2023年山东美国护士资格认证(CGFNS)考试真题卷.docx

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1、2023年山东美国护士资格认证(CGFNS)考试真题卷本卷共分为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.Which of the following signs and symptoms would alert the nurse to possible internal bleeding in a client who has undergone pulmonary lobectomyA. Increased blood pressure and decreased pulse and re

2、spiratory rates.B. Sanguineous drainage from the chest tube at a rate of 50 mL per hour during the past 3 hours.C. Restlessness and shortness of breath.D. Urine output of 180 mL during the past 3 hours. 2.The nurse is preparing to care for a client diagnosed with catatonic schizophrenia. In anticipa

3、tion of this clients arrival, what should the nurse doA. Notify security.B. Prepare a magnesium sulfate drip.C. Place a specialty mattress overlay on the bed.D. Communicate the clients nothing-by-mouth status to the dietary department.3.A client is fully dilated. Which of the following actions would

4、 be inappropriate during the second stage of laborA. Positioning the mother for effective pushing.B. Preparing for delivery of the baby.C. Assessing for rupture of membranes.D. Assessing vital signs every 15 minutes. 4.Which nursing action is most effective in defusing a clients impending violent be

5、haviorA. Helping the client identify 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. 5.A client undergoes extracorporeal shock wave lithotrip

6、sy (ESWL) to break up and remove renal calculi. Which of the following nursing measures is appropriate for the postoperative care of this clientA. Maintain client on strict bed rest for 48 hours after the procedure.B. Instruct client to anticipate a decrease in urinary output.C. Instruct client to a

7、nticipate hematuria for about 24 hours after the procedure.D. Limit fluid intake to 1000 mL/day until all stone fragments have been passe 6.Which nursing measure would be most effective in helping the client cough and deep breathe after a cholecystectomyA. Having the client take rapid, shallow breat

8、hs to decrease pain.B. Having the client lay on the left side while coughing and deep breathing.C. Teaching the client to use a folded blanket or pillow to splint the incision.D. Withholding pain medication so the client can be alert enough to follow the nurses instructions. 7.The physician has orde

9、red the client to receive digoxin (Lanoxicaps) twice per day until a therapeutic level is attained. When the nurse takes the clients apical pulse on the 3rd day, the pulse is 58, and the client complains of nausea. What should the nurse do nextA. Administer the medication and leave a note on the cha

10、rt for the physician.B. Order a serum digoxin level to be drawn.C. Administer the medication and medicate the client for nausea.D. Withhold the medication and notify the physician.8.A client in labor received an epidural anesthetic when her dilation reached 5 cm. Which of the following nursing diagn

11、oses would have the highest priority for her at this timeA. Impaired skin integrity related to inability to move lower extremities.B. Impaired urinary elimination related to the effects of the epidural.C. Deficient knowledge related to lack of information about regional anesthesia.D. Risk for injury

12、 related to hypotension secondary to vasodilation and pooling in extremities. 9.A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, Youre worried about your medication The nurses communication isA. an exampl

13、e of presenting reality.B. reinforcing the clients delusions.C. focusing on emotional content.D. a nontherapeutic technique called mind readin 10.The nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, which of the following interventions

14、is appropriateA. Administer oxygen.B. Have the client take deep breaths and cough.C. Place the client in high Fowlers position.D. Perform chest physiotherapy.11.Following an earthquake, a client who was rescued from a collapsed building is seen in the emergency department. He has blunt trauma to the

15、 thorax and abdomen. Which nursing observation most suggests the client is bleedingA. Prolonged partial thromboplastin time (PTT).B. Recent history of warfarin (Coumadin) usage.C. Diminished breath sounds.D. Orthostatic hypotension. 12.The nurse instructs the client with hemorrhoids about how to dec

16、rease the discomfort. Which of the following interventions would be most likely recommended by the nurseA. Decrease fiber in the diet.B. Decrease physical activity.C. Take laxatives to promote bowel movements.D. Use warm sitz baths. 13.A client with peptic ulcer has been prescribed propantheline (Pr

