1、美国护士资格认证(CGFNS)-6 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.Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)?A. Monthly blood tests will be necessary.B. Report a sore throat or fever to the physician i
2、mmediately.C. Blood pressure must be monitored for hypertension.D. Stop the medication when symptoms subside.(分数:1.00)A.B.C.D.2.A client is brought to the hospital after vomiting bright red blood and is admitted through the emergency department with a diagnosis of bleeding duodenal ulcer. While the
3、client is bleeding, it will be essential for the nurse to assess frequently for signs of early shock. Which one of the following is an important indicator of early shock?A. Tachycardia.B. Dry, flushed skin.C. Increased urine output.D. Loss of consciousness.(分数:1.00)A.B.C.D.3.Which condition could a
4、mother have and still be allowed to breast-feed her child?A. Positive for human immunodeficiency virus (HIV).B. Active tuberculosis (TB).C. Cardiac disease.D. Endometritis.(分数:1.00)A.B.C.D.4.For a client in addisonian crisis, it would be very risky for a nurse to administerA. potassium chloride.B. n
5、ormal saline solution.C. hydrocortisone.D. fludrocortisone.(分数:1.00)A.B.C.D.5.The client has a newly positive Mantoux skin test although she does not have active tuberculosis. Which medical therapy would be appropriate for her?A. Reevaluating the clients condition every 6 months.B. Performing a repe
6、at skin test every 6 months.C. Administering isoniazid for about 9 months.D. Administering isoniazid until the skin test reverts to negative.(分数:1.00)A.B.C.D.6.Theophylline ethylenediamide is administered to a client with COPD. The nurse knows that the medication is for which of the following purpos
7、e?A. To reduce bronchial secretions.B. To relax bronchial smooth muscle.C. To strengthen myocardial contractions.D. To decrease alveolar elasticity.(分数:1.00)A.B.C.D.7.The nurse is preparing the client with heart failure to go home. Which of the following should be most important to include in the di
8、scharge education?A. Monitor urine output daily.B. Monitor daily potassium intake.C. Maintain bed rest for at least 1 week.D. Weigh daily.(分数:1.00)A.B.C.D.8.During a private conversation, a client with borderline personality disorder asks the nurse to “keep my secret“ and then displays multiple self
9、-inflicted, superficial lacerations on the forearms. What is the nurses best response?A. “This type of behavior requires you to be on suicide precautions. “B. “Im going to tell your physician. Do you want to tell me why you did that?“C. “Tell me what type of instrument you used. Im concerned about i
10、nfection. “D. “Whenever something important occurs in treatment, the team needs to know about it. Ill have to tell the others, but lets talk about it first. /(分数:1.00)A.B.C.D.9.Which outcome would indicate successful treatment of diabetes insipidus?A. Fluid intake of less than 2,500 mL in 24 hours.B
11、. Urine output of more than 200 mL/hour.C. Blood pressure of 90/50 mmHg.D. Pulse rate of 126 beats/minute.(分数:1.00)A.B.C.D.10.All of the following would be appropriate interventions for a client with acute epididymitis EXCEPT which of the following?A. Maintaining bed rest.B. Elevating the testes.C.
12、Applying ice packs intermittently.D. Applying hot packs to the scrotum.(分数:1.00)A.B.C.D.11.A 15-year-old boy is admitted to the health care facility after acting out his aggressions inappropriately at school. Predisposing factors to the expression of aggression include which of the following?A. Viol
13、ence on television.B. Passive parents.C. An internal locus of control.D. A single-parent family.(分数:1.00)A.B.C.D.12.Which of the following home regimens should the nurse suggest to relieve itching in children with chicken pox?A. Generous amounts of fine baby powder.B. Oatmeal preparation baths.C. Te
14、rrycloth towels moistened with hydrogen peroxide.D. Cool compresses moistened with a weak salt solution.(分数:1.00)A.B.C.D.13.Eight hours after catheterization, the postoperative client with abdominal hysterectomy has not voided. The client tells the nurse, “I dont think I can urinate. “ What should t
15、he nurse do?A. Call and inform the surgeon of the clients status.B. Administer additional pain medication.C. Increase the clients fluid intake.D. Assess the clients bladder.(分数:1.00)A.B.C.D.14.When assessing the fetal heart rate tracing, the nurse becomes concerned about the fetal heart rate pattern
16、. In response to the loss of variability, the nurse repositions the client to her left side and administers oxygen. These actions are likely to improve which of the following?A. Fetal hypoxia.B. Maternal comfort.C. The contraction pattern.D. The status of a trapped cord.(分数:1.00)A.B.C.D.15.The plan
