网站首页  |  关于我们  |  最新公告  |  新闻动态  |  备考指南  |  下载中心  |  考点简介  |  培训基地展示  |  在线留言  |  联系我们
ISPN学习中心
护理名人堂
    最新公告
    新闻动态
    下载中心
    法律声明
    备考指南
    考点简介
    培训基地展示
 
    
 
  

  

 
 
 首页信息中心 备考指南知识题库
 
ISPN考试模拟试题(四十二)

Questions

1.Which age-related change should the nurse consider when formulating a plan of care for an older adult? Select all that apply.

A.Difficulty in swallowing

B.Increased sensitivity to heat

C.Increased sensitivity to glare

D.Diminished sensation of pain 5. Heightened response to stimuli


2.A nurse is caring for an older adult with a hearing loss secondary to aging. What can the nurse expect to identify when assessing this client? Select all that apply.

A. Dry cerumen

B.Tears in the tympanic membrane

C.Difficulty hearing women’s voices

D.Decrease of hair in the auditory canal

E.Overgrowth of the epithelial auditory lining


3.A 93-year-old client in a nursing home has been eating less food during mealtimes. What is the priority nursing intervention?

A.Substitute a supplemental drink for the meal.

B.Spoon-feed the client until the food is completely eaten.

C.Allow the client a longer period of time to complete the meal.

D.Arrange a consultation for the placement of a gastrostomy tube.


4.A 78-year-old client who has hypertension is beginning treatment with furosemide (Lasix). Considering the client’s age, what should the nurse teach the client to do?

A.Limit fluids at bedtime.

B. Change positions slowly.

C.Take the medication between meals.

D.Assess the skin for breakdown daily.Circulatory Sy


5.A nurse must obtain a client’s apical pulse. Place an X over the site where thenurse should place the stethoscope.


Rationales

1. Answer: C, D.

A,There should be no interference with swallowing in older individuals.

B,Older individuals tend to feel the cold and rarely complain of the heat.

C,Changes in the ciliary muscles, decrease in pupil size, and a more rigid pupil sphincter contribute to an increased sensitivity to glare.

D,This may make an older individual unaware of a serious illness, thermal extremes, or excessive pressure