【点名时间】——国际护士考试模拟题3

　　今天是国际护士考试模拟题与你第3次见面。

　　鉴于大家对昨天5道试题没有在作答过程中提出疑问，小编相信，聪明的你已经从我们详细的解答中掌握了相关知识。

　　今天，我们继续。

　　11. A child with impetigo is to be discharged from the hospital. The nurse's plan of care should include which of the following measures?

　　A. Providing high protein meals for the child.

　　B. Teaching the child and family members about good hand-washing technique.

　　C. Instructing the child and family members about decreasing playground activity.

　　D. Providing sun lamp treatments for the child.

　　12. A nurse is providing discharge teaching to the family of an elderly patient who is confused and is taking several oral medications. Which of the following instructions should be given priority?

　　A. Administer medications with meals.

　　B. Withhold medications that the patient refuses.

　　C. Supervise the patient's medication administration.

　　D. Allow the patient to self-medicate when possible.

　　13. A I5-month-old child who is postoperative after a cleft palate repair has elbow restraints in place. Which of the following instructions should the nurse include in the patient's plan of care?

　　A. Place mittens on the child's hands.

　　B. Remove the restraints briefly every two hours.

　　C. Tell the parents that they may remove the restraints while they are in the child's room.

　　D. Have the parents sign a release form before applying the restraints.

　　14. Which of the following measures is most appropriate for a nurse to take to prevent injury in a patient who is confused?

　　A. Apply a soft restraint on the patient's wrist.

　　B. Administer Lorazepam (Ativan) as ordered.

　　C. Change the patient's environment.

　　D. Keep the bed in the lowest position.

　　15. A nurse is assigned to all of the following patients.Which patient should the nurse assess first?

　　A. The patient requesting medication for chest pain.

　　B. The patient who has an intravenous medication due in 30 minutes.

　　C. The patient who has a temperature of 101'F.

　　D. The patient who is scheduled to go to surgery within the hour.

　　昨天试题答案解析：

　　6. Key: C

　　Client Need : Safety and Infection Control

　　C. The child is being discharged to home and is oxygen dependent. Oxygen may be administered in the home. Home oxygen therapy requires that a number of safety features should be in place. Because oxygen is a highly flammable gas, precautions must be taken to ensure the safety of the patient and family.Assessing the home for potential fire hazards is necessary. There should be no open flames, electrical sparks or flammable materials present. Smoking in the home by any person when oxygen is in use is contraindicated.

　　A. Drafts or air leaks in the home may affect the environmental temperature but would have no direct impact on the care or safety of the child at home who requires oxygen therapy.

　　B. Other children in the home do not pose any direct threat to the child who is at home on oxygen. Returning the child to home will reduce the amount of developmental delay or social handicap related to prolonged hospitalization.

　　D. Pets in the home could be a potential problem if they shed fine hair. Small particles. such as dust and fine hair. could potentially cause obstruction of the tracheostomy. Keeping the child separate from the family pet should be sufficient to maintain a clear airway.

　　7. Key: B

　　Client Need: Safety and Injection Control

　　B. It is important that the patient knows how to call the nurse. The patient needs to be aware of how to use the call light. Since the patient has a tracheostomy, he is unable to speak. Due to the patient's impaired ability to speak. Communication tools should be kept close at hand along with the call light or bell.

　　A. The patient may not have an oxygen collar. Not all patients with a tracheostomy require oxygen.

　　C. While the procedure for suctioning should be explained to the patient. it is not the most important aspect when orienting the patient to the room.

　　D. Preventing infetti:m in a new tracheostomy patient is primarily the responsibility of the nurse. It is not most important when orienting the patient to the room.

　　8. Key: C

　　Client Need: Safety and Infection Control

　　C. Potentially harmful objects should be removed from the immediate environment. This protects the patient from potential injury. The primary nursing outcome is that seizures are controlled and the patient remains free of injury.

　　A. Objects such as tongue blades may cause injury to the patient and are not placed in the mouth during seizure activity.

　　B. Restraints should never be applied during a seizure.

　　D. The family should remain with the patient during seizure activity. Not every seizure will be a medical emergency in the patient with chronic seizures.

　　9. Key: C

　　Client Need: Physiological Adaptation

　　C. The infectious stage of tuberculosis declines immediately after effective chemotherapy. The risk of infectious tuberculosis is much higher for persons who are immunosup-pressed. Patients need to be taught to cover their mouth when coughing, because tuberculosis is spread by droplets.

　　A. Antimycobacterial therapy is usually prescribed for six to nine months. Short-term use of antibiotics is not effective chemotherapy. The Centers for Disease Control (CDC) recommends a minimum of six months of therapy.

　　B. For a definite diagnosis of tuberculosis, a positive sputum culture is necessary. A Mantoux test identifies individuals exposed to mycobacterium tuberculosis. This test does not differentiate between active and dormant infection.

　　D. BCG (Bacille Calmette-Guerin) strengthens the body's immune system.

　　10. Key: C

　　Client Need: Safety and Infection Control

　　C. A child must be properly restrained when undergoing a lumbar puncture to prevent trauma from an unexpected or involuntary movement. Children are usually controlled best in a side-lying position, with the head flexed and the knees drawn up toward the chest. The child is placed on his / her side with the back close to the edge of the examining table on the side from which the practitioner is working. The nurse maintains the child's spine in a flexed position by holding the child with one arm behind the neck and the other behind the thighs.

　　A. Soft arm restraints or leg restraints are used occasionally when one or more extremity needs to be restrained or limited in motion. However. this type of restraint does not help to maintain the child in the proper position required for a lumbar puncture.

　　B. A jacket restraint is sometimes used as an alternative to a crib net to prevent a child from climbing out of a crib or to keep the child from falling out of a chair. This type of restraint fits over the child's torso and would not allow access to the lumbar area. A jacket restraint would interfere with proper positioning of the child.

　　D. Placing a child supine on a papoose board (a type of restraint where the child's whole body is usually covered and tied down to prevent any movement) will not allow the practitioner access to the lumbar region. The patient must be in a flexed position in order for the needle to easily enter the lumbar space.

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