美国护士资格认证(CGFNS)试卷2017年

1、美国护士资格认证(CGFNS)试卷2017年(总分：100.00，做题时间：180分钟)一、单项选择题（共50题，每题2分。每题的备选项中，只有一个最符合题意）(总题数：50，分数：100.00)1.The nurse is teaching a client about using vaginal medications. The nurse should instruct the client （）（分数：2.00）A.use a tampon after insertion to increase medication absorption.B.release and pull up o

2、n the applicator before removal.C.never refrigerate suppositories.D.use only a water-soluble lubricant when inserting a suppository.解析：The nurse should instruct the client to use only a water-soluble lubricant when inserting a suppository. Tampons shouldnt be used because the tampon will absorb some

3、 medication, making the medication less effective. When removing the applicator, the client should keep the plunger depressed. Suppositories may be refrigerated to keep their form.2.A male client with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to

4、bed after ambulating, he complains of severe pain in the surgical wound. Which action should the nurse take（）（分数：2.00）A.Assume hes anxious about discharge, and administer pain medication.B.Assess the surgical site and affected extremity.C.Reassure the client that pain is a direct result of increased

5、 activity.D.Suspect a wound infection, and monitor the clients temperature and vital signs.解析：Worsening pain after a total hip replacement may indicate dislocation of the prosthesis. Assessment of pain should include evaluation of the wound and the affected extremity. Assuming hes anxious about disc

6、harge and administering pain medication dont address the cause of the pain. Sudden severe pain isnt normal after hip replacement. Wound infections are usually distinguished by purulent drainage.3.A 4-year-old girl is admitted to the hospital to rule out leukemia. Which of the following would be the

7、best room assignment（）（分数：2.00）A.With a 4-year-old girl who has rheumatoid arthritis.B.With a 5-year-old boy who is having a tonsillectomy.C.With a 4-year-old girl who has leukemia.D.Alone in a private room.解析：Avoiding exposure to infection requires a private room.4.A client is to have a cesarean de

8、livery because of continuous vaginal bleeding and an abnormal fetal heart rate tracing. Which of the following would be the best preoperative medication for this client（）（分数：2.00）A.Meperidine (Demerol).B.Oxytocin (Pitocin).C.Promethazine (Phenergan).D.Glycopyrrolate (Robinul).解析：Glycopyrrolate is a

9、parasympatholytic that will decrease the risk of aspiration. Meperidine and promethazine can cause central nervous system and respiratory depression in neonates. Oxytocin precipitates labor.5.An elderly client with Alzheimers disease begins supplemental tube feedings through a gastrostomy tube to pr

10、ovide adequate calorie intake. The nurse should be concerned most with the potential for（）（分数：2.00）A.hypoglycemia.B.fluid volume excess.C.aspiration.D.constipation.解析：Of the choices listed, aspiration is the most serious potential complication of tube feedings. Dehydration-not fluid volume excess-is

11、 a concern because of decreased free water intake. Hyperglycemia, not hypoglycemia, is a complication secondary to carbohydrate load of enterat feeding solutions. Constipation is a problem, but it usually isnt a serious one. The client would most likely experience diarrhea.6.The nurse is administeri

12、ng warfarin (Coumadin) to a client with deep vein thrombophlebitis. Which laboratory value indicates warfarin is at therapeutic levels（）（分数：2.00）A.Partial thromboplastin time (PTT) 1 1/2 to 2 times the control.B.Prothrombin time (PT) 1 1/2 to 2 times the control.C.International normalized ratio (INR

13、) of 3 to 4.D.Hematocrit of 32%.解析：Warfarin is at therapeutic levels when the clients PT is 1 1/2 to 2 times the control. Higher values indicate increased risk of bleeding and hemorrhage; whereas lower values indicate increased risk of blood clot formation. Heparin-not warfarin-prolongs PTT. The INR

14、 may also be used to determine if warfarin is at a therapeutic level. An INR of 2 to 3 is considered therapeutic. Hematocrit doesnt provide information on the effectiveness of warfarin; however, a falling hematocrit in a client taking warfarin may be a sign of hemorrhage. 7.The nurse teaches a mothe

