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ISPN考试模拟试题(二十一)

Questions

1. A client asks the nurse, “Should I tell my partner that I just found out I’m HIV positive?” What is the nurse’s most appropriate response?

A. “This is a decision you alone can make.”

B. “Do not tell your partner unless asked.”

C. “You are having difficulty deciding what to say.”

D. “Tell your partner that you don’t know how you became sick.”


2. A client becomes anxious after being scheduled for a colostomy.What is the most effective way for the nurse to help the client?

A. Administer the prescribed prn sedative.

B. Encourage the client to express feelings.

C. Explain the postprocedure course of treatment.

D. Reassure the client that there are others with this problem.


3.A client with hemiplegia is staring blankly at the wall and reports feeling like half a person. What is the initial nursing action?

A. Use techniques to distract the client.

B. Include the client in decision making.

C. Offer to spend more time with the client.

D. Help the client to problem-solve personal issues.


4.While receiving a preoperative enema, a client starts to cry and says, “I’m sorry you have to do this messy thing for me.” What is the nurse’s best response?

A. “I don’t mind it.”

B. “You seem upset.”

C. “This is part of my job.”

D. “Nurses get used to this.”


5.A nurse is teaching a client about a restricted diet.What is the nurse’s best initial comment?

A. “What type of foods do you usually eat?”

B. “You should follow this diet exactly as written.”

C. “You must limit the intake of foods on this special list.”

D. “What do you know about this diet that was ordered for you?”

Rationales

1. C 

This response promotes an exploration of the client's dilemma; it encourages further communication.

A,Although this is true, this response is not supportive and abandons the client.

C, D, It is inappropriate for the nurse to give advice.

Client Need:Psychosocial Integrity;

Cognitive Level:Application;

Integrated Process:Communication/Documentation;

Nursing Process:Planning/Implementation;

Reference:Ch 2 The Nurse-Client Relationship


2. B 

Communication is important in relieving anxiety and reducing stress.

A,This does not acknowledge the client’s feelings and does not address the source of the anxiety.

C, Learning is limited when anxiety is too high.

D,The focus should be on the client, not others.Reassurance may cut off communication and deny emotions.

Client Need:Psychosocial Integrity;

Cognitive Level:Application;

Integrated Process:Communication/Documentation;

Nursing Process:Planning/Implementation;

Reference: Ch 2,The Nurse-Client Relationship


3. C 

Because of the profound effect of paralysis on body image, the nurse should foster an environment that permits exploration of feelings without judgment, punishment, or rejection.

A,Attempts to distract the client may be interpreted as denial of the client’s feelings and will not resolve the underlying problem.

B, D, This is an important part of nursing care, but it is not related to the client’s feelings.

Client Need:Psychosocial Integrity;

Cognitive Level:Application;

Integrated Process:Caring;

Nursing Process:Planning/Implementation;

Reference:Ch 2, The Nurse-Client Relationship


4.B 

The nurse should identify clues to a clients anxiety and encourage verbalization of feelings.

A, D, This response negates the client’s feelings and presents a negative connotation.

C,This response focuses on the task rather than on the client’s feelings.

Client Need:Psychosocial Integrity;

Cognitive Level:Application;

Integrated Process:Communication/Documentation;

Nursing Process:Planning/Implementation;

Reference:Ch 2, The Nurse-Client Relationship


5.D 

This question may validate the clients understanding; the response may indicate the need for further teaching or that the client understands; understanding and accepting the need for restrictions will increase adherence to the diet.

A,Assessing the client’s food preferences and teaching about diets follow an assessment of the client’s understanding about the need for a specific diet; the client must understand the need for and the benefits of the diet before there is a readiness for learning.

B, C, This is an authoritarian approach that should be avoided.

Client Need:Health Promotion and Maintenance;

Cognitive Level: Application;

Integrated Process: Teaching/Learning;

Communication/Documentation;

Nursing Process: Assessment/Analysis;

Reference:Ch 2, Teaching-Learning 

小编寄语:越努力,越幸运!Fighting!


时间:2019-06-03 14:52:22
 
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