2021陕西美国护士资格认证(CGFNS)考试真题卷（3）.docx

2021陕西美国护士资格认证(CGFNS)考试真题卷（3）本卷共分为1大题50小题，作答时间为180分钟，总分100分，60分及格。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） 1.What is the most appropriate nursing diagnosis for the client with acute pancreatitisADeficient fluid volume.BExcess fluid volume.CDecreased cardiac output.DIneffective gastrointestinal tissue perfusion. 2.After assessing a newly admitted 5-year-old child, the nurse makes the nursing diagnosis of Parental role conflict related to child's hospitalization. Which defining characteristic would most suggest this diagnosisASupportive child-parent interaction (speaking, listening, touching, and eye-to-eye contact).BParents' active participation in child's physical or emotional care.CParents' failure to use available support systems or agencies to assist in coping.DEvidence of adaptation to parental role changes. 3.When caring for a client who is having her second baby, the nurse can anticipate the client's labor will be which of the followingAShorter than her first labor.BAbout half as long as her first labor.CAbout the same length of time as her first labor.DA length of time that can't be determined based on her first labor. 4.The nurse is caring for a primigravida who is scheduled for a fetal acoustic stimulation test (FAST). The nurse should explain to the client that the primary purpose of this test is toAinduce contractions.Binduce fetal heart rate accelerations.Cshorten the contraction stress test.Ddetermine fluid volume. 5.The nurse is caring for a client whom she suspects is paranoid. How would the nurse confirm this assessmentAIndirect questioning.BDirect questioning.CLead-in sentences.DOpen-ended sentences. 6.A client refuses his evening dose of haloperidol (Haldol) then becomes extremely agitated in the day room while other clients are watching television. He begins cursing and throwing furniture. The nurse's first action is toAcheck the client's medical record for an order for an IM as needed dose of medication for agitation.Bplace the client in full leather restraints.Ccall the physician and report the behavior.Dremove all other clients from the day room. 7.A client is admitted to the hospital with a productive cough, night sweats, and a fever. Which action is most important in the initial plan of careAAssessing the client's temperature every 8 hours.BPlacing the client in respiratory isolation.CMonitoring the client's fluid intake and output.DWearing gloves during all client contact. 8.Following a transsphenoidal hypophysectomy, the nurse should assess the client carefully for which conditionAHypocortisolism.BHypoglycemia.CHyperglycemia.DHypercalcemia. 9.Which nursing intervention would most likely lead to a hyposmolar stateAPerforming nasogastric (NG) tube irrigation with normal saline solution.BWeighing the client daily.CAdministering tap water enema until the return is clear.DEncouraging the client with excessive perspiration to drink broth. 10.Which of the following would be the best approach when trying to take a crying toddler's temperatureAIgnore the crying and screaming.BEncourage the mother to hold the child.CTalk to the mother first and then to the toddler.DBring extra help so it can be done quickly. 11.The nurse is providing care for a pregnant client in her second trimester. Glucose tolerance test results show a blood glucose level of 160 mg/dL. The nurse should anticipate that the client will need toAstart using insulin.Bstart taking an oral antidiabetic drug.Cmonitor her urine for glucose.Dbe taught about diet. 12.Which of these signs suggests that a client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion has developed complicationsATetanic contractions.BNeck vein distention.CWeight loss.DPolyuria. 13.In a group therapy setting, one member is very demanding, repeatedly interrupting others, and taking most of the group time. The nurse's best response would be,A"Will you briefly summarize your point because others need time also"B"Your behavior is obnoxious and drains the group. "CTo ignore the behavior and allow him to vent.D"I'm so frustrated with your behavior. " 14.The nurse notices that a client with obsessive-compulsive disorder washes his hands for long periods each day. How should the nurse respond to this compulsive behaviorABy designating times during which the client can focus on the behavior.BBy urging the client to reduce the frequency of the behavior as rapidly as possible.CBy calling attention to or attempting to prevent the behavior.DBy discouraging the client from verbalizing anxieties. 