15、r how to provide adequate nutrition for her toddler, who has cerebral palsy. Which of the following observations indicates that teaching has been effective（）（分数：2.00）A.The toddler stays neat while eating.B.The toddler finishes the meal within a specified period of time.C.The child lies down to rest

16、after eating.D.The child eats finger foods by himself.解析：The child with cerebral palsy should be encouraged to be as independent as possible. Finger foods allow the toddler to feed himself. Because spasticity affects coordinated chewing and swallowing as well as the ability to bring food to the mout

17、h, its difficult for the child with cerebral palsy to eat neatly. Independence in eating should take precedence over neatness. The child with cerebral palsy may require more time to bring food to the mouth; thus, chewing and swallowing shouldnt be rushed to finish a meal by a specified time. The chi

18、ld with cerebral palsy may vomit after eating, due to a hyperactive gag reflex. Therefore, the child should remain in an upright position after eating to prevent aspiration and choking.8.The nurse is giving instructions to a client who is going home with a cast on his leg. Which point is most critic

19、al（）（分数：2.00）A.Using crutches properly.B.Exercising joints above and below the cast, as ordered.C.Avoiding walking on a leg cast without the physicians permission.D.Reporting signs of impaired circulation.解析：Although all of these interventions are important, reporting signs of impaired circulation i

20、s the most critical. Signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. The other options reflect more long- term concerns. The client should learn to use his crutches properly to avoid nerve damage. The client may exercise above and below the ca

21、st, as the physician orders. The client should be told not to walk on the cast without the physicians permission.9.A 15-year-old primigravida gave birth 2 days ago. She tells the nurse that having her own little baby will be wonderful. Which nursing response would best evaluate the accuracy of the c

22、lients expectations（）（分数：2.00）A.Tell me what your day will be like after you take your baby home. B.Will anyone be available to help you at home with the babyC.Have you had any experience taking care of babiesD.What are you planning to do with your baby when you return to school解析：Teenage lifestyles

23、 and support systems can vary immensely. This open-ended question will best help the health team gather data about the teen mothers feelings and expectations. The other options arent open-ended and dont clearly ask the client about her expectations. 10.The nurse is teaching a new group of mental hea

24、lth aides. The nurse should teach the aides that setting limits is most important for（） （分数：2.00）A.a depressed client.B.a manic client.C.a suicidal client.D.an anxious client.解析：Setting limits for unacceptable behavior is most important in a manic client. Typically, depressed, anxious, or suicidal c

25、lients dont physically or mentally test the limits of the caregiver.11.The nurse provides fluid replacement for a client with burns on 35% of his body. It has been 12 hours since the burns occurred. His blood pressure is 85/60 mmHg. His pulse is 124 beats/minute. Urine output was 25 mL during the pa

26、st hour. What orders should the nurse expect to receive from the physician（）（分数：2.00）A.Maintain IV fluids at the present rate, and continue to reassess vital signs and urine output hourly.B.Increase the IV rate, and continue to reassess vital signs and urine output hourly.C.Decrease the IV rate, and

27、 continue to reassess vital signs and urine output hourly.D.Administer a vasoconstrictor, and reassess vital signs and urine output hourly.解析：During the first 24 hours after a burn, interstitial and intracellular fluid shifts occur and intravascular fluid volume decreases. Hypovolemia calls for flui

28、d replacement therapy to maintain vital organ perfusion. Keeping IV fluids at the current rate wouldnt correct the clients fluid deficit. A vasoconstrictor would be inappropriate because it doesnt correct fluid volume deficits.12.The nurse is caring for a client who is suicidal. When accompanying th

29、e client to the bathroom, the nurse should（）（分数：2.00）A.give him privacy in the bathroom.B.allow him to shave.C.open the window and allow him to get some fresh air.D.observe him.解析：The nurse has a responsibility to observe continuously the acutely suicidal client-not provide privacy. The nurse should

