1、美国护士资格认证(CGFNS)-25 及答案解析(总分：50.00，做题时间：90 分钟)一、BPart One/B(总题数：30，分数：30.00)1.A client delivered a healthy full-term female neonate 2 hours ago by cesarean delivery. When assessing this client, which finding requires immediate nursing action? A. Tachycardia and hypotension. B. Gush of vaginal blood w
2、hen the client stands up. C. Blood stain 2“ (5 cm) in diameter on the abdominal dressing. D. Complaints of abdominal pain.（分数：1.00）A.B.C.D.2.Which of the following is used to treat serious depression when drug therapy has failed? A.Electroconvulsive therapy B.Insulin treatment C.Psychosurgery D.Hydr
3、otherapy（分数：1.00）A.B.C.D.3.During a shock state, the renin-angiotensin-aldosterone system exerts which effect on renal function? A. Decreased urine output, increased reabsorption of sodium and water. B. Decreased urine output, decreased reabsorption of sodium and water. C. Increased urine output, in
4、creased reabsorption of sodium and water. D. Increased urine output, decreased reabsorption of sodium and water.（分数：1.00）A.B.C.D.4.The nurse is caring for a child with leukemia. Which of the following should the nurse priority pay more attention to? A. Preventing injury. B. Monitoring the childs pla
5、telet count. C. Monitoring the childs temperature. D. Encouraging increased fluid intake.（分数：1.00）A.B.C.D.5.A client with intrauterine growth retardation is admitted to the labor and delivery unit and started on an IV infusion of oxytocin (Pitocin). Which of the following is LEAST likely to be inclu
6、ded in her plan of care? A. Monitoring vital signs, including assessment of fetal well-being, every 15 to 30 minutes. B. Allowing the client to ambulate as tolerated. C. Helping the client use breathing exercises to manage her contractions. D. Carefully titrating the oxytocin based on her pattern of
7、 labor.（分数：1.00）A.B.C.D.6.The client with a lumbar laminectomy asks to be turned onto his side. What should the nurse do? A. Inform the client that because of his laminectomy, he may only lie supine. B. Ask the client to help by using an overhead trapeze to turn himself. C. Turn the clients shoulder
8、s first, followed by his hips and legs. D. Get another nurse to help log roll the client into position.（分数：1.00）A.B.C.D.7.The nurse is caring for a client with a fractured hip. The client is combative and confused, and hes trying to get out of bed. The nurse should A. leave the client and get help.
9、B. obtain a physicians order to restrain the client. C. read the facilitys policy on restraints. D. order soft restraints from the storeroom.（分数：1.00）A.B.C.D.8.A client has been placed on levodopa to treat his Parkinsons disease. Which of the following is a common side effect of levodopa that the nu
10、rse should include in the clients teaching plan? A. Pancytopenia. B. Peptic ulcer. C. Orthostatic hypotension. D. Weight loss.（分数：1.00）A.B.C.D.9.A disturbed client is scheduled to begin group therapy. The client refuses to attend. The nurse should A.Accept the clients decision without discussion B.H
11、ave another client ask the client to reconsider C.Tell the client that attendance at the meeting is required D.Insist that the client join the group to help the socialization process（分数：1.00）A.B.C.D.10.What is the nurses most important role in caring for a client with a mental health disorder? A. To
12、 offer advice. B. To know how to solve the clients problems. C. To establish trust and rapport. D. To set limits with the client.（分数：1.00）A.B.C.D.11.Which laboratory test results would the nurse expect to find in a client diagnosed with Hashimotos thyroiditis? A. Thyroxine (T4), 22g/dL; triiodothyro
13、nine (T 3), 320ng/dL; thyroid-stimulating hormone (TSH) undetectable. B. T4, 22g/dL; T 3, 200ng/dL; TSH,0.1IU/mL. C. T4, 2g/dL; T 3, 200ng/dL; TSH,5.9IU/mL. D. T4, 2g/dL; T 3, 35ng/dL; TSH,45IU/mL.（分数：1.00）A.B.C.D.12.A client has had a total gastrectomy for gastric cancer. Which one of the following
14、 is the most appropriate expected outcomes about nutrition? A. The client will learn to self-administer enteral feedings every 4 hours. B. The client will maintain adequate nutrition through oral or parenteral feedings. C. The client will regain any weight lost within 4 weeks of the surgical procedu
15、re. D. The client will eat three full meals a day without experiencing gastric complications.（分数：1.00）A.B.C.D.13.A 6-year-old girl has been hospitalized with rheumatic fever for 4 weeks. Her symptoms have gradually subsided, and shes now ready for discharge. Which of the following plans for her heal
16、th care is most important for her future well-being? A. Arrange for her to return to school as soon as possible to promote psychosocial development. B. Encourage her to engage in unrestricted physical activity to regain physical strength. C. Arrange for the administration of prophylactic antibiotics