17、o-Banthine) as part of the treatment. Which of the following side effects is associated with this medicationA. Nausea.B. Hypotension.C. Urinary frequency.D. Fatigu 14.When bandaging the burned clients hand, the nurse should pay more attention about which of the followingA. The bandage is free of ela

18、stic.B. The bandage material is moistened with sterile normal saline solution.C. The hand and finger surfaces do not touch.D. The hand and fingers are not elevated above heart level. 15.The client is taking triamcinolone acetonide (Azmacort) inhalant to treat her bronchial asthma. Which of the follo

19、wing conditions is the client at increased risk for developing while taking this medicationA. Oral candidiasis.B. Hyperglycemia.C. Gastric ulcer.D. Fluid retention.16.An 18-year-old primagravida tells the nurse that the physician told her that she needed to increase her intake of thiamine (vitamin B

20、i) in her diet. Which of the following foods should the nurse instruct the client to consume moreA. Milk.B. Rice.C. Asparagus.D. Bee 17.A client has been told to take ibuprofen (Motrin, Advil) to relieve the pain of her rheumatoid arthritis. Which of the following statements indicates the client und

21、erstands how to take this drug safely and effectivelyA. I should not take aspirin with this drug unless my physician says to. B. I should not take this drug with antacids or food products. C. I do not need to worry about this medicine irritating my stomach. D. I should notice the effects of this med

22、icine within the first few days. 18.A 5-month-old infant is brought to the clinic by his parents because he cries too much and vomits a lot. The infants birth weight was 6 pounds, 10 ounces, and his current weight is 7 pounds, 4 ounces, falling below the 5th percentile on a standard growth chart. Wh

23、ich of the following data would the nurse identify as the priorityA. Frequency of regular checkups.B. Feeding pattern.C. Pattern of weight gain.D. Family dynamics. 19.An 8-year-old child with asthma is being switched from parenteral steroid therapy to a daily dose of oral prednisone. Which of the fo

24、llowing instructions would the nurse give to the parentsA. Have the child take the dose with meals to prevent gastric irritation.B. Make sure the pill is given intact to maintain the enteric coating.C. Administer the dose before bedtime to minimize side effects.D. Give the medication according to th

25、e childs respons 20.The nurse is reviewing discharge instructions with a client after an uncomplicated delivery. Which of the following symptoms is LEAST important in characterizing postpartum depressionA. Crying easily and feeling despondent.B. Loss of appetite and anxiety.C. Altered body image.D.

26、Difficulty sleeping and poor concentration. 21.A client undergoes a total laryngectomy and tracheostomy formation. On discharge, which instruction should the nurse give to the client and familyA. Clean the tracheostomy tube with alcohol and water. B. Family members should continue to talk to the cli

27、ent. C. Oral intake of fluids should be limited for 1 week only. D. Limit the amount of protein in the diet. 22.The nurse is providing care for a client with multiple myeloma, a disorder characterized by episodes of remissions and exacerbations. Which of the following resources can best help the cli

28、ent adapt to the diseaseA. The clients family.B. Support group.C. Pastoral care.D. Hospice car 23.The nurse is preparing to administer a unit of blood to a client who is anemic. After its removal from the refrigerator, the blood should be administered withinA. 1 hour.B. 2 hours.C. 4 hours.D. 6 hours

29、. 24.The client with a total laryngectomy receives tube feedings to meet his fluid and nutrition needs. The nurse explains to the client that the purpose of the tube feedings is toA. prevent pain from swallowing.B. prevent fistula development.C. ensure adequate intake.D. allow for adequate suture li

30、ne healin 25.The nurse formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands such as the followingA. drinking

31、 more than 1,500 mL of fluid daily.B. eating a high-protein snack at bedtime.C. eating more than three large meals per day.D. being overweight. 26.The nurse notices that the clients pupils are fixed and dilated. What does this finding indicateA. The client is permanently paralyzed.B. The client is g

32、oing to be blind as a result of an injury.C. The client probably has meningitis.D. The client has received a significant brain injury. 27.The nurse is caring for a client who is experiencing auditory hallucinations. What would be most critical for the nurse to assessA. Possible hearing impairment.B.

