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Questions 164

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Question 1 of 5

The parents of a 4-year-old tell the nurse that the child won't go to sleep at night due to fear of tigers living under the bed. Which response by the nurse is most helpful?

Correct Answer: C

Rationale: Night fears are normal in preschoolers (
C). Checking under the bed with the child validates their fear while showing safety. Linking to a zoo visit (
A) or media (
D) assumes unconfirmed triggers. Agreeing with fears (
B) may reinforce them.

Question 2 of 5

While performing an initial assessment on a newborn following a breech delivery, the nurse suspects hip dislocation. Which of the following is most suggestive of the abnormality?

Correct Answer: D

Rationale: Irregular hip symmetry. Early assessment of irregular hip symmetry alerts the nurse and the provider to a correctable congenital hip dislocation.

Question 3 of 5

A client is admitted for hemodialysis. Which abnormal lab value would the nurse anticipate not being improved by hemodialysis?

Correct Answer: A

Rationale: Low hemoglobin. Hemodialysis corrects electrolyte imbalances but does not improve anemia.

Question 4 of 5

The nurse is teaching a client with dysrhythmia about the electrical pathway of an impulse as it travels through the heart. Which of these describes the normal pathway?

Correct Answer: D

Rationale: SA node, AV node, Bundle of His, Purkinje fibers. This is the normal pathway of an electrical impulse through the heart.

Question 5 of 5

The nurse is caring for assigned clients. The nurse should first check the client with

Correct Answer: D

Rationale: Pericarditis with paradoxical pulse (
D) suggests tamponade, requiring immediate assessment. Atrial fibrillation (
C), pneumonia (
B), and cirrhosis (
A) are less urgent.

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