17、 to prevent a recurrence of rheumatic fever. D. Maintain seizure precautions, as central nervous system involvement may persist for several months.（分数：1.00）A.B.C.D.14.The nurse is teaching the mother of an infant with tetralogy of Fallot. The mother asks what to do when her infant becomes very blue
18、and has trouble breathing after crying. The nurse should tell the mother, A. “Leave the infant alone until the crying stops. “ B. “Put the infant in the knee-chest position. “ C. “Offer the infant a bottle of formula. “ D. “Take the infant for a ride in the car. “（分数：1.00）A.B.C.D.15.A client with an
19、 indwelling urinary catheter is suspected of having a urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by A. disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container. B. wiping the self-sealing aspiration por
20、t with antiseptic solution and aspirating urine with a sterile needle. C. draining urine from the drainage bag into a sterile container. D. clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine.（分数：1.00）A.B.C.D.16.A 23-month-old child is
21、brought to the emergency department with suspected croup. Which assessment finding reflects increasing respiratory distress? A. Intercostal retractions. B. Bradycardia. C. Decreased level of consciousness. D. Flushed skin.（分数：1.00）A.B.C.D.17.One morning the nurse overhears Elma, who is admitted with
22、 BPD, having an argument with her mother, When suppertime, Elma is very angry with the nurse and complains nurse must say something bad to her mother about her performance in ward. What the defense mechanism Elma is using? A.Dissociation B.Denial C.Projection D.Splitting（分数：1.00）A.B.C.D.18.The nurse
23、 is assessing a pregnant woman in the clinic. In the course of the assessment, the nurse learns that this woman smokes one pack of cigarettes per day. Which of the following is the first step the nurse should take to help the woman stop smoking? A. Assess the clients readiness to stop. B. Suggest th
24、at the client reduce the daily number of cigarettes smoked by one-half. C. Provide the client with the telephone number of a formal smoking-cessation program. D. Help the client develop a plan to stop.（分数：1.00）A.B.C.D.19.The physician orders supplemental oxygen for a client with a respiratory proble
25、m. To provide the highest possible oxygen concentration, the nurse expects to use which oxygen delivery device? A. Nasal cannula. B. Venturi mask. C. Partial rebreathing mask. D. Nonrebreathing mask.（分数：1.00）A.B.C.D.20.A client with testicular cancer is scheduled for a right orchiectomy. The day bef
26、ore surgery, the client asks the nurse whether losing a testicle will have influence on his manhood. Which of the following facts about orchiectomy should form the basis for the nurses response? A. Testosterone levels are decreased. B. Sexual drive and libido are unchanged. C. Sperm count increases
27、in the remaining testicle. D. Secondary sexual characteristics change.（分数：1.00）A.B.C.D.21.While auscultating heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as A. a first heart sound (S1).
28、 B. a third heart sound (S3). C. a fourth heart sound (S4). D. a murmur.（分数：1.00）A.B.C.D.22.Before a transesophageal echocardiogram, a client is given an oral topical anesthetic spray. Upon return from the procedure, the nurse observes that the client has no active gag reflex. In response, the nurse
29、 should A. insert an oral airway. B. withhold food and fluids. C. position the client on his side. D. introduce a nasogastric (NG) tube.（分数：1.00）A.B.C.D.23.Which of the following home regimens should the nurse suggest to relieve itching in children with chicken pox? A. Generous amounts of fine baby
30、powder. B. Oatmeal preparation baths. C. Terrycloth towels moistened with hydrogen peroxide. D. Cool compresses moistened with a weak salt solution.（分数：1.00）A.B.C.D.24.The nurse is caring for a client who has a history of alcohol abuse. Why would the client act as if he didnt have a problem? A. The
31、client has never taken the CAGE questionnaire. B. Denial is a defense mechanism commonly used by alcoholics. C. Thought processes are distorted. D. Alcohol is expensive.（分数：1.00）A.B.C.D.25.Drugs to treat acute anxiety are prescribed to a client hospitalized for an acute myocardial infarction. The cl
32、ient is reluctant to take anti-anxiety drugs. The nurse suspects that the client is holding the drugs under his tongue and disposing of them after she has left the room. What should the nurse do first? A. Report her suspicions to the clients physician. B. Talk to the client about his attitude toward
33、 the medications. C. Search the clients room for evidence of the medications. D. Tell the client that his behavior must stop for his own well-being.（分数：1.00）A.B.C.D.26.One day, the nurse sits by a depressed clients bed and states, “I will be spending some time with you today. “ The client responds a