30、 watch for clues, such as communicating suicidal thoughts, threats, and messages; hoarding medications; and talking about death. By accompanying the client to the bathroom, the nurse will naturally prevent hanging or other injury. The nurse will check the clients area and fix dangerous conditions, s

31、uch as exposed pipes and windows without safety glass. The nurse will also remove potentially dangerous objects, such as belts, razors, suspenders, glass, and knives.13.The employer of a client on the psychiatric unit calls the nursing station inquiring about the clients progress. The nurse doesnt k

32、now if the client has given consent to allow the staff to give information out to callers on the phone. Which of the following would be the nurses best response（）（分数：2.00）A.Im not permitted to discuss her progress. B.Ill give you the name and telephone number of her physician. C.Ill have her call yo

33、u. D.I cant confirm whether your employee is a client here. 解析：The nurses release of information to the clients employer without the clients consent is a breach of confidentiality. The stigma associated with psychiatric illness may affect the clients employment; therefore, its better to maintain con

34、fidentiality and refrain from disclosing any information about the client, including whether shes a client in the hospital.14.A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client（）（分数：2.00）A.This condition puts her at

35、 a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test annually.B.The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days.C.The potential for transmission to her sexual partner will be eliminated if condoms are use

36、d every time they have sexual intercourse.D.The human papillomavirus (HPV), which causes condylomata aeuminata, cant be transmitted during oral sex.解析：Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap tests are important for early detection. Because condylom

37、ata acuminata is a virus, theres no permanent cure. Because condylomata acuminata can occur on the vulva, a condom wont protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx.15.The nurse is caring for an elderly client who exhibits sign

38、s of dementia. The most common cause of dementia in an elderly client is（）（分数：2.00）A.delirium.B.depression.C.excessive drug use.D.Alzheimers disease.解析：Alzheimers disease is the most common cause of dementia in the elderly. Approximately 10% of people over age 65 have Alzheimers disease; about 50% o

39、f people over age 85 have the disease. Delirium, or acute confusion, is caused by an underlying disease and isnt itself a cause of dementia. Depression is common in the elderly but, in many cases, manifests itself in apathy, self-deprecation, or inertia-not dementia. Excessive drug use, commonly ste

40、mming from the client seeing multiple physicians who are unaware of drugs that other physicians have prescribed, can cause dementia. Although its a problem among the elderly, it isnt as common as Alzheimers disease.16.Which procedure or practice is associated with surgical asepsis（）（分数：2.00）A.Hand w

41、ashing.B.Nasogastrie (NG) tube irrigation.C.Colostomy irrigation.D.IV catheter insertion.解析：Caregivers must use surgical asepsis when performing any procedure in which skin integrity is broken or a sterile body cavity is entered. Because it disrupts skin integrity and involves entry into a sterile c

42、avity (a vein), inserting an IV catheter requires surgical asepsis. The other options require the use of clean technique to prevent the spread of infection. Hand washing cleans the hands; it doesnt sterilize them. The GI tract isnt sterile; therefore, irrigating an NG tube or a colostomy requires on

43、ly clean technique.17.Which of the following assessments indicates fetal distress（）（分数：2.00）A.Fetal scalp pH of 7.14.B.Fetal heart rate (FHR) of 144 beats/minute.C.Acceleration of FHR with contractions.D.Long-term variability.解析：A scalp pH of less than 7.25 indicates acidosis and fetal hypoxia. The

44、other options are normal responses of a healthy fetus to labor.18.The nurse is caring for a client who has hemoconcentration after fluid loss. Which IV fluids would be the most appropriate fluid replacement therapy for this client（）（分数：2.00）A.Distilled water.B.Dextrose 5% in water (D5W) only.C.DSW w

45、ith 40 mEq of potassium chloride.D.Dextrose 10% in saline.解析：Increasing fluid volume and urine output is the main consideration when fluid replacement therapy is indicated. Therefore, DSW and a hypotonic solution would be indicated. Distilled water is never given for IV replacement therapy, even tho

