2023年CGNS美国海外护士资格认证考试历年考试真题摘选含答案难题附带详解

2023年CGNS美国海外护士资格认证考试历年考试真题摘选含答案难题带详解卷I一.Comprehensivetestcenter(共50题)1.A28-year-oldaccountantisadmittedtotheneurologicunitafterasuddenonsetofblindnessthedaybeforeanimportantprojectisdueforherboss.Afterpreliminaryevaluationandtestingyieldsnopositivefindings,thephysician'sinitialreactionisthattheclientmaybedemonstratingwhichdefensemechanism?A.Repression.B.Transference.C.Reactionformation.D.Conversion.2.Afterstrikinghisheadonatreewhilefallingfromaladder,ayoungmanisadmittedtotheemergencydepartment.He'sunconsciousandhispupilsarenonreactive.Whichinterventionwouldbethemostdangerousfortheclient?A.Givehimabarbiturate.B.Placehimonmechanicalventilation.C.Performalumbarpuncture.D.Elevatetheheadofhisbed.3.A54-year-oldfemalewasfoundunconsciousonthefloorofherbathroomwithself-inflictedwristlacerations.Anambulancewascalledandtheclientwastakentotheemergencydepartment.Whenshewasstable,theclientwastransferredtotheinpatientpsychiatricunitforobservationandtreatmentwithantidepressants.Nowthattheclientisfeelingbetter,whichnursinginterventionismostappropriate?A.Observingforextrapyramidalsymptoms.B.Beginningatherapeuticrelationship.C.Cancelinganyno-suicidecontracts.D.Continuingsuicideprecautions.4.AclientisprescribedGentamycin(Garamycin)IVtotreatinfection.Itisimportanttomonitortheclientforthedevelopmentofwhichofthefollowingsideeffectsfromthemedication?A.Ascites.B.Confusion.C.Ototoxicity.D.Cardiacdysrhythmias.5.Thenurseisteachinganewmentalhealthaide.Forwhichofthefollowingclientsissettinglimitsmostimportant?A.Adepressedclient.B.Amanicclient.C.Asuicidalclient.D.Ananxiousclient.6.Mrs.Wilson,aprimigravida,wasadmittedtothehospitalat12weeks'gestation.Sheiscomplainingofabdominalcramping,exhibitsbrightredvaginalspottingwithoutcervicaldilation.Thenursedeterminesthattheclientismostlikelyexperiencingwhichofthefollowingtypesofabortion?A.Complete.B.Threatened.C.Inevitable.D.Missed.7.Aclientwithahistoryofheartfailureisexaminedintheoutpatientdepartmenttoinvestigatetherecentonsetofperipheraledemaandincreasedshortnessofbreath.Physicalfindingsincludebilateralcrackles,athirdheartsound(S3),distendedneckveins,elevatedbloodpressure,andpittingedemaoftheankles.Thenursedocumentstheseverityofpittingedemaas+1.Whatisthebestdescriptionofthistypeofedema?A.Barelydetectabledepressionwhenthethumbisreleasedfromtheswollenarea;normalfootandlegcontours.B.Detectabledepressionoflessthan5mmwhenthethumbisreleasedfromtheswollenarea;normalfootandlegcontours.C.A5-to10-mmdepressionwhenthethumbisreleasedfromtheswollenarea;footandlegswelling.D.Adepressionofmorethan1cmwhenthethumbisreleasedfromtheswollenarea;severefootandlegswelling.8.Thenursesuspectsthata68-year-oldclienthasdigoxintoxicity.ThenurseshouldassessforA.hearingloss.B.visionchanges.C.decreasedurineoutput.D.gaitinstability.9.Aclientisscheduledtoundergopercutaneoustransluminalcoronaryangioplasty(PTCA).Thenurseexplainstheproceduretotheclient.Whichofthefollowingstatementsbythenurseismostappropriate?A."PTCAinvolvesopeningablockedarterywithaninflatableballoonlocatedontheendofacatheter."B."PTCAinvolvescuttingawayblockageswithaspecialcatheter."C."PTCAinvolvespassingacatheterthroughthecoronaryarteriestofindblockedarteries."D."PTCAinvolvesinsertinggraftstodivertbloodfromblockedcoronaryarteries."10.Thenurseisassessingan8-month-oldduringawellnesscheckup.Whichofthefollowingisanormaldevelopmentaltaskforaninfantthisage?A.Sittingwithoutsupport.B.Sayingtwowords.C.Feedinghimselfwithaspoon.D.Playingpatty-cake.11.A32-year-oldblackmanisadmittedtothehospitalinvaso-occlusivesicklecellcrisis.Hecomplainsofchestpain,shortnessofbreath,severemyalgia,andarthralgia.Whichofthefollowingmaybeeffectiveinrelievingtheclient'sjointpain?A.Applyingicepackstothejoints.B.Performingactiveresistiverange-of-motionexercises.C.Applyingwarmcompressestothejoints.D.Applyingtranscutaneouselectricalnervestimulation(TENS).12.Whichofthefollowingwouldbebesttohelpprepareapreschool-agedchildforaninjection?A.Havinganolderchildexplainthatshotsdonothurt.B.Helpingthechildtoimaginesheisinadifferentplace.C.Givingthechildaplaysyringeandabandagetogiveadollinjections.D.Givingthechildapoundingboardtoencourageexpressionsofanger.13.Thechildwithrheumaticfevermusthavehisheartratemeasuredwhileawakeandwhilesleeping.Whyaretworeadingsnecessary?A.Toobtainaheartratethatisn'taffectedbymedication.B.Toeliminateinterferencefromthejerkymovementsofchorea.C.Toensurethatthechildcan'tconsciouslyraiseorlowertheheartrate.D.Tocompensatefortheeffectsofactivityontheheartrate.14.AfteraclientreceivesanIMinjection,hecomplainsofburningpainintheinjectionsite.Whichnursingactionwouldbethebesttotakeatthistime?A.Applyacoldcompresstodecreaseswelling.B.Applyawarmcompresstodilatethebloodvessels.C.Massagetheareatopromoteabsorptionofthedrug.D.Instructtheclienttotightenhisglutealmusclestopromotebetterabsorption.15.Beforebowelsurgery,theinfantistoreceiveoralneomycinfor3days.Theappropriatepediatricdosageofneomycinsulfateis10.3mg/kgq4hours.Theinfantweighs15pounds,6.4ounces.Whichofthefollowingdosagesmostcloselyapproximatesasafedailydose?A.50mg/day.B.150mg/day.C.280mg/day.D.430mg/day.16.Preventionofpretermbirthsisvitalforwhichofthefollowingreasons?A.It'scostlytocarefortheseneonates.B.Theseneonatesareusuallymentallyretarded.C.Pretermbirthcauseshighincidenceoftheneonataldeaths.D.Theseneonatesusuallywindupwithlong-termhealthcareneeds.17.An8-year-oldchildwithasthmaisbeingswitchedfromparenteralsteroidtherapytoadailydoseoforalprednisone.Whichofthefollowinginstructionswouldthenursegivetotheparents?A.Havethechildtakethedosewithmealstopreventgastricirritation.B.Makesurethepillisgivenintacttomaintaintheentericcoating.C.Administerthedosebeforebedtimetominimizesideeffects.D.Givethemedicationaccordingtothechild'sresponse.18.Aclientwithcholecystitisisreceivingpropanthelinebromide.TheclientisgiventhismedicationbecauseitA.reducesgastricsolutionproductionandhypermobility.B.slowsemptyingofthestomachandreduceschymeintheduodenum.C.inhibitscontractionofthebileductandgallbladder.D.decreasesbilesecretions.19.Aclientseekscareforlowbackpainof2weeks'duration.Whichassessmentfindingsuggestsaherniatedintervertebraldisk?A.Painthatradiatesdowntheposteriorthigh.B.Backpainwhenthekneesareflexed.C.Atrophyofthelowerlegmuscles.D.PositiveHomans'sign.20.Encouragementandpraiseshouldbegiventohyperactiveclientstohelpthemincreasetheirfeelingsofself-esteem.Whentheyhavebehavedwelt,thebestwaytoletthemknowthestaffisawareoftheirimprovementisforthenursetosayA."Youbehavedwelltoday."B."Weknewyoucouldbehave."C."Everyonelikesyoubetterwhenyoubehavelikethis."D."Yourbehaviortodaywasmuchbetterthanyesterday."21.Thenurseiscaringforaclientadmittedtotheemergencydepartmentafteramotorvehicleaccident.Underthelaw,thenursemustobtaininformedconsentbeforetreatmentunlessA.theclientismentallyill.B.theclientrefusestogiveinformedconsent.C.theclientisinanemergencysituation.D.theclientasksthenursetogivesubstitutedconsent.22.Whichstatementaboutfluidreplacementisaccurateforaclientwithhyperosmolarhyperglycemicnonketoticsyndrome(HHNS)?A.Administer2to3LofIVfluidrapidly.B.Administer6LofIVfluidoverthefirst24hours.C.Administeradextrosesolutioncontainingnormalsalinesolution.D.AdministerIVfluidslowlytopreventcirculatoryoverloadandcollapse.23.Thenurseiscaringforaclientwithadultrespiratorydistresssyndrome(ARDS).Whatisthemostlikelylaboratoryfindingintheearlystagesofthisdisease?

