美国护士资格认证CGFNS15.docx

美国护士资格认证CGFNS15.docx

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美国护士资格认证CGFNS15

美国护士资格认证（CGFNS）-15

（总分：

53.00，做题时间：

90分钟）

一、PartOne（总题数：

30，分数：

30.00）

1.Aclientwhoagreedtobecomeanorgandonorispronounceddead.Whatisthemostimportantfactorinselectingatransplantrecipient?

A.Bloodrelationship.

B.Sexandsize.

C.Compatiblebloodandtissuetypes.

D.Need.

 A.

 B.

 C. √

 D.

解析：

Thedonorandrecipientmusthavecompatiblebloodandtissuetypes.Theyshouldbefairlycloseinsizeandage.Whenalivingdonorisconsidered,it'spreferabletohavearelativedonatetheorgan.Needisimportant,butitcan'tbethecriticalfactorifacompatibledonorisn'tavailable.

2.Thenurseiscaringforaclientwhohasjusthadamodifiedradicalmastectomywithimmediatereconstruction.She'sinher30sandhastwoyoungchildren.Althoughshe'sworriedaboutherfuture,sheseemstobeadjustingwelltoherdiagnosis.Whatshouldthenursedotosupporthercoping?

A.Telltheclient'sspouseorpartnertobesupportivewhilesherecovers.

B.Encouragetheclienttoproceedwiththenextphaseoftreatment.

C.Recommendthattheclientremaincheerfulforthesakeofherchildren.

D.RefertheclienttotheAmericanCancerSociety'sReachforRecoveryprogramoranothersupportprogram.

 A.

 B.

 C.

 D. √

解析：

Theclientisn'twithdrawnorshowingothersignsofanxietyordepression.Therefore,thenursecanprobablysafelyapproachherabouttalkingwithotherswhohavehadsimilarexperiences,eitherthroughReachforRecoveryoranotherformalsupportgroup.Thenursemayeducatetheclient'sspouseorpartnertolistenforconcerns,butthenurseshouldn'ttelltheclient'sspousewhattodo.Theclientmustconsultwithherphysicianandmakeherowndecisionsaboutfurthertreatment.Theclientneedstoexpresshersadness,frustration,andfear.Shecan'tbeexpectedtobecheerfulatalltimes.

3.A19-year-oldprimigravidaisadmittedtothelaboranddeliveryunitinlabor.She's2cmdilatedand50%effaced,andthefetalheadisat0station.She'shavingmoderatelystrong40-secondcontractionsevery5minutes.Sheseemsratheranxiousandbecomesverytenseduringeachcontraction.Whentheclientasksforpainrelief,whatshouldthenursedonext?

A.Determinethesourceofheranxietyandinstituteinterventionstohelpherrelax.

B.Immediatelycheckthephysician'sorderandgivehertheanalgesicordered.

C.Informherthattheneonate'sheadisn'tdownfarenoughjustyetbutthat,assoonasitis,medicationwillbegiven.

D.Tellherthathercontractionsareonlymoderatelystrongandthatsheshouldwaituntillatertotakemedication.

 A. √

 B.

 C.

 D.

解析：

Decreasinganxietycanbreakthefear-tension-paincycle.Analgesicsgiventooearlycanprolonglabor.Informingtheclientthattheneonate'sheadisn'tdownfarenoughandtellingherthathercontractionsareonlymoderatelystrongaren'thelpfulorencouraging;sheobviouslyneedsimmediateattentionofsomekind.

4.Thenurseiscaringforaclientadmittedtotheemergencydepartmentafteramotorvehicleaccident.Underthelaw,thenursemustobtaininformedconsentbeforetreatmentunless

A.theclientismentallyill.

B.theclientrefusestogiveinformedconsent.

C.theclientisinanemergencysituation.

D.theclientasksthenursetogivesubstitutedconsent.

 A.

 B.

 C. √

 D.

解析：

Thelawdoesn'trequireinformedconsentinanemergencysituationwhentheclientisunabletogiveconsentandnonextofkinispresent.Amentallycompetentclientmayrefuseorrevokeconsentatanytime.Eventhoughaclientwhoisdeclaredmentallyincompetentcan'tgiveinformedconsent,mentalillnessdoesn'tbyitselfindicatethattheclientisincompetenttogiveinformedconsent.Althoughthenursemayactasaclientadvocate,thenursecannevergivesubstitutedconsent.

5.Thenurseiscaringforaclientwithotosclerosisscheduledtoundergoastapedectomy.Theclientasksthenursewhenherhearingwillimprove.Whichresponsebythenurseismostappropriate?

A.Yourhearingmaynotimprovebutyou'llnolongerbebotheredbytinnitus.

B.Yourhearingmaybedramaticallyimprovedrightaftersurgery.

C.Youmaynoticeimprovedhearingwithin1to2weeks.

D.Yourhearingmayimprove3to6weeksaftersurgery.

 A.

 B.

 C.

 D. √

解析：

Afterstapedectomy,itcantakeaslongas6weeksforhearingtoimprove.Theclientmaynotnoticeanyimprovementinthefirst2weeksaftersurgery.Aftersurgery,hearingmayinitiallyworsenbecauseofswellingandfluidaccumulationintheear.Tinnitusmaynotresolve.

6.Aclient'sbloodglucoselevelis45mg/dL.Thenurseshouldbealertforwhichsignsandsymptoms?

A.Coma,anxiety,confusion,headache,andcool,moistskin.

B.Kussmaul'srespirations,dryskin,hypotension,andbradycardia.