15.The nurse is interviewing a client about his medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancerADuodenal ulcers.BHemorrhoids.CWeight gain.DPolyps. 16.Lochia normally progresses in which patternARubra, serosa, alba.BSerosa, rubra, alba.CSerosa, alba, rubra.DRubra, alba, serosa. 17.A client who is 7 months pregnant reports severe leg cramps at night. Which nursing action would be most effective in helping her cope with these crampsASuggesting that she walk for 1 hour twice per day.BAdvising her to take over-the-counter calcium supplements twice per day.CTeaching her to dorsiflex her foot during the cramp.DInstructing her to increase milk and cheese intake to 8 to 10 servings per day. 18.A term neonate's mother is O-negative, and cord studies indicate that the neonate is A-positive. Which of the following would be least likely if the neonate developed neonate hemolytic diseaseALethargy or irritability.BPoor feeding patterns including vomiting.CWeight loss greater than 10%.DSigns of kernicterus. 19.The nurse is caring for a toddler with Down syndrome. To help the toddler cope with painful procedures, the nurse canAprepare the child by positive self-talk.Bestablish a time limit to get ready for the procedure.Chold and rock him and give him a security object.Dcount and sing with the child. 20.A 15-year-old female with a urinary tract infection is admitted to the facility. She tells the nurse she hopes she's pregnant. Which of the following would be the best response by the nurseA"Does your mother know about this"B"Tell me what pregnancy would mean to you. "C"Congratulations. Does the baby's father know"D"I hope you aren't pregnant; you're too young. " 21.A client with a diagnosis of a bleeding gastric ulcer goes to the operating room for a partial gastrectomy. Postoperative nursing care would includeAadministering pain medications every 6 hours.Bwithholding fluids by mouth until the return of peristalsis.Cpositioning the client in high Fowler position.Dflushing the nasogastric (NG) tube with sterile water. 22.Which of the following would be least likely to indicate anticipated bonding behaviors by new parentsAThe parents' willingness to touch and hold the neonate.BThe parents' expression of interest about the size of the neonate.CThe parents' indication that they want to see the neonate.DThe parents' interactions with each other. 23.A client who is breast-feeding has a temperature of 102°F (38.9) and complains that her breasts are engorged. Her breasts are swollen, hard, and red. Which of the following actions would be inappropriate in managing the client's breast engorgementAApplying frozen cabbage leaves to the breasts.BEncouraging the client to shower with her back to the water.CEncouraging the client to nurse her baby frequently.DApplying a breast binder to support the breasts. 24.A client is hospitalized with a diagnosis of chronic renal failure. An arteriovenous fistula was created in his left arm for hemodialysis. When preparing the client for discharge, the nurse should reinforce which dietary instructionA"Be sure to eat meat at every meal. "B"Monitor your fruit intake and eat plenty of bananas. "C"Restrict your salt intake. "D"Drink plenty of fluids. " 25.The least serious form of brain trauma, characterized by a brief loss of consciousness and period of confusion, is calledAcontusion.Bconcussion.Ccoup.Dcontrecoup. 26.During her first prenatal visit, a client expresses concern about gaining weight. Which of the following would be the nurse's best actionAAsk the client how she feels about gaining weight and provide instructions about expected weight gain and diet.BBe alert for a possible eating problem and do a further in-depth assessment.CReport the client's concerns to her caregiver.DAsk her to come back to the clinic every 2 weeks for a weight check. 27.The physician orders a tricyclic antidepressant for a client who has suffered an acute myocardial infarction (MI) within the past 6 months. The nurse should take which of the following actionsAAdminister the medication as ordered.BDiscontinue the medication.CQuestion the order with the physician.DInform the client that he should discuss the MI with the physician. 28.A client has been diagnosed with type A hepatitis. What special precautions should the nurse take when caring for this clientAPut on a mask and gown before entering the client's room.BWear gloves and a gown when removing the client's bedpan.CPrevent the droplet spread of the organism.DUse caution when bringing food to the client. 