A.Increasedcarboxyhemoglobin.

B.Decreasedpartialpressureofarterialoxygen(PaO2).

C.Increasedpartialpressureofarterialcarbondioxide(PaCO2).

D.Decreasedbicarbonate().24.Client:"Ihadanaccident."

Nurse:"Tellmeaboutyouraccident."

Thisisanexampleofwhichtherapeuticcommunicationtechnique?A.MakingobservationsB.OfferingselfC.GeneralleadD.Reflection25.A15-year-oldboyisadmittedtothehealthcarefacilityafteractingouthisaggressionsinappropriatelyatschool.Predisposingfactorstotheexpressionofaggressionincludewhichofthefollowing?A.Violenceontelevision.B.Passiveparents.C.Aninternallocusofcontrol.D.Asingle-parentfamily.26.Aclientexhibitsconfusionandseverememoryloss.At11:30AM,hetellsthenursethatheisgoingtoworkandproceedstowalktowardthedoor.Whichofthefollowingactionsshouldbethenursetake?A.Remindhimthatheretiredfromhisjob10yearsago.B.Tellhimthatshe'llaccompanyhimforashortwalkoutdoors.C.Diverthisattentiontowardthediningroomwherelunchisbeingserved.D.Tellhimthathedoesnothavetogotoworktoday.27.Whichnursinginterventionwouldmostlikelyleadtoahyposmolarstate?A.Performingnasogastric(NG)tubeirrigationwithnormalsalinesolution.B.Weighingtheclientdaily.C.Administeringtapwaterenemauntilthereturnisclear.D.Encouragingtheclientwithexcessiveperspirationtodrinkbroth.28.Aclientwithleft-sidedheartfailurecomplainsofincreasingshortnessofbreathandisagitatedandcoughinguppink-tinged,foamysputum.ThenurseshouldrecognizetheseassignsandsymptomsofA.right-sidedheartfailure.B.acutepulmonaryedema.C.pneumonia.D.cardiogenicshock.29.Asanadolescentisreceivingcare,he'sinadvertentlyinjuredwithawarmcompress.Thenursecompletesanincidentreportbasedontheknowledgethatidentificationofwhichofthefollowingisnotagoalofthereport?A.Staffinvolvedsothey'rereprimandedfortheiractions.B.Learningneedsofstafftopreventrecurrenceofincidents.C.Patternsofclientcareproblems.D.Factssurroundingeachincident.30.Thenurseiscaringforaclientwhomshesuspectsisparanoid.Howwouldthenurseconfirmthisassessment?A.Indirectquestioning.B.Directquestioning.C.Lead-insentences.D.Open-endedsentences.31.Aclientwithtype1(insulin-dependent)diabetesmellituswhoisamultigravidavisitstheclinicat28weeks'gestation.Whichofthefollowinginstructionbythenurseisappropriatefortheclient?A.Nonstresstestingisperformedweeklyuntil32weeks'gestation.B.Weeklyfetalmovementcountsaremadebythemother.C.Contractionstresstestingisperformedweekly.D.Inductionoflaborisbegunat34weeks'gestation.32.Theoverweightadolescentclienttellsthenursethathewouldliketoloseweightandasksthenurse'sopiniononhowtoaccomplishhisgoal.Whichofthefollowingsuggestionswouldbemostappropriate?A.Exercisingmoreoften.B.Severelylimitingcalorieintake.C.Participatinginanadolescentweight-reductionprogram.D.Cuttingclownonsweetsandothersnacks.33.ThenurseiscaringforatoddlerwithDownsyndrome.Tohelpthetoddlercopewithpainfulprocedures,thenursecanA.preparethechildbypositiveself-talk.B.establishatimelimittogetreadyfortheprocedure.C.holdandrockhimandgivehimasecurityobject.D.countandsingwiththechild.34.After5daysofhospitalization,theclientwhoisreceivingmorphinesulfateforpaincontrolasksformorepainmedicationwithincreasingfrequencyandexhibitsincreasedanxietyandrestlessness.Hisphysicalconditionisstable.Whatistheprobablecauseofhisbehavior?A.Hismorphinedosageistoohigh.B.Hiscopingmechanismsareexhausted.C.Heisbecomingaddictedtothenarcotic.D.Hehasdevelopedtolerancetohisnarcoticdosage.35.Whenassessingthefetalheartratetracing,thenursebecomesconcernedaboutthefetalheartratepattern.Inresponsetothelossofvariability,thenurserepositionstheclienttoherleftsideandadministersoxygen.Theseactionsarelikelytoimprovewhichofthefollowing?A.Fetalhypoxia.B.Thecontractionpattern.C.Thestatusofatrappedcord.D.Maternalcomfort.36.ThenurseisteachingthemotherofaninfantwithtetralogyofFallot.Themotheraskswhattodowhenherinfantbecomesveryblueandhastroublebreathingaftercrying.Thenurseshouldtellthemother,A."Leavetheinfantaloneuntilthecryingstops."B."Puttheinfantintheknee-chestposition."C."Offertheinfantabottleofformula."D."Taketheinfantforarideinthecar."37.AnurseinapsychiatricsettinghaspromotedatherapeuticrelationshipwithanAPDpatient.Onedaythenurseisoffdutyandisprepareforleaving,theclientssaysinapitytone,"Don'tletmealone,please,otherstaffdon'tlikemeandoftenpunishme."Whatthenursesayissuitableandcanassistthepatient?A."Don'tworry,Iwillbebacksoon."B."Iwillaskthestaffnottopunishyou."C."Youarelying,noneofstaffwillpunishyou."D."YouknowIleaveatthistimeeveryday.We'lltalkaboutthisinmynextdutytime."38.WheninterviewingapatientwithBPD,anattendingnursingshouldassesswhetherthepatienthasarisktosuicide.TheriskfactorssheshouldcollectincludingthefollowingsexceptA.Physiologicandself-careconsiderationsB.EmotionalantecedentsC.AbusehistoryD.Workingperformance39.Whenmagnesiumsulfateisadministeredtoaclientinlabor,itsactionoccursatwhichofthefollowingsites?A.Neural-muscularjunctions.B.Distalrenaltubules.C.Centralnervoussystem(CNS).D.Myocardialfibers.40.InteachingafemaleclientwhoisHIV-positiveaboutpregnancy,thenursewouldknowmoreteachingisnecessarywhentheclientsays,A."Thebabycangetthevirusfrommyplacenta."B."I'mplanningonstartingonbirthcontrolpills."C."Noteveryonewhohasthevirusgivesbirthtoababywhohasthevirus."D."I'llneedtohaveaC-sectionifIbecomepregnantandhaveababy."41.Amotherwhosedaughteriskilledinaschoolbusaccidenttellsthenursethatherdaughterwasjustgettingoverthechickenpoxanddidnotwanttogotoschool,butsheinsistedthatshego.Themothercriesbitterlyandsaysherchild'sdeathisherfault.Thenurseshouldrealizethatperceivingadeathaspreventablewouldmostofteninfluencethegrievingprocessinthat:A.ThelossmaybeeasiertounderstandandtoacceptB.BereavementmaybeofgreaterintensityanddurationC.ThegrievingprocessmayprogresstoapsychiatricillnessD.Itcausesthemournertoexperienceapathologicgriefreaction42.AclientwithintrauterinegrowthretardationisadmittedtothelaboranddeliveryunitandstartedonanIVinfusionofoxytocin(Pitocin).WhichofthefollowingisLEASTlikelytobeincludedinherplanofcare?A.Monitoringvitalsigns,includingassessmentoffetalwell-being,every15to30minutes.B.Allowingtheclienttoambulateastolerated.C.Helpingtheclientusebreathingexercisestomanagehercontractions.D.Carefullytitratingtheoxytocinbasedonherpatternoflabor.43.Becauseantianxietyagentssuchaschlordiazepoxide(Librium)canpotentiatetheeffectsofotherdrugs,thenurseshouldincorporatewhichofthefollowinginstructionsinherteachingplan?A.Avoidmixingantianxietyagentswithalcoholorothercentralnervoussystem(CNS)depressants.B.Avoidtakingantianxietyagentsatbedtime.C.Avoidtakingantianxietyagentsonanemptystomach.D.Avoidconsumingagedcheesewhentakingantianxietyagents.44.Whencaringforaclientwithpreeclampsia,whichactionisapriority?A.Monitoringtheclient'slaborcarefullyandpreparingforafastdelivery.B.Continuallyassessingthefetaltracingforsignsoffetaldistress.C.Checkingvitalsignsevery15minutestowatchforincreasingbloodpressure.D.Reducingvisualandauditorystimulation.45.Aclientwhoisagravida1para0hasbeenadmittedtotheperinataladmissionunitandisinearlylabor.Theclient'scervicalexaminationwouldrevealwhichofthefollowing?A.2cmdilated;100%effacedat0station.B.4to5cmdilated;80%effacedat-1station.C.2cmdilated;50%effacedat+1station.D.3cmdilated;50%effacedat0station.46.AclientwithHashimoto'sthyroiditisandahistoryoftwomyocardialinfarctionsandcoronaryarterydiseaseistoreceivelevothyroxine(Synthroid).Becauseoftheclient'scardiachistory,thenursewouldexpectthattheclient'sinitialdoseforthethyroidreplacementwouldbewhichofthefollowing?A.25g/day,initially.B.100g/day,initially.C.Delayeduntilafterthyroidsurgery.D.Initiatedbeforethyroidsurgery.47.Thenurseiscaringaclientinanacutecarementalhealthprogram.Theclientrefuseshismorningdoseofanoralantipsychoticmedicationandbelieveshe'sbeingpoisoned.Whatshouldthenursedo?A.Crushingthemedicationandputtingitinhisfood.B.Consultingwiththephysicianaboutaplanofcare.C.Administeringthemedicationbyinjection.D.Omittingthedoseandtryingagainthenextday.48.ThephysicianordersIVfluidvolumereplacementwithlactatedRinger'ssolutionatarateof75mL/hour.Usinganinfusionsetthatprovides15gtt/mL,thenurseshouldcalculatetheflowratetobeA.10gtt/min.B.12gtt/min.C.19gtt/min.D.75gtt/min.49.A24-year-oldclientonthelaborunitisbeingcoachedintheLamazemethodbyherhusband.Onassessment,thenursefindstheclienttobe5cmdilated,90%effaced,at+1stationwithcontractionscomingevery2to3minutesandlasting35to40seconds.Theclienthasaskedforpainrelief.What'sthenurse'sbestaction?A.Checkmaternalbloodpressureandpulseandfetalheartrateinresponsetocontractions.B.Realizethatit'stooearlytogivepainmedication,andencouragethehusbandtocontinuewiththeLamazecoaching.C.Arrangeforasonogramtodeterminefetalposition.D.Performavaginalexaminationtodeterminedilation,effacement,andstation.50.AllofthefollowingwouldbeappropriateinterventionsforaclientwithacuteepididymitisEXCEPTwhichofthefollowing?A.Maintainingbedrest.B.Elevatingthetestes.C.Applyingicepacksintermittently.D.Applyinghotpackstothescrotum.卷I参考答案一.Comprehensivetestcenter1.参考答案：DApersoncanconvertunbearablefeelingsintoaphysicalsymptomwithnoorganiccause.Thisdefensemechanismusuallymanifestsitselfnearthetimeofatraumaticorconflict-producingevent.Thesymptomcommonlyprovidesattentionorameansofescapingtheconflict.Repressionisadefensemechanisminwhichapersonunconsciouslykeepsunwantedfeelingsfromenteringawareness.Transferenceinvolvestheprojectionoffeelings,thoughts,andwishes(positiveornegative)ontosomeone,usuallyatherapist,whorepresentsafigurefromtheperson'spast.Reactionformationisameansofalleviatingunresolvedconflictsbetweenfeelingsorimpulsesbyreinforcingonefeelingandrepressinganother,therebydisguisingthetruefeelingsfromtheself.2.