33、 Family history of psychosis.C. Content of the hallucinations.D. Possible sella turcica tumors. 28.Which of the following should the nurse include in a postoperative teaching plan for a client with a laryngectomyA. Telling the client to speak by covering the stoma with a sterile gauze pad.B. Reassur

34、ing the client that normal eating will be possible after healing has occurred.C. Instructing the client to avoid coughing until the sutures are removed.D. Instructing the client to control oral secretions by swabbing them with tissues or by expectorating into an emesis basin. 29.A client has a nasog

35、astric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates which of the followingA. Absence of nausea and vomiting.B. Absence of stomach drainage for 24 hours.C. Passage of mucus from the rectum.D. Pas

36、sage of flatus and feces from the colostomy. 30.Which of the following is an early symptom of glaucomaA. Hazy vision.B. Loss of central vision.C. Blurred or sooty vision.D. Impaired peripheral vision. 31.When developing a teaching plan for the family of a child with seizures, which of the following

37、would the nurse include when discussing pharmacologic treatmentA. Medication is adjusted independently when side effects occur.B. Abrupt cessation of the medication must be avoided.C. Dosages will be decreased as the child grows older.D. Medication therapy is necessary for the rest of the childs lif

38、 32.A 9-month-old, well-nourished boy who lives with his extensive extended family tests positive for tuberculosis. Which of the following is a risk factor for tuberculosis in this clientA. Male sex.B. The infant is in the 95th percentile for height and weight.C. His mother did not receive prenatal

39、care until the second trimester of her pregnancy.D. Ag 33.A young adult had a significant reaction to the Mantoux test. What conclusion would the nurse make from the findingsA. The client has active tuberculosis.B. The client had active tuberculosis.C. The client has been exposed to tuberculosis.D.

40、The client is immunocompromise 34.A primigravida at 36 weeks gestation tells the nurse that she has moderate breast 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 ins

41、tructionsA. I should wear a supportive bra at all times. B. I should clean my nipples with soap. C. I should change my sleeping positions. D. I should clean up the colostrum with water. 35.The nurse is teaching a group of couples in a childbirth class. The nurse describes normal labor, including the

42、 premonitory signs of labor. Which of the following comments from the client indicates that further teaching is necessaryA. My membranes wont rupture until Im ready to deliver. B. I may feel Braxton Hicks contractions as my pregnancy progresses. C. Lightening usually occurs 2 weeks before labor begi

43、ns in a first pregnancy. D. Ill begin to see a bloody mucus vaginal discharge as my cervix begins to dilate. 36.A neonate girl is admitted to the nursery following a long and difficult labor. Admission vital signs are temperature 96.5F (35.8), heart rate 168 beats/minute, and respiratory rate 64 bre

44、aths/minute. The infant is placed under the radiant heater. What should the nurse do nextA. Review the pregnancy and delivery history.B. Call the pediatrician to report findings.C. Perform a full neonate assessment.D. Check the neonates blood glucose level. 37.A voluntary client in a health care fac

45、ility decides to leave the unit before treatment is complete. To detain the client, the nurse refuses to return the clients personal effects. This is an example of which of the followingA. False imprisonment.B. Limit setting.C. Slander.D. Violation of confidentiality. 38.The nurse is caring for a cl

46、ient with cirrhosis. Which manifestations indicate deficient vitamin K absorption caused by cirrhosisA. Dyspnea and fatigue.B. Ascites and orthopnea.C. Purpura and petechiae.D. Gynecomastia and testicular atrophy. 39.Which of the following is the most appropriate activity for the nurse to assess motor strength for a neurologically injured clientA. Compare equality of hand grasps.B. Observe spontaneous movements.C. Observe the client feed himself.D. Ask the client to signal if he feels pressure applied to his feet. 40.A community nurse is teachi