1. While you are planning the nursing care of the patient with stomach ulcer, you keep in mind that a major goal of therapy is to help her
A. Talk about the recent stressful situation in her life which may have contributed to the ulcer formation
B. Understand the pathogenesis of the ulcer
C. Accept that she is under stress and needs rest
D. Discover what substances caused her to have pain
答案為C。因?yàn)樵跐儾≈委熯^程中,保持患者身心放松十分重要,是護(hù)理的一個重要目標(biāo)。與患者談?wù)撍纳顗毫、發(fā)病機(jī)理均不利于此。
2. A patient is admitted to the coronary care unit of the hospital with a myocardial infarction. The patients orders include cardiac monitoring. When initiating the cardiac monitoring, the nursing should explain to the patient that the procedure is performed to monitor
A. How much blood the heart is pumping
B. The rate and rhythm of the heart
C. How much fluid of the body is retaining
D. the strength of the myocardium
答案為B。因?yàn)閯偘l(fā)生心肌梗塞或可疑心肌梗塞患者應(yīng)當(dāng)進(jìn)行心電監(jiān)護(hù),它可以顯示心率和心律并及時發(fā)現(xiàn)心律失常如室顫等,以給與及時處理,挽救生命。
3. A female patient who has insulin-dependent diabetes mellitus is given instructions in the administration of insulin. When she administers insulin to herself, which of these actions observed by the nurse indicates that the patient needs further instruction?
A. She rotates the insulin bottle before withdrawing the insulin
B. She cleans the needle with alcohol wipe before giving herself the insulin
C. She holds the needle at a 900 angle to inject the insulin into her abdomen
D. She masseges the injection site after administering the insulin
答案B。注射胰島素的注射器和針頭都是無菌的,不必再用酒精消毒。
4. Which of these nursing diagnoses should be given priority in the care plan for a patient who has Parkinsons disease?
A. Alteration in nutrition B. Ineffective individual coping
C. Altered mood state D. High risk for injury
答案D。 帕金森癥患者肌張力增高、震顫容易摔倒而受傷。