17、of care for a client with hypertension taking propranolol hydrochloride would include which of the following?A. Instructing the client to discontinue the drug if nausea occurs and to monitor blood pressure.B. Instructing the client to notify the physician of irregular or slowed pulse rate.C. Monitor
18、ing blood pressure every week and adjusting the medication dose accordingly.D. Measuring partial thromboplastin time weekly to evaluate blood clotting status.(分数:1.00)A.B.C.D.16.Which of the following pieces of equipment would do best job to help prevent external rotation of the clients right leg po
19、stoperatively?A. Sandbags.B. A high footboard.C. A rubber air ring.D. A metal bed cradle.(分数:1.00)A.B.C.D.17.The client asks when he can stop taking the eye medication for his chronic open-angle glaucoma. Which would be the nurses best response?A. “You can stop using the eye drops when your vision i
20、mproves. “B. “You Need to use the eye drops only when you has symptoms. “C. “You can discontinue the eye drops after 2 months of normal eye examinations. “D. “You must use the eye medication for the rest of his life. /(分数:1.00)A.B.C.D.18.Which of the following postoperative complications would the n
21、urse particularly anticipate in a client undergoing a pelvic surgical procedure such as an ileal conduit?A. Bleeding.B. Infection.C. Thrombophlebitis.D. Atelectasis.(分数:1.00)A.B.C.D.19.A parent reports that his 2-year-old child often fails when running. The nurse interprets this as indicating which
22、of the following as a normal aspect of a toddlers vision?A. Near-sightedness.B. Far-sightedness.C. Binocular vision.D. Strabismus.(分数:1.00)A.B.C.D.20.A school-aged child is admitted to the hospital with newly diagnosed, insulin-dependent diabetes mellitus. On admission his blood sugar is 180 mg/dL.
23、His urine tests negative for ketones. He receives 10 units of regular humulin insulin subcutaneously half hour after admission. What should the nurse do next?A. Carefully regulate an intravenous solution of normal saline and insulin at 2. 5 hours after admission.B. Encourage the child to drink at le
24、ast 500 mL of a sugar-free clear liquid 1.5 hours after admission.C. Begin intravenous administration of 5% dextrose in water 1 hour after admission.D. Assess the child 2. 5 hours after admission for shakiness, feelings of anxiety, or decreased level of consciousness.(分数:1.00)A.B.C.D.21.Which of the
25、 following nursing measures would be most important to decrease the risk of a surgical wound infection in a client with an internal fixation and hip pinning?A. Inserting an indwelling urinary catheter to prevent possible soiling of the dressing.B. Accurately measuring drainage from the surgical drai
26、nage tube.C. Changing the surgical dressings using strict sterile technique.D. Monitoring the incision for signs of redness, swelling, and warmth.(分数:1.00)A.B.C.D.22.The nurse should plan to include which of the following interventions in the plan of care for a child admitted to the hospital with a
27、medical diagnosis of febrile seizure?A. Keep the child supine.B. Place the child in respiratory isolation and restrict visitors.C. Keep the room temperature low and bedclothes to a minimum.D. Place a padded tongue blade at the bedside.(分数:1.00)A.B.C.D.23.When preparing to give a child with insulin-d
28、ependent diabetes his dose of regular and NPH humulin insulin, which of the following actions would be most appropriate?A. Taking the premixed insulin out of the refrigerator, then withdrawing the amount into in one syringe.B. Using two syringes, one for each type of insulin, and giving two injectio
29、ns.C. Withdrawing the NPH insulin first, then withdrawing the regular insulin into one syringe.D. Withdrawing the regular insulin first, then withdrawing the NPH insulin into one syringe.(分数:1.00)A.B.C.D.24.The client with diverticulitis is treated as an outpatient with drug therapy. Which drug ther
30、apy will most probably be employed?A. Antidepressants.B. Laxatives.C. Steroids.D. Broad-spectrum antibiotics.(分数:1.00)A.B.C.D.25.Prevention of preterm births is vital for which of the following reasons?A. Its costly to care for these neonates.B. These neonates are usually mentally retarded.C. Preter
31、m birth causes high incidence of the neonatal deaths.D. These neonates usually wind up with long-term health care needs.(分数:1.00)A.B.C.D.26.Promethazine hydrochloride (Phenergan) 35 mg IM is ordered for a client who is experiencing nausea and vomiting after surgery. The ampules label reads 25 mg/mL.