参考答案：CTheclient'shistoryandassessmentsuggestthathemayhaveincreasedintracranialpressure(ICP).Ifthisisthecase,lumbarpunctureshouldn'tbedonebecauseitcanquicklydecompressthecentralnervoussystemand,thereby,causeadditionaldamage.Afteraheadinjury,barbituratesmaybegiventopreventseizures;mechanicalventilationmayberequiredifbreathingdeteriorates;andelevatingtheheadofthebedmaybeusedtoreduceICP.3.参考答案：DAsantidepressantsbegintotakeeffectandtheclientfeelsbetter,shemayhavetheenergytoinitiateandcompleteanothersuicideattempt.Astheclient'senergylevelincreases,thenursemustcontinuetobevigilanttotheriskofsuicide.Extrapyramidalsymptomsmayoccurwithantipsychoticsandaren'tadverseeffectsofantidepressants.Atherapeuticrelationshipshouldbeinitiateduponadmissiontothepsychiatricunit,aftersuicideprecautionshavebeeninstituted.It'sthroughthisrelationshipthattheclientdevelopsfeelingsofself-worthandtrustandproblem-solvingtakesplace.Inano-suicidecontract,theclientstatesverballyorinwritingthatshewon'tattemptsuicideandwillseekoutstaffifshehassuicidalthoughts.Whenthetimeperiodforacontracthasexpired,anewcontractshouldbeobtainedfromtheclient.4.参考答案：COtotoxicityisaserioussideeffectofgentamycin.Tinnitusanddizzinessarecommon;irreversibledeafnesscandevelopiftheonsetofototoxicityisnotdetectedearly.Gentamycinisalsoknowntobenephrotoxicandhepatoxic.5.参考答案：BSettinglimitsforunacceptablebehaviorismostimportantinamanicclient.Typically,depressed,suicidal,oranxiousclientsdon'tphysicallyormentallytestthelimitsofthecaregiver.6.参考答案：BInathreatenedabortion,vaginalbleedingorspottingoccursandabdominalcrampingmayoccur.However,thecervixisnotdilated.Terminationofthepregnancymayormaynotbeprevented.7.参考答案：APittingedemaisdocumentedas+1whendepressionisbarelydetectableonreleaseofthumbpressureandwhenfootandlegcontoursarenormal.Adetectabledepressionoflessthan5mmaccompaniedbynormallegandfootcontourswarrantsa+2rating.Adeeperdepression(5to10mm)accompaniedbyfootandlegswellingisevaluatedas+3.Anevendeeperdepression(morethan1cm)accompaniedbyseverefootandlegswellingratesa+4.8.参考答案：BVisionchanges,suchashalosaroundobjects,aresignsofdigoxintoxicity.Hearinglosscanbedetectedthroughhearingassessment;however,itisn'tacommonsignofdigoxintoxicity.Intakeandoutputaren'taffectedunlessthere'snephrotoxicity,butthatsituationisuncommon.Gaitchangesarealsouncommon.9.参考答案：APTCAisbestdescribedasinsertionofaballoon-tippedcatheterintothecoronaryarterytocompressaplaque,therebyopeningastenosedorblockedartery.10.参考答案：AAccordingtotheDenverIIDevelopmentalScreeningtest,mostinfantsshouldbeabletositunsupportedbyage7months.A15-month-oldchildshouldbeabletosaytwowords.By17months,thetoddlershouldbeabletofeedhimselfwithaspoon.A10-month-oldshouldbeabletoplaypatty-cake.11.参考答案：CWarmcompressesincreasebloodflowtotheaffectedjoint,relievingpain.Icecausesdecreasedbloodflowtotheaffectedjoint,increasingpain.Thenurseshouldturntheclientfrequentlytopreventskinbreakdownandconservetheclient'senergy.TENSapplicationisreservedforchronicpain.12.参考答案：CAllowingthepreschool-agedchildtogiveplayinjectionscanhelptopreparethechildtoreceiveaninjection.Preschoolershavealimitedvocabulary.Theyexpresstheirfeelingsthroughplay.Theyalsouseplaytohelpcopewithstress.13.