XACTIMATE X2 EXAM STUDY GUIDE 2026
PRACTICE QUESTIONS AND SOLUTIONS
◉ Which intervention should the school nurse implement to decrease the
incidence of hepatitis A in a preschool setting?
A. Promote hygiene by ensuring that children's faces and hair are kept
clean.
B. Ensure that all enrolled children have been immunized for Hepatitis
A. Correct
C. Put a strip bandage on bleeding injuries to prevent contamination of
others.
D. Teach children the correct handwashing technique to use after
toileting. Answer: B. The CDC recommended immunization schedule
for children includes the hepatitis A vaccine (HAV), so follow-up of
enrolled children's immunization status with HAV or human-immune
gamma globulin should be implemented (B). Preschoolers should be
taught the importance of hygiene practices, such as (A and D), but
hepatitis A is transmitted via the fecal-oral route and immunization
provides the best universal protection. Hepatitis A is not transmitted
through blood contact (C). Category: Community Health
◉ When examining the wound of a client who had abdominal surgery
yesterday, the nurse finds that the wound edges are close together, there
,is no sign of redness, and there is a slight amount of bright red blood
oozing from the incision. What action should the nurse take?
A. Record these findings in the client's record. Correct
B. Observe closely for possible dehiscence.
C. Notify the healthcare provider that the client's wound is producing a
sanguineous drainage.
D. Increase the IV fluid rate and encourage the client to eat more ice
chips. Answer: A. These are normal findings for one-day postoperative
and indicate that the wound is healing by primary intention (A).
Dehiscence (B) is separation of a surgical incision, and there is no
indication that this is a possibility at this time. Serosanguineous drainage
is thin and red and is composed of serum and blood, and this client is not
exhibiting this finding, and even if the wound was producing this
drainage, the finding does not warrant (C). There is no indication of
dehydration, so (D) is not indicated at this time. Category: Fundamentals
◉ When culturing a wound, the nurse should obtain the sample from
which part of the wound?
A. The outer edges of the wound.
B. All necrotic sections of the wound.
C. Areas containing purulent or pooled exudates. Correct
D. Any particularly painful area of the wound. Answer: C. To collect a
wound culture, the nurse should first clean the wound to remove skin
flora and then insert a sterile swab from a culturette tube into the wound
secretions (C), then return the swab to the culturette tube, cap the tube,
and crush the inner ampoule so that the medium for the organism growth
, coats the swab. The culture should not be collected from (A, B, or D).
Category: Fundamentals
◉ While conducting a routine health assessment of a woman who
recently immigrated to the U.S. from China, the nurse notes that the
client makes little direct eye contact, is deferential to healthcare
personnel, and avoids sharing her personal thoughts and feelings. What
action should the nurse take?
A. Continue the interview process and record the findings. Correct
B. Refer the client to a psychiatric outpatient clinic.
C. Determine if there is a family history of emotional disorders.
D. Encourage the woman to attend citizenship classes. Answer: A. The
nurse should accept these behaviors as culturally determined and
continue with the interview (A). These behaviors are common in the
Chinese culture where people are members of strong, cohesive groups
that focus on the group rather than the individual. These behaviors are
not related to a psychiatric disorder (B and C). Citizenship (D) is an
individual choice, while cultural behaviors evolve over time. Category:
Fundamentals
◉ After the sudden death of a severely injured client while in transport
by helicopter, the flight nurse discovers that the oxygen tank that was
attached to the oxygen supply was empty during the transport. What
action should the flight nurse take?
A. Replace the empty tank without reporting the situation to any
members of the agency.
PRACTICE QUESTIONS AND SOLUTIONS
◉ Which intervention should the school nurse implement to decrease the
incidence of hepatitis A in a preschool setting?
A. Promote hygiene by ensuring that children's faces and hair are kept
clean.
B. Ensure that all enrolled children have been immunized for Hepatitis
A. Correct
C. Put a strip bandage on bleeding injuries to prevent contamination of
others.
D. Teach children the correct handwashing technique to use after
toileting. Answer: B. The CDC recommended immunization schedule
for children includes the hepatitis A vaccine (HAV), so follow-up of
enrolled children's immunization status with HAV or human-immune
gamma globulin should be implemented (B). Preschoolers should be
taught the importance of hygiene practices, such as (A and D), but
hepatitis A is transmitted via the fecal-oral route and immunization
provides the best universal protection. Hepatitis A is not transmitted
through blood contact (C). Category: Community Health
◉ When examining the wound of a client who had abdominal surgery
yesterday, the nurse finds that the wound edges are close together, there
,is no sign of redness, and there is a slight amount of bright red blood
oozing from the incision. What action should the nurse take?
A. Record these findings in the client's record. Correct
B. Observe closely for possible dehiscence.
C. Notify the healthcare provider that the client's wound is producing a
sanguineous drainage.
D. Increase the IV fluid rate and encourage the client to eat more ice
chips. Answer: A. These are normal findings for one-day postoperative
and indicate that the wound is healing by primary intention (A).
Dehiscence (B) is separation of a surgical incision, and there is no
indication that this is a possibility at this time. Serosanguineous drainage
is thin and red and is composed of serum and blood, and this client is not
exhibiting this finding, and even if the wound was producing this
drainage, the finding does not warrant (C). There is no indication of
dehydration, so (D) is not indicated at this time. Category: Fundamentals
◉ When culturing a wound, the nurse should obtain the sample from
which part of the wound?
A. The outer edges of the wound.
B. All necrotic sections of the wound.
C. Areas containing purulent or pooled exudates. Correct
D. Any particularly painful area of the wound. Answer: C. To collect a
wound culture, the nurse should first clean the wound to remove skin
flora and then insert a sterile swab from a culturette tube into the wound
secretions (C), then return the swab to the culturette tube, cap the tube,
and crush the inner ampoule so that the medium for the organism growth
, coats the swab. The culture should not be collected from (A, B, or D).
Category: Fundamentals
◉ While conducting a routine health assessment of a woman who
recently immigrated to the U.S. from China, the nurse notes that the
client makes little direct eye contact, is deferential to healthcare
personnel, and avoids sharing her personal thoughts and feelings. What
action should the nurse take?
A. Continue the interview process and record the findings. Correct
B. Refer the client to a psychiatric outpatient clinic.
C. Determine if there is a family history of emotional disorders.
D. Encourage the woman to attend citizenship classes. Answer: A. The
nurse should accept these behaviors as culturally determined and
continue with the interview (A). These behaviors are common in the
Chinese culture where people are members of strong, cohesive groups
that focus on the group rather than the individual. These behaviors are
not related to a psychiatric disorder (B and C). Citizenship (D) is an
individual choice, while cultural behaviors evolve over time. Category:
Fundamentals
◉ After the sudden death of a severely injured client while in transport
by helicopter, the flight nurse discovers that the oxygen tank that was
attached to the oxygen supply was empty during the transport. What
action should the flight nurse take?
A. Replace the empty tank without reporting the situation to any
members of the agency.
