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ISPN考试模拟试题(十一)

Questions

1. A nurse is reviewing a client’s plan of care. What is the determining factor in the revision of the plan?

A. Time available for care

B. Validity of the problem

C. Method for providing care

D.Effectiveness of the interventions


2. A nurse is teaching an adolescent about type 1 diabetes and self-care. 

Which client questions indicate a need for additional teaching in the cognitive domain?Select all that apply.

A. “What is diabetes?”

B. “What will my friends think?”

C. “How do I give myself an injection?”

D. “Can you tell me how the glucose monitor works?”

E. “How do I get the insulin from the vial into the syringe?”


3. A nurse is caring for a client with hemiplegia who is frustrated. How can the nurse motivate the client toward independence?

A. Establish long-range goals for the client.

B. Identify errors that the client can correct.

C. Reinforce success in tasks accomplished.

D. Demonstrate ways to promote self-reliance.


4.A client is receiving an antihypertensive drug intravenously for control of severe hypertension. The client’s blood pressure is unstable and is 160/94 mm Hg before the infusion. Fifteen minutes after the infusion is started,the blood pressure increases to 180/100 mm Hg. Which type of response is the client demonstrating?

A. Allergic

B. Synergistic

C. Paradoxical

D. Hypersusceptibility


5. A client has an anaphylactic reaction after receiving intravenous penicillin.What does the nurse conclude is the cause of this reaction?

A. An acquired atopic sensitization occurred.

B. There was passive immunity to the penicillin allergen.

C. Antibodies to penicillin developed after a previous exposure.

D. Potent antibodies were produced when the infusion was instituted

Rationales

1.D 

When the implementation of a plan of care does not effectively produce the desired outcome, the plan should be changed.

A,Time is not relevant in the revision of a plan of care.

B,Client response to care is the determining factor, not the validity of the health problem.

C,Various methods may have the same outcome; their effectiveness is most important.

Client Need:Management of Care;

Cognitive Level:Comprehension;

Nursing Process: Evaluation/Outcomes;

Reference:Ch 2, Nursing Process


2.A, D

A,Acquiring knowledge or understanding aids in developing concepts, rather than skills or attitudes, and is a basic learning task in the cognitive domain.

B,Values and self-realization are in the affective domain.

C,Skills acquisition is in the psychomotor domain.

D,Acquiring knowledge or understanding aids in developing concepts rather than skills or attitudes and is a basic learning task in the cognitive domain.

E,Skills acquisition is in the psychomotor domain.

Client Need: Health Promotion and Maintenance;

Cognitive Level: Analysis;

Integrated Process: Teaching/Learning;

Nursing Process: Evaluation/Outcomes;

Reference: Ch 2, Teaching-Learning


3.C 

Success is a basic motivation for learning. People receive satisfaction when a goal is reached.

A,Progress toward long-range goals is often not readily apparent and may be discouraging.

B,Constructive criticism is an important aspect of client teaching,but if it is not tempered with praise, it is discouraging.

D,This is an important part of teaching, but it probably will not motivate the client.

Client Need: Health Promotion and Maintenance;

Cognitive Level: Application;

Integrated Process: Teaching/Learning;

Nursing Process:Planning/Implementation;

Reference: Ch 2, Teaching-Learning


4.C 

A paradoxical response to a drug is directly opposite the desired therapeutic response.

A,An allergic response is an antigen-antibody reaction.

B,A synergistic response involves drug combinations that enhance each other.

D,This is a response to a drug that is more pronounced than the common response.

Client Need: Pharmacological and Parenteral Therapies;

Cognitive Level:Application;

Nursing Process: Evaluation/Outcomes;

Reference: Ch 2, Medication Administration, Drug Effects


5.C 

Hypersensitivity results from the production of antibodies in response to exposure to certain foreign substances (allergens). Earlier exposure is necessary for the development of these antibodies.

A,This is not a sensitivity reaction to penicillin; hay fever and asthma are atopic conditions.

B,It is an active, not passive, immune response.

D,Antibodies developed when there was a prior, not current, exposure to penicillin.

Client Need: Pharmacological and Parenteral Therapies;

Cognitive Level:Application;

Nursing Process: Evaluation/Outcomes;

Reference: Ch 2, Medication Administration, Drug Effects
小编寄语:越努力,越幸运!Fighting!

时间:2019-05-15 16:42:58
 
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