Place the sterile drape with the shiny side up
D. Clean each labial fold with the same cotton ball
Answer: B
Rationale: Sterile gloves are required before handling sterile supplies.
Opening the inner wrap after gloving maintains sterility. Shiny side is
usually impermeable but should be down. Each fold requires a separate
cotton ball.
2. A client with chronic obstructive pulmonary disease (COPD) has an
oxygen saturation of 88%. The nurse should first:
A. Increase oxygen to 4 L/min via nasal cannula
B. Encourage deep breathing and coughing
C. Place client in high Fowler's position
D. Auscultate lung sounds
Answer: C
Rationale: Positioning to maximize lung expansion is the first
noninvasive intervention. Increasing O2 without assessment can
worsen CO2 retention in some COPD clients.
,3. A nurse is calculating intake for a client with heart failure. The client
drank 240 mL of water, 120 mL of coffee, and ate 180 mL of ice chips.
What is the total intake?
A. 420 mL
B. 450 mL
C. 540 mL
D. 620 mL
Answer: B
Rationale: Ice chips are counted as half volume (180 mL ice chips = 90
mL water). Total = 240 + 120 + 90 = 450 mL.
4. Which client is at highest risk for developing a pressure injury?
A. 35-year-old with a fractured tibia in a cast
B. 68-year-old with incontinence and immobility
C. 50-year-old with hypertension on a beta-blocker
D. 42-year-old with diabetes and normal skin turgor
Answer: B
Rationale: Incontinence (moisture) + immobility (pressure) + advanced
age are major risk factors for pressure injuries.
5. A nurse delegates vital signs to an unlicensed assistive personnel
(UAP). Which client should the nurse assign to the UAP?
A. Client 1 hour post-cardiac catheterization
B. Client on a patient-controlled analgesia (PCA) pump
C. Client with stable vital signs and ambulatory
D. Client with new-onset confusion
Answer: C
Rationale: Stable, predictable clients are appropriate for UAP
,delegation. Unstable or post-procedure clients require licensed nurse
assessment.
6. A client has a prescription for enoxaparin (Lovenox) subcutaneously.
Which technique is correct?
A. Aspirate before injection
B. Massage the site after injection
C. Inject into the deltoid muscle
D. Pinch skin fold and insert needle at 90 degrees
Answer: D
Rationale: Enoxaparin is given subcutaneously into the abdomen, 90-
degree angle with skin fold. No aspiration, no massage (prevents
bruising/hematoma).
7. A nurse is teaching a client with a new colostomy. Which statement
indicates understanding?
A. "I will change the pouch every day."
B. "I should eat more popcorn and nuts for fiber."
C. "I will cut the wafer opening 1/8 inch larger than my stoma."
D. "I can use soap and water to clean the stoma directly."
Answer: C
Rationale: Allows for stoma swelling without skin contact. Daily
changing causes skin breakdown; popcorn/nuts risk blockage; stoma
should be cleaned with water only.
8. A client's ABG results: pH 7.30, PaCO2 50 mm Hg, HCO3 24 mEq/L.
The nurse interprets this as:
A. Metabolic acidosis
B. Metabolic alkalosis
, C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: Low pH (acidosis) + high PaCO2 (respiratory cause) +
normal HCO3 (no renal compensation yet) = acute respiratory acidosis.
9. Which finding in a client with a new tracheostomy requires
immediate action?
A. Small amount of blood-tinged mucus
B. Crackles in bilateral lung bases
C. Tracheostomy ties that allow one finger underneath
D. Client unable to speak
Answer: D
Rationale: Sudden inability to speak may indicate tube obstruction or
displacement. This is an airway emergency.
10. A nurse is performing a sterile wound dressing change. After
opening the sterile kit, the nurse drops a sterile gauze onto the bedside
table. What should the nurse do?
A. Use the gauze since it fell on a clean surface
B. Discard the gauze and obtain a new one
C. Rinse the gauze with sterile saline
D. Flip the gauze over and use the other side
Answer: B
Rationale: Any sterile item that touches a nonsterile surface (including
bedside table) is contaminated and must be discarded.
11. A client with dementia repeatedly tries to get out of bed. Which
intervention is most appropriate?
