急救护理学A卷.doc

Final Examination OfEmergency Nursing Grade 2003 Nursing department Nanchang University Medical College (A)南昌大学医学院护理学系2003级急救护理学试卷（A卷）Part : Term Definition ( 5 points each, 15 points totally ) 1. Shock2. heat stroke 3. hypertensive emergenciesPart : True or False ( 2 points each, 10 points totally )1. W e can use iodine tincture (碘酊) to degerm (消毒) the primary wound. ( )2. Blood pressure starts decreasing since the early stage of shock. ( )3.Terminal stage of liver cancer is a kind of disease that can be hospitalized in ICU. ( )4. Hypertensive emergencies patients BP should be decreased to normal level at once. ( )5. Any chemical that may burn skin is indication for use dermal decontamination ( )Part : Single Choice ( 2 points each, 20 points totally )1. Which is not included in the emergency nursing? ( )A. prehospital first-aid B. critical care C. disaster preparedness and management D. rehabilitation service2. The normal value of shock index(指数) is . ( )A. 1 B. 2 C. 3 D. 0.53. When disturbance of acid - base balance happened, which is the PH value limits for salvage. ( ) A.5.806.80B.6.807.80C.6.257.37D.7.357.454. Whats the common characteristic of all kind of shock? ( ) A. blood pressure decrease B. narrowed BPC. sharp decreasing of circulating volume D. decreased CVP5. which Trauma Scores (TS) is best for salvage. ( ) A.13B.413C.1416D.16206. Which will not induce diabetic ketoacidosis(酮症酸中毒)? ( ) A. infection B. discontinue insulin C. dewatering treatmentD. stress to operating 7. The adults airway pressure is ( ) A. 812mmH2OB. 1016 mmH2O C. 1220 mmH2O D. 1624 mmH2O8. Barbiturate(巴比妥酸盐) poisoning mechanism is ( ) A. hypoxia B. anesthetic(麻醉) actionC. inhibit enzymic(酶的) vigor D. receptor competition9. ECG shows ventricular fibrillation. The nurse decides to perform external defibrillation on patients. First you select energy _ in adult. ( )A.50J B.100J C.200J D.300J10. Which is not the nursing interventions of coma ( ) A. Provide oxygen B. Gastric lavage(灌洗)C. Suction if necessary D. Establish IV accessPart : Brief Answers ( 10 points each, 40 points totally )1. What are the manifestations for cardiac arrest? (10 points) （Please answer in English, or you will lose the half score请用英文回答，否则扣一半分）2. What are the first aid care points of a hyperthermic(体温过高) crisis patient? (10 points)3. Please describe the WHO analgesic ladder for pain management ? (10 points)4.Write down the indications(适应证) of ventilator application(呼吸机应用). (10 points)Part : Case Analysis ( 15 points )A male patient，23 years old, lower limbs crush(压伤) trauma, still conscious, apathia(淡漠), thirsty, pale, moist and cold skin, Pulse 112 times/minute， BP 90/60mmHg，CVP 4cmH2O，capillary refill time longer than normal, blood gas analysis, PH 7.30, HCO3一 15mmol/L, BE 9mmol/L.(1 )Whats the matter with this patient?(5 points)(2) Whats the nursing point of this patients?(10 points)Part : Term Definition ( 5 points each, 15 points totally ) 1 Shock: 是由多种原因引起的以循环障碍为主要特征的急性循环功能衰竭.(3分)由于微循环障碍,导致维持生命的主要器官、组织的血液灌注不足，从而在临床上出现一系列的症状和体征（2分）。2. heat stroke: 热射病是一种严重的热相关疾病（2分），通常是在烈日底下劳动时间过长，又没有防护措施而发生的（1分）。其临床特征是中心温度大于40度，并伴有中枢神经系统异常的症状，如谵妄、惊厥，昏迷等（2分）。3. hypertensive emergencies：是发生在高血压病或症状性高血压过程中的一种特殊临床危象（2分），是指在高血压病程中，由于某些诱因，外周小动脉发生暂时性强烈收缩（1分），血压急剧升高，伴有重要器官的功能障碍或不可逆的损害（2分）。Part : True or False ( 2 points each, 10 points totally )1.False 2.False 3. False 4. False 5.TruePart : Single Choice ( 2 points each, 20 points totally )1.D 2. D 3. B 4. C 5. B 6. C 7. C 8. A 9. C 10. BPart : Brief Answers ( 10 points each, 40 points totally )1. 每小点2分，答全得10分。临床表现：意识丧失；脉搏扪不到；呼吸断断续续，后停止；心音消失；瞳孔散大；面色苍白兼青紫。 Patient is unresponsive； The femoral pulses are not palpable; Respiratory motion of the chest wall cannot be detected.; No audible heart sound can be discerned; Patient has a blue, pale, or deathlike appearance; Dilated pupils and no response to light.2. 每小点2分，答全得10分。 1)严密观察病情;2)一般处理;3)降温：迅速而有效地将体温降至38.5左右是治疗高热危象的关键;4)病因治疗;5)基础护理和对症护理。3. 答全得10分第一阶梯轻度疼痛给予非阿片类(非甾类抗炎药)加减辅助止痛药。如阿司匹林。（3分）第二阶梯中度疼痛给予弱阿片类加减非甾类抗炎药和辅助止痛药。常用药物有可待因等。（3分）第三阶梯重度疼痛给予阿片类加减非甾类抗炎药和辅助止痛药。（3分）4. Indications(适应证) of ventilator application(呼吸机应用). 每小点1分，答全得10分。1)急、慢性呼吸衰竭 2)心源性或非心源性肺水肿 3)ARDS 4)胸部创伤、多发性肋骨骨折、连枷胸 5)呼吸中枢控制失调、神经肌肉疾患 6)呼吸性酸碱平衡失调