C.Polyuria,polydipsia,hypotension,andhypernatremia.

D.Polyuria,polydipsia,polyphagia,andweightloss.

 A. √

 B.

 C.

 D.

解析：

Signsandsymptomsofhypoglycemiaincludeanxiety,restlessness,headache,irritability,confusion,diaphoresis,coolskin,tremors,coma,andseizures.Kussmaul'srespirations,dryskin,hypotension,andbradycardiaaresignsofdiabeticketoacidosis.Excessivethirst,hunger,hypotension,andhypernatremiaaresymptomsofdiabetesinsipidus.Polyuria,polydipsia,polyphagia,andweightlossareclassicsignsandsymptomsofdiabetesmellitus.

7.Whenreportingtothesurgeonthatachesttubeismalfunctioning,thenurseisorderedtorepositionthetubeandobtainachestradiograph.Thenurseshould

A.informthesurgeonthisisn'twithinherscopeofpractice.

B.reportthesurgeontotheEthicsCommittee.

C.reportthesurgeontothenursingsupervisor.

D.followtheorderasrequestedbythesurgeon.

 A. √

 B.

 C.

 D.

解析：

Initially,thenurseneedstoinformthesurgeonthatthetaskisoutsidethescopeofnursingpractice.Ifthesurgeonstillrequeststheactivity,thenurseshouldrefusetoperformthetaskandshouldfollowthechainofcommunicationforreportingunsafepracticeaccordingtothehospital'spolicy.Thenursemustnotcomplywithanyorderthatgoesbeyondthescopeofnursingpractice.

8.Thenurseisprovidingcaretoaclientwithcatatonictypeofschizophreniawhoexhibitsextremenegativism.Tohelptheclientmeethisbasicneeds,thenurseshould

A.asktheclientwhichactivityhewouldprefertodofirst.

B.negotiateatimewhentheclientwillperformactivities.

C.telltheclientspecificallyandconciselywhatneedstobedone.

D.preparetheclientaheadoftimefortheactivity.

 A.

 B.

 C. √

 D.

解析：

Theclientneedstobeinformedoftheactivityandwhenitwillbedone.Givingtheclientchoicesisn'tdesirablebecausehecanhemanipulativeorrefusetodoanything.Negotiatingandpreparingtheclientaheadoftimealsoisn'ttherapeuticwiththistypeofclientbecausehemaynotwanttoperformtheactivity.

9.Aclientisadmittedforasuspectedeatingdisorder.Whichofthefollowingstatementswouldindicatethattheclientmaybesufferingfromanorexianervosa?

A."I'vegained3poundsinthelastmonth."

B."Ieatloadsofspinachandyellowvegetableseachday."

C."I'maperfectionist,andIworkhardtogetA's."

D."Ibingefrequentlyinthemorningandfeelfat./

 A.

 B.

 C. √

 D.

解析：

Typically,theanorexicclientworkshardtoachieveperfectionandlosestheabilitytoaccepthelp.OptionAreferstoweightgain,whichmayindicatebulimia.OptionBisatypicalofanorexicclients,whohaveanintensefearofbecomingobeseandcompulsivelyresistanyattemptsateating.Bingeeating（optionD）ischaracteristicofbulimia（althoughbulimicstendtobingemorefrequentlyintheevening,and"feelingfat"ischaracteristicofanorexia）.

10.Thenurseadministersracemicepinephrinetoachild.Tenminutesafteradministration,thenurseshouldbealertfor

A.respiratorydistress.

B.profoundtachycardia.

C.signsofimprovedoxygenation.

D.diminishedcyanosis.

 A. √

 B.

 C.

 D.

解析：

Areboundeffectfromracemicepinephrinecanoccurupto4hoursaftertreatmentwithsignsofrespiratorydistress（tachypnea,restlessness,cyanosis）.Tachycardiamayinitiallyfollowtreatmentwithracemicepinephrineaswellasimprovementinclientstatus（improvedoxygenationandimprovedcolor）.

11.A4-month-oldinfantisbroughttothepediatricianbyhisparentsbecausethey'reconcernedabouthisfrequentrespiratoryinfections,poorfeedinghabits,frequentvomiting,andcolic.Thephysiciannotesthatthebabyhasfailedtogainexpectedweightandrecommendsthatthebabyhaveasweattestperformedtodetectpossiblecysticfibrosis.Topreparetheparentsforthetest,thenurseshouldexplainthat

A.thebabywillneedtofastbeforethetest.

B.asampleofbloodwillbenecessary.

C.alow-sodiumdietisnecessaryfor24hoursbeforethetest.

D.alow-intensity,painlesselectricalcurrentisappliedtotheskin.

 A.

 B.

 C.

 D. √

解析：

Becausecysticfibrosisclientshaveelevatedlevelsofsodiumandchlorideintheirsweat,asweattestisperformedtoconfirmthisdisorder.Afterpilocarpine（acholinergicmedicationthatinducessweating）isappliedtoagauzepadandplacedonthearm,alow-intensity,painlesselectricalcurrentisappliedforseveralminutes.Thearmisthenwashedoff,andafilterpaperisplacedoverthesitewithforcepstocollectthesweat.Elevatedlevelsofsodiumandchloridearediagnosticofcysticfibrosis.Nofastingisnecessarybeforethistestandnobloodsampleisrequired.Alow-sodiumdietisn'trequiredbeforethetest.

12.A24-year-oldclientonthelaborunitisbeingcoachedintheLamazemethodbyherhusband.Onassessment,thenursefindstheclienttobe5cmdilated,90%effaced,at+1stationwithcont