32、 How many mL should the nurse prepare to administer?A. 0.7 mL.B. 1.0 mL.C. 1.4 mL.D. 1.8 mL.(分数:1.00)A.B.C.D.27.When assessing a toddler diagnosed with spastic cerebral palsy, which of the following would the nurse expect to find?A. Toe-walking.B. Drooling.C. Facial grimacing.D. Wide-based gait.(分数:
33、1.00)A.B.C.D.28.A 35-year-old multigravida at 16 weeks gestation tells the nurse that she has had frequent mood swings during this pregnancy. What would be the nurses best suggestion to the client?A. Seek professional counseling.B. Keep her feelings to herself.C. Try to avoid fatigue and stress.D. D
34、ecrease her narcissistic behaviors.(分数:1.00)A.B.C.D.29.A client diagnosed with gestational diabetes has been admitted for induction of labor at 38 weeks. The client asks the nurse, “My previous labors started on their own. How will this induction of labor be different from my last labor?“ Upon which
35、 theory would the nurse base her response?A. An induction causes the contractions to be more intense during the first stage of labor.B. The risk of uterine rupture is less because the oxytocin (Pitocin) is controlled with an infusion pump.C. The goal of induction is to produce a contractile pattern
36、similar to that observed in spontaneous labor.D. During an induction, fetal monitoring begins as soon as oxytocin is started, whereas in a spontaneous labor, monitoring begins when signs of distress occur.(分数:1.00)A.B.C.D.30.The nurse is changing the subclavian dressing over the catheter insertion s
37、ite. Which one of the following actions would be appropriate for the nurse to incorporate into the dressing change?A. Place the client in high-Fowlers position.B. Check for tubing kinks and leakage.C. Cleanse the area, starting 2 inches from the insertion site and moving inward.D. Remove old ointmen
38、t from the insertion site with soap and warm water.(分数:1.00)A.B.C.D.二、Part Two(总题数:23,分数:23.00)31.A client with peptic ulcer has been prescribed propantheline (Pro-Banthine) as part of the treatment. Which of the following side effects is associated with this medication?A. Nausea.B. Hypotension.C. U
39、rinary frequency.D. Fatigue.(分数:1.00)A.B.C.D.32.The nurse formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen deman
40、ds such as the followingA. drinking more than 1,500 mL of fluid daily.B. eating a high-protein snack at bedtime.C. eating more than three large meals per day.D. being overweight.(分数:1.00)A.B.C.D.33.Which of the following would the nurse expect to include in a community health program designed to con
41、trol sexually transmitted diseases (STDs)?A. Mass screening of all individuals.B. Location of the possible sources of infection.C. Treatment of those with the disease.D. Isolation of those suspected of having STDs.(分数:1.00)A.B.C.D.34.The mother of a 2-year-old child tells the nurse that her baby is
42、using a potty seat but is still having problems toilet-training. Which of the following suggestions by the nurse would he most appropriate?A. Offer the child more praise each time.B. Use a potty chair instead of a potty seat.C. Focus on the “accidents“ that occur during training.D. Defer training un
43、til the child is developmentally ready.(分数:1.00)A.B.C.D.35.Which nursing action is most effective in defusing a clients impending violent behavior?A. Helping the client identify and express feelings of anxiety and anger.B. Involving the client in a quiet activity to divert attention.C. Leaving the c
44、lient alone until he can talk about his feelings.D. Placing the client in seclusion.(分数:1.00)A.B.C.D.36.A toddler with croup is given a vaponefrin updraft because of increasing respiratory distress. The nurse evaluates the treatment as being effective when see which of the following?A. The childs co
45、lor is normal.B. The childs retractions are less severe.C. The childs heart rate is 100 bpm.D. The childs pulse oximeter reads 90.(分数:1.00)A.B.C.D.37.The nurse is providing care for a client with multiple myeloma, a disorder characterized by episodes of remissions and exacerbations. Which of the fol
46、lowing resources can best help the client adapt to the disease?A. The clients family.B. Support group.C. Pastoral care.D. Hospice care.(分数:1.00)A.B.C.D.38.The nurse is performing a neurologic assessment on a client during a routine physical examination. To assess the Bakinskis reflex, indicate the p
47、oint where the nurse would place the tongue blade to begin the stroke of the foot.(分数:1.00)A.B.C.D.39.A young adult had a significant reaction to the Mantoux test. What conclusion would the nurse make from the findings?A. The client has active tuberculosis.B. The client had active tuberculosis.C. Th
48、e client has been exposed to tuberculosis.D. The client is immunocompromised.(分数:1.00)A.B.C.D.40.A client undergoes extracorporeal shock wave lithotripsy (ESWL) to break up and remove renal calculi. Which of the following nursing measures is appropriate for the postoperative care of this client?A. M
49、aintain client on strict bed rest for 48 hours after the procedure.B. Instruct client to anticipate a decrease in urinary output.C. Instruct client to anticipate hematuria for about 24 hours after the procedure.D. Limit fluid intake to 1000 mL/day until all stone fragments have been passed.(分数:1.00)A.B.C.D.41.The nurse teaches the mother of an infant diagnosed with congenital hypothyroidism about daily oral levothyroxine sodium (Synthroid) therapy. Which of the following signs and symptoms would indicate an overdose?A. Anorexia.B. Constipation.C. Sweating.D. Sleepiness.