NUR 255 – Exam Review Questions
2026 | Actual Q&A | 100% Correct-
Felbry College School of Nursing
1. 1. Question: A nurse is obtaining the blood pressure in a client's
lower extremity. Which of the following actions should the
nurse take?
Answer: D. Place the bladder of the cuff over the posterior aspect
of the thigh
Rationale: To accurately measure blood pressure using the
popliteal artery, the cuff must be placed over the posterior thigh
where the artery lies. This ensures proper alignment and reliable
readings. Other positions or arteries, like the dorsalis pedis, are
not appropriate for auscultation.
2. 2. Question: A nurse is caring for a client who has a positive
Mantoux skin test following screening for tuberculosis (TB). The
nurse should inform the client that this positive reaction
indicates which of the following findings?
Answer: D. Further evaluation is required
, Rationale: A positive Mantoux test shows TB exposure but doesn’t
confirm active disease. Further diagnostics like chest X-ray and
sputum culture are needed to determine whether the infection is
latent or active.
3. 3. Question: A nurse is assessing a client who has late-stage
heart failure and is experiencing fluid volume overload. Which
of the following findings should the nurse expect?
Answer: A. Weight gain of 1 kg (2.2 lb) in 1 day
Rationale: Sudden weight gain is the most sensitive indicator of
fluid retention in heart failure. It reflects acute volume overload
and is more objective than symptoms like mild edema or cough.
4. 4. Question: A nurse is caring for a client who has been unable
to leave the house for the past 10 years without
accompaniment. When attempting to go out alone, the client
becomes anxious and must quickly return inside. The nurse
should identify that the client is exhibiting which of the
following disorders?
Answer: A. Agoraphobia
Rationale: Agoraphobia involves fear of being alone in public
spaces where escape might be difficult. The client’s behavior—
avoiding going out alone and experiencing anxiety—is a textbook
presentation.
2026 | Actual Q&A | 100% Correct-
Felbry College School of Nursing
1. 1. Question: A nurse is obtaining the blood pressure in a client's
lower extremity. Which of the following actions should the
nurse take?
Answer: D. Place the bladder of the cuff over the posterior aspect
of the thigh
Rationale: To accurately measure blood pressure using the
popliteal artery, the cuff must be placed over the posterior thigh
where the artery lies. This ensures proper alignment and reliable
readings. Other positions or arteries, like the dorsalis pedis, are
not appropriate for auscultation.
2. 2. Question: A nurse is caring for a client who has a positive
Mantoux skin test following screening for tuberculosis (TB). The
nurse should inform the client that this positive reaction
indicates which of the following findings?
Answer: D. Further evaluation is required
, Rationale: A positive Mantoux test shows TB exposure but doesn’t
confirm active disease. Further diagnostics like chest X-ray and
sputum culture are needed to determine whether the infection is
latent or active.
3. 3. Question: A nurse is assessing a client who has late-stage
heart failure and is experiencing fluid volume overload. Which
of the following findings should the nurse expect?
Answer: A. Weight gain of 1 kg (2.2 lb) in 1 day
Rationale: Sudden weight gain is the most sensitive indicator of
fluid retention in heart failure. It reflects acute volume overload
and is more objective than symptoms like mild edema or cough.
4. 4. Question: A nurse is caring for a client who has been unable
to leave the house for the past 10 years without
accompaniment. When attempting to go out alone, the client
becomes anxious and must quickly return inside. The nurse
should identify that the client is exhibiting which of the
following disorders?
Answer: A. Agoraphobia
Rationale: Agoraphobia involves fear of being alone in public
spaces where escape might be difficult. The client’s behavior—
avoiding going out alone and experiencing anxiety—is a textbook
presentation.
