1、美国护士资格认证(CGFNS)-24 及答案解析(总分：53.00，做题时间：90 分钟)一、Part One(总题数：30，分数：30.00)1.A client with ulcerative colitis is chatting with the nurse. Which of the following statements indicates the client understands the lifestyle modifications he needs to make?A. “I will have to stop smoking. “B. “I can eat popco
2、rn for an evening snack. “C. “I may have coffee with my meals. “D. “I am allowed to have alcohol as long as I only drink wine. /（分数：1.00）A.B.C.D.2.The client is taking medication to control his cancer pain. Which of the following statements indicates that the client needs further instruction?A. “I s
3、hould take my medication around-the-clock to control my pain. “B. “I should skip doses periodically so I dont get hooked on my drugs. “C. “It is okay to take my pain medication even if I am not having any pain. “D. “I should contact the oncology nurse if my pain is not effectively controlled. /（分数：1
4、.00）A.B.C.D.3.Which of the following interventions would likely be most effective for the client to use at home when managing the discomfort of rhinoplasty the initial 2 days after surgery?A. Applying ice compresses.B. Applying warm, moist compresses.C. Lying in a prone position.D. Blowing the nose
5、gently.（分数：1.00）A.B.C.D.4.The client is advised by the physician to have mammography screening annually. Which of the following is the best measure to improve adherence with mammography screening?A. Making sure that the individual barriers to screening are minimized.B. Emphasizing that mammography s
6、creening can prevent breast cancer.C. Emphasizing that mammography screening is a low-cost approach to cancer prevention.D. Informing the client that she is at high risk for breast cancer and needs to follow the physicians recommendation.（分数：1.00）A.B.C.D.5.The client is taking carbamazepine (Tegreto
7、l) to treat his trigeminal neuralgia. While preparing the clients teaching plan, which of the following instructions should the nurse include?A. Limit physical activity while taking the drug.B. Eliminate caffeine from the diet while taking drug.C. Arrange to have a CBC drawn weekly.D. Take the drug
8、on an empty stomach.（分数：1.00）A.B.C.D.6.A preschool-aged child who is hospitalized with gastroenteritis has been NPO. The physician has written an order to advance the diet as tolerated. Which of the following food is the most appropriate for the first feeding the nurse should offer the child?A. Clea
9、r lemon carbonated beverage.B. Toast.C. Cooked cereal.D. Ice cream shake.（分数：1.00）A.B.C.D.7.The nurse is caring for a child with leukemia. Which of the following should the nurse priority pay more attention to?A. Preventing injury.B. Monitoring the childs platelet count.C. Monitoring the childs temp
10、erature.D. Encouraging increased fluid intake.（分数：1.00）A.B.C.D.8.A client has been placed on levodopa to treat his Parkinsons disease. Which of the following is a common side effect of levodopa that the nurse should include in the clients teaching plan?A. Pancytopenia.B. Peptic ulcer.C. Orthostatic
11、hypotension.D. Weight loss.（分数：1.00）A.B.C.D.9.Three weeks after the application of the spica cast following surgery for an infant, the mother told the nurse that the infants toes are swollen and cool to the touch. Which of the following would the nurses suspect?A. Cotton wadding lining of the cast h
12、as shrunk.B. An infection has developed under the cast.C. Childs feet were in a dependent position.D. Child has outgrown the spica cast.（分数：1.00）A.B.C.D.10.A client is prescribed Gentamycin (Garamycin) IV to treat infection. It is important to monitor the client for the development of which of the f
13、ollowing side effects from the medication?A. Ascites.B. Confusion.C. Ototoxicity.D. Cardiac dysrhythmias.（分数：1.00）A.B.C.D.11.Mrs. S with preterm labor will be under Terbutaline (Brethine) therapy. Before beginning the therapy, which of the following assessments would be most important?A. Estimated f
14、etal size.B. Maternal heart rate.C. Contraction intensity.D. Deep tendon reflexes.（分数：1.00）A.B.C.D.12.While managing the separation anxiety during hospitalization for a two-year-old boy, which of the following suggestions would be most helpful to the parents?A. Tell the child the time they are leavi
15、ng and returning.B. Bring the childs favorite toys from home.C. Leave while the child is sleeping.D. Keep the visit time short.（分数：1.00）A.B.C.D.13.The nurse is evaluating the effectiveness of airway suctioning. Which of the following outcome criteria is most appropriate?A. Respirations unlabored.B.