参考答案：DTachycardiamaybeasignofheartfailure.Mildtachycardiaismoreeasilydetectedduringsleepthanduringthedaywhenactivitycancauseanincreaseinheartrate.Medicationsgivenforrheumaticfeverandrheumaticheartdisease,suchasdigoxin,exerttheirinfluencedayandnight.Chorea,asymptomofrheumaticfever,isthelossofvoluntarymusclecontrol.However,itdoesn'taffectpulsebecausethechildwouldbesittingquietlyandnotinvolvedinpurposefulmovement.Aten-year-oldchildisunlikelytobeabletoconsciouslyraiseorlowerhisheartrate.14.参考答案：BApplyingheatincreasesbloodflowtothearea,which,inturn,increasestheabsorptionofthemedication.Colddecreasesthepainbutallowsthemedicationtostayinthemusclelonger.Massageisagoodinterventionbutapplyingawarmcompressisbetter.Tighteningtheglutealmusclesmaycauseadditionalburningifthedrugirritatesmusculartissues.15.参考答案：DThedoseiscalculatedbyfirstdeterminingtheweightinkilograms:15pounds,6.4ouncesisequalto15.4pounds;15.4poundsdividedby2.2isequalto7kg.Multiplying10.3mgby7kgequals72.1mg.Incomputingadailydosage,thedoseismultipliedbythenumberoftimesitwillbegivenperday(72.1mg×6=432.6mg/day).16.参考答案：CPrematurityistheleadingcauseofneonataldeathsintheUnitedStates;otherindustrializednationshavefewerprematurebirthsandfewerneonataldeathsthantheUnitedStatesdoes.Althoughtheotherthreeanswersarecomplicationsofprematurity,preventionistheoutcomenursesmustfocusonwhileprovidingcaretotheirclients.17.参考答案：APrednisonecausesseveregastricupset.Therefore,itshouldbegivenwithfood.18.参考答案：CPropanthelinebromideisclassifiedasaGIanticholinergic;themedicationinhibitsmuscarinicactionsofacetylcholineatpostganglionicparasympatheticneuroeffectorsites.Forgallbladderdisease,propanthelinehasanantispasmodiceffectonthebileductandgallbladder.Althoughthemedicationreducesproductionofgastricsolutionsandalsoreduceshypermobility,itisn'tthemainreasonforthemedication.Thedrugdoesn'tslowemptyingofthestomachorreducechymeintheduodenum.19.参考答案：ADiskherniationmaycompressspinalnerveroots,causingsciaticnerveinflammation,whichproducespainthatradiatesdowntheleg.Slightkneeflexionshouldrelievelowerbackpain.Ifnerverootcompressionremainsuntreated,weaknessorparalysisoftheinnervatedmusclegroupmayresult;lowerlegatrophymayoccurifmusclesaren'tused.PositiveHomans'signismoreindicativeofphlebothrombosis.20.参考答案：A21.参考答案：CThelawdoesn'trequireinformedconsentinanemergencysituationwhentheclientisunabletogiveconsentandnonextofkinispresent.Amentallycompetentclientmayrefuseorrevokeconsentatanytime.Eventhoughaclientwhoisdeclaredmentallyincompetentcan'tgiveinformedconsent,mentalillnessdoesn'tbyitselfindicatethattheclientisincompetenttogiveinformedconsent.Althoughthenursemayactasaclientadvocate,thenursecannevergivesubstitutedconsent.22.参考答案：ARegardlessoftheclient'smedicalhistory,rapidfluidresuscitationiscriticalformaintainingcardiovascularintegrity.Profoundintravasculardepletionrequiresaggressivefluidreplacement.Atypicalfluidresuscitationprotocolis6Loffluidoverthefirst12hours,withmorefluidtofollowoverthenext24hours.Variousfluidscanbeused,dependingonthedegreeofhypovolemia.Commonlyprescribedfluidsi