29.A 9-month-old infant is admitted with diarrhea and deficient fluid volume. The nurse plans to assess this client's vital signs frequently. What other action would provide the most important assessment informationAMeasuring the infant's body weight.BObtaining a stool specimen for analysis.CObtaining a urine specimen for analysis.DInspecting the infant's posterior fontanel. 30.A client's chest X-ray reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results fromAcardiogenic pulmonary edema.Brespiratory alkalosis.Cincreased pulmonary capillary permeability.Drenal failure. 31.When developing a plan of care for a toddler with a seizure disorder, which of the following would be inappropriateAPadded side rails.BOxygen mask and bag system at bedside.CArm restraints while asleep.DCardiopulmonary monitoring. 32.When administering gentamicin to a preschooler, which of the following monitoring schedules is best for determining the drug's effectivenessAA serum trough level every morning.BA serum peak level after the second dose.CA serum trough and peak level around the third dose.DSerial serum trough levels after three doses (24 hours). 33.The nurse is assessing the puncture site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluationA15-mm induration.BReddened area.C10-mm bruise.DBlister. 34.When assessing a client with chest pain, the nurse obtains a thorough history. Which statement by the client is most suggestive of angina pectorisA"The pain lasted for about 45 minutes. "B"The pain resolved after I ate a sandwich. "C"The pain worsened when I took a deep breath. "D"The pain occurred while I was mowing the lawn. " 35.A 3-month-old infant just had a cleft lip and palate repair. To prevent trauma to the operative site, the nurse should do which of the followingAGive the baby a pacifier to help soothe him.BLie the baby in the prone position.CPlace the infant's arms in soft elbow restraints.DAvoid touching the suture line, even to clean. 36.To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instructionsALie down after meals to promote digestion.BAvoid coffee and alcoholic beverages.CTake antacids before meals.DLimit fluids with meals. 37.A client undergoes a total hip replacement. Which statement made by the client would indicate to the nurse that the client requires further teachingA"I'll need to keep several pillows between my legs at night. "B"I need to remember not to cross my legs. It's such a habit. "C"The occupational therapist is showing me how to use a 'sock puller' to help me get dressed. "D"I don't know if I'll be able to get off that low toilet seat at home by myself. " 38.Which behavior would cause the nurse to suspect that a client's labor is moving quickly and that the physician should be notifiedAAn increased sense of rectal pressure.BA decrease in intensity of contractions.CAn increase in fetal heart rate variability.DEpisodes of nausea and vomiting. 39.When assessing an infant for changes in intracranial pressure (ICP), it's important to palpate the fontanels. Where the nurse should palpate to assess the anterior fontanelAABBCCDD 40.A 10-year-old diagnosed with acute glomerulonephritis is admitted to the pediatric unit. The nurse should ensure that which of the following is a part of the child's careATaking vital signs every 4 hours and obtaining daily weight.BObtaining a blood sample for electrolyte analysis every morning.CChecking every urine specimen for protein and specific gravity.DEnsuring that the child has accurate intake and output and eats a high-protein diet. 41.The nurse reinforces the physician's description of a fasciotomy for a client. When a fasciotomy is performed to alleviate compartment syndrome, the fascia is opened along the length of the muscle compartment andAthe skin is sutured loosely.Ba pressure dressing is applied.Cthe skin is left open.Da skin graft is placed. 42.Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia shown by which of the followingAMuscle weakness.BTremors.CDiaphoresis.DConstipation. 43.Which of the following describes how the nurse interprets a neonate's Apgar score of 8 at 5 minutesAA neonate who is in good condition.BA neonate who is mildly depressed.CA neonate who is moderately depressed.DA neonate who needs additional oxygen to improve the Apgar score. 44.Which of the following describes the rationale for administering vitamin K to every neonateANeonates don't receive the clotting factor in utero.BThe neonate