16、Decreased mucus production.C. Hollow sound on chest percussion.D. Breath sounds clear on auscultation.（分数：1.00）A.B.C.D.14.Positive symptoms of schizophrenia include which of the following?A. Waxy flexibility, alogia, and apathy.B. Flat affect, avolition, and anhedonia.C. Hallucinations, delusions, a
17、nd disorganized thinking.D. Somatic delusions, echolalia, and a flat affect.（分数：1.00）A.B.C.D.15.The development of laryngeal cancer is most clearly linked to which of the following factors?A. High-fat, low-fiber diet.B. Alcohol and tobacco use.C. Low socioeconomic status.D. Overuse of artificial swe
18、eteners.（分数：1.00）A.B.C.D.16.One-year-old Susan, the second child to have sickle cell disease in a family of five children, is admitted to the hospital with sickle cell crisis. When preparing the plan of care for her, which of the following treatments would the nurse most likely expect to include in
19、the plan?A. Intravenous fluid therapy.B. Fast-acting anticoagulant therapy.C. Parenteral iron therapy.D. Exchange transfusion.（分数：1.00）A.B.C.D.17.A young man is remanded by the courts for psychiatric treatment. From his police record the nurse notices that the client has records of delinquency, runn
20、ing away, auto theft, and vandalism in his early teenage years. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping. Which of the following problems is most associated with maladaptive coping?A. Antisocial personality disorder.B. Bord
21、erline personality disorder.C. Obsessive-compulsive personality disorder.D. Narcissistic personality disorder.（分数：1.00）A.B.C.D.18.A client has had a cerebrovascular accident (CVA). Because the CVA affected the left side of the clients brain, the nurse should anticipate that the client would most lik
22、ely experienceA. dyslexia.B. apraxia.C. agnosia.D. expressive aphasia.（分数：1.00）A.B.C.D.19.The most significant sign of acute renal failure isA. elevated body temperature.B. increased blood pressure.C. decreased urine output.D. increased urine specific gravity.（分数：1.00）A.B.C.D.20.Trimethobenzamide (T
23、igan) 150 mg IM has been ordered to treat a clients nausea and vomiting. The nurse has an ampule of Tigan labeled 200 mg/mL. How many mL should the nurse prepare to give the client?A. 0.50 mL.B. 0.75 mL.C. 1.0 mL.D. 1.5 mL.（分数：1.00）A.B.C.D.21.An adolescent is admitted to the hospital for headaches.
24、She approaches the nurse and confides that she is being sexually abused by a family friend. Which of the following would be the nurses best initial response?A. “Can you tell me what happened?“B. “I believe you; you were right to tell me. “C. “Have you told your mother and father about this?“D. “Who
25、else have you told about this?/（分数：1.00）A.B.C.D.22.When caring for an adolescent client diagnosed with depression, the nurse should remember that depression manifests differently in adolescents and adults. In an adolescent, signs and symptoms of depression are likely to include which of the followin
26、g?A. Helplessness, hopelessness, hypersomnolence, and anorexia.B. Truancy, a change of friends, social withdrawal, and oppositional behavior.C. Curfew breaking, stealing from family members, truancy, and oppositional behavior.D. Hypersomnolence, obsession with body image, and valuing of peers opinio
27、ns.（分数：1.00）A.B.C.D.23.During the assessment stage, a client with schizophrenia leaves his arm in the air after the nurse has taken his blood pressure. Which of the following explains his action?A. Somatic delusions.B. Waxy flexibility.C. Neologisms.D. Nihilistic delusions.（分数：1.00）A.B.C.D.24.The nu
28、rse noticed that an 8-month-old childs posterior fontanel is slightly open. Which of the following should the nurse do next?A. Check the childs head circumference.B. Question the mother about the childs delivery.C. Schedule an X-ray of the childs head.D. Document this as a normal finding.（分数：1.00）A.
29、B.C.D.25.A mother of an ill child tells the nurse that her child “isnt eating well. “ Which of the following strategies devised by the mother to help increase the childs intake is not appropriate?A. Asking the child to say why he is not eating.B. Telling the child he must eat or else he will not get
30、 better.C. Allowing the child to choose his meals from an acceptable list of foods.D. Letting the child to substitute items on his tray for other nutritious foods.（分数：1.00）A.B.C.D.26.The client with a head injury receives mannitol (Osmitrol) during surgery to help decrease intracranial pressure. Whi
31、ch of the following nursing observations would most likely indicate that the drug is having the desired effect?A. Urine output increases.B. Pulse rate decreases.C. Blood pressure decreases.D. Muscular relaxation increases.（分数：1.00）A.B.C.D.27.A 9-year-old child is in diabetes. The nurse offers to mee
32、t with the mother and the childs teacher before school to discuss the teachers responsibilities in relation to the childs diabetes. Which of the following would the nurse expect to discuss in this meeting?A. How to perform a glucometer test.B. How to give an insulin injection.C. Signs and symptoms o
33、f hypoglycemia.D. The American Diabetic Association (ADA) diet.（分数：1.00）A.B.C.D.28.The nurse is caring for a client in the first 4 weeks of pregnancy. The nurse should expect to collect which assessment findings?A. Presence of menses.B. Uterine enlargement.C. Breast sensitivity.D. Fetal heart tones.