46、ugh its a hypotonic solution. Potassium chloride is added when adequate output is established, depending on the extent of hypokalemia determined by laboratory electrolyte studies. Dextrose 10% in saline is a hypertonic solution that increases the degree of osmotic pressure and would increase intrace

47、llular dehydration; therefore, its contraindicated.19.The nurse is assessing a 15-year-old female who is being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find（）（分数：2.00）A.Tachycardia.B.Warm, flushed extremities.C.Parotid gland tenderness.D.Co

48、arse hair growth.解析：Frequent vomiting causes tenderness and swelling of the parotid glands. The reduced metabolism that occurs with severe weight loss produces bradycardia and cold extremities. Soft, downlike hair (called lanugo) may cover the extremities, shoulders, and face of an anorexic client.2

49、0.A family member is caring for a client diagnosed with Alzheimers disease. Which of the following is most likely to cause the caregiver depression and role strain（）（分数：2.00）A.The caregiver had a close relationship with the client before diagnosis of the illness.B.The caregiver has no formal support

50、, such as a visiting nurse or day care worker.C.The caregiver understands the full reality of the disease and its inevitable progression.D.The caregiver feels unable to control the client and unable to cope with caregiving.解析：The caregiver who feels unable to control the clients behavior and unable

51、to cope with the responsibility of caregiving is at the greatest risk for depression and role strain. A close relationship with the client who has Alzheimers disease doesnt place the caregiver at greater risk for role strain and depression. Absence of formal support may cause role strain and depress

52、ion, but the effect may be mitigated by the caregivers coping mechanisms and skills. A deeper understanding of the disease is unlikely to increase role strain or depression.21.The nurse is caring for a client admitted to the hospital with a bowel obstruction. The nurse should wear sterile gloves whe

53、n（）（分数：2.00）A.inserting an indwelling urinary catheter.B.giving a back rub on intact skin.C.changing an oxygen system.D.inserting an IV catheter.解析：Inserting an indwelling urinary catheter is the only sterile procedure listed here. Gloves arent necessary when giving a back rub on intact skin or when

54、 changing an oxygen system. Nonsterile gloves would be worn when inserting an IV catheter.22.A 16-year-old student has been admitted to your psychiatric unit after fainting in physical education class. She has a diagnosis of anorexia nervosa, weighs 88 lb (40 kg), and is 54 (1.6 m) tall. She has bee

55、n weighing herself several times per day at home and has lost 30 lb (13.5 kg) in the past 3 months. Which nursing diagnosis would be most appropriate for the client（）（分数：2.00）A.Disturbed thought processes.B.Impaired adjustment.C.Imbalanced nutrition. Less than body requirements.D.Ineffective sexuali

56、ty patterns.解析：Addressing the clients urgent physical needs is most important. The other diagnoses are possible with anorexia nervosa, but no data in the case study directly support them.23.A 38-year-old client is hospitalized with obsessive-compulsive disorder. On admission, she becomes nervous and

57、 asks to go to the bathroom to brush her teeth. Her husband says that she brushes her teeth at least 25 times per day. The nurse notes that the clients gums are inflamed and bleeding. Whats the best nursing intervention（）（分数：2.00）A.Have her stop brushing her teeth until the gums heal.B.Allow her to

58、continue her routine of daily brushing.C.Monitor her dental care and set limits on the amount of daily brushing.D.Brush her teeth for her.解析：This allows the behavior that reduces anxiety for the client, but it sets limits as a first step in modifying the behavior. Having her stop brushing her teeth

59、until her gums heal may leave the client unable to manage anxiety. Allowing her to continue her routine of daily brushing does nothing to change the behavior. Brushing her teeth for her treats the client like a toddler.24.While evaluating the needs of a client during the second trimester, the nurse

60、can anticipate which of the following（）（分数：2.00）A.Feelings of disbelief and ambivalence.B.Feelings of clumsiness and ugliness.C.Increasing introspection but a general sense of well-being.D.Anxiety about the labor and delivery experience.解析：Women generally feel best during the second trimester. Most