34、ngrily, “Go talk to someone else. They need you more. “ The most therapeutic response by the nurse would he: A.“Why are you angry with me?“ B.“Ill go, but I will be back tomorrow. “ C.“Dont say that. You are important, too. “ D.“I will be spending the next 15 minutes with you. “（分数：1.00）A.B.C.D.27.W
35、hich of the following discharge instructions should the nurse give the parents of an infant with a temporary colostomy? A. Flush the stoma with tap water at least once a day. B. Allow the diaper to absorb the colostomy drainage. C. Give the infant plenty of liquids to drink. D. Expect the stoma to b
36、ecome dusky red within 2 weeks.（分数：1.00）A.B.C.D.28.Oxytocin (Pitocin) is administrated to a client during labor. Which of the following is the most serious adverse effect associated with oxytocin? A. Water intoxication. B. Tetanic contractions. C. Elevated blood pressure. D. Early decelerations of f
37、etal heart rate.（分数：1.00）A.B.C.D.29.A client asks the nurse to help her make out her will. In this situation, what should be the nurses best response? A. “I dont believe in getting involved in legal matters, but maybe I can find another nurse wholl help you. “ B. “You need to consult an attorney bec
38、ause Im not trained in such matters. Is there a family lawyer I can call for you?“ C. “Im not a lawyer, but Ill do what I can for you. “ D. “You have a long way to go before youll need to do that. Lets wait on it a while, shall we?“（分数：1.00）A.B.C.D.30.The decision to get married might indicate that
39、Johnny is in which of Freuds psychosexual stages? A.Latency B.Oral C.Genital D.Phallic（分数：1.00）A.B.C.D.二、BPart Two/B(总题数：20，分数：20.00)31.Which of the following would be least likely to indicate anticipated bonding behaviors by new parents? A. The parents willingness to touch and hold the neonate. B.
40、The parents expression of interest about the size of the neonate. C. The parents indication that they want to see the neonate. D. The parents interactions with each other.（分数：1.00）A.B.C.D.32.Which pregnancy-related physiologic change would place the client with a history of cardiac disease at the gr
41、eatest risk for developing severe cardiac problems? A. Decreased heart rate. B. Decreased cardiac output. C. Increased plasma volume. D. Increased blood pressure.（分数：1.00）A.B.C.D.33.After gastric resection surgery, which of the following signs and symptoms would alert the nurse to the development of
42、 a leaking anastomosis? A. Pain, fever, and abdominal rigidity. B. Diarrhea with fat in the stool. C. Palpitations, pallor, and diaphoresis after eating. D. Feelings of fullness and nausea after eating.（分数：1.00）A.B.C.D.34.A primigravida at 36 weeks gestation tells the nurse that she has moderate bre
43、ast tenderness. The nurse teaches the client with some suggestions for relief measures. Which of the following statements by the client suggests the nurse that the client needs further instructions? A. “I should wear a supportive bra at all times. “ B. “I should clean my nipples with soap. “ C. “I s
44、hould change my sleeping positions. “ D. “I should clean up the colostrum with water. “（分数：1.00）A.B.C.D.35.The parents of a 4-year-old with sickle cell anemia tell the nurse that they would like to have other children, but theyre concerned about passing sickle cell anemia on to them. Which health ca
45、re team member would be the most appropriate person for the nurse to refer them to? A. Clergy. B. Social worker. C. Certified nurse midwife. D. Genetic counselor.（分数：1.00）A.B.C.D.36.Which nursing action is most effective in defusing a clients impending violent behavior? A. Helping the client identif
46、y and express feelings of anxiety and anger. B. Involving the client in a quiet activity to divert attention. C. Leaving the client alone until he can talk about his feelings. D. Placing the client in seclusion.（分数：1.00）A.B.C.D.37.During her first prenatal visit, a client expresses concern about gai
47、ning weight. Which of the following would be the nurses best action? A. Ask the client how she feels about gaining weight and provide instructions about expected weight gain and diet. B. Be alert for a possible eating problem and do a further in-depth assessment. C. Report the clients concerns to he
48、r caregiver. D. Ask her to come back to the clinic every 2 weeks for a weight check.（分数：1.00）A.B.C.D.38.A 4-year-old child with pain and itching around the rectum has just been diagnosed with a pinworm infestation. The physician prescribes mebendazole (Vermox). When teaching the childs parents about the treatment regimen, the nurse should emphasize which instruction? A. Look for white patches in the childs mouth. B. Make sure that all family members are treated. C. Encourage the child to drink lots of apple juice. D. Limit dai