34、（分数：1.00）A.B.C.D.29.Which of the following fluid and electrolyte imbalances would the nurse anticipate that the client would be particularly susceptible to in the emergent phase of burn care?A. Metabolic alkalosis.B. Hemodilution.C. Hypernatremia.D. Hyperkalemia.（分数：1.00）A.B.C.D.30.To encourage adeq
35、uate nutritional intake for a client with Alzheimers disease, what should the nurse do?A. Stay with the client and encourage him to eat.B. Help the client fill out his menu.C. Give the client privacy during meals.D. Fill out the menu for the client.（分数：1.00）A.B.C.D.二、Part Two(总题数：23，分数：23.00)31.The
36、parents of a child being discharged from the day surgery center after insertion of tympanostomy tubes ask the nurse. “What will happen to the tubes in my childs ears?“ Which of the following would be the nurses best response?A. “The tubes usually dissolve on their own in about 1 year. “B. “The tubes
37、 must remain permanently in place. “C. “Youll probably see them fall out in about 6 months. “D. “Call for an appointment to have them removed in about 6 months. /（分数：1.00）A.B.C.D.32.To assess the clients dorsalis pedis pulse, the nurse should palpate theA. medial surface of the ankle.B. lateral surf
38、ace of the ankle.C. ventral aspect of the top of the foot.D. medial aspect of the dorsum of the foot.（分数：1.00）A.B.C.D.33.Which of the following is an appropriate health promotion activity to reduce the incidence of osteoporosis?A. Teaching women to maintain adequate calcium intake.B. Teaching women
39、how to administer pain medication safely.C. Avoiding estrogen replacement therapy when postmenopausal.D. Teaching women to increase caffeine intake as a preventive measure.（分数：1.00）A.B.C.D.34.A client is admitted to the psychiatric unit with a diagnosis of anorexia nervosa. Although she is 57“ and w
40、eighs only 100 lb, she keeps on telling the nurse about how fat she is. What should the nurse do first?A. Discuss cultural stereotypes regarding thinness and attractiveness.B. Explore the reasons why the client doesnt eat.C. Teach the client about nutrition, calories, and a balanced diet.D. Establis
41、h a trusting relationship with the client.（分数：1.00）A.B.C.D.35.To obtain a good monitor tracing on a client in labor, the mother lies on her back. Suddenly, she complains of feeling light-headed and becomes diaphoretic. Which of the following should be the nurses first action?A. Reposition the client
42、 to her left side.B. Immediately take the clients blood pressure and call the physician.C. Start oxygen at 6 L via nasal cannula.D. Increase the IV fluids to correct the clients dehydration.（分数：1.00）A.B.C.D.36.A hospitalized client craves a drink while withdrawing from alcohol. Which of the followin
43、g measures is the best way to help the client resist the urge to drink?A. A routine search of visitors.B. A locked-door policy.C. One-to-one supervision by the staff.D. Support from other alcoholic clients.（分数：1.00）A.B.C.D.37.Which nursing diagnosis would the nurse anticipate as having the highest p
44、riority for the client with gestational diabetes in labor?A. Risk for infection related to invasive procedures during labor.B. Risk for injury to fetus related to the effects of diabetes on uteroplacental functioning.C. Deficient knowledge related to lack of information about care during labor.D. In
45、terrupted family processes related to diabetes increasing the clients risk of complications.（分数：1.00）A.B.C.D.38.Sedative-hypnotic drugs are used to treat which of the following problems?A. Hallucinations and delusions.B. Anxiety and insomnia.C. Obsessive-compulsive disorder (OCD).D. Attention defici
46、t hyperactivity disorder (ADHD).（分数：1.00）A.B.C.D.39.In developing a plan of care for a client with rheumatoid arthritis, the nurse should consider that clients with rheumatoid arthritis should be positioned so as toA. prevent flexion deformities of the joints.B. decrease edema around the joints.C. p
47、romote maximum comfort.D. prevent venous stasis.（分数：1.00）A.B.C.D.40.When caring for a client during the second stage of labor, which action would be least appropriate?A. Assisting the client with pushing.B. Ensuring the clients legs are positioned appropriately.C. Allowing the client clear liquids.D
48、. Monitoring the fetal heart rate.（分数：1.00）A.B.C.D.41.Nitroglycerin is also available in ointment or paste form. Before applying nitroglycerin ointment, what should the nurse do first?A. Cleanse the skin with alcohol where the ointment will be placed.B. Obtain the clients pulse rate and rhythm.C. Re
49、move the ointment previously applied.“D. Instruct the client to expect pain relief in the next 15 minutes.（分数：1.00）A.B.C.D.42.Of the following signs and symptoms of bowel obstruction, which is related primarily to small bowel obstruction rather than large bowel obstruction?A. Profuse vomiting.B. Cramping abdominal pain.C. Abdominal distention.D. High-pitched bowel sounds above the obstruction.（分数：1.00）A.B.C.D.43.A client who was found huddled in her apartment by the police is admitted to the clinic. The client stares toward one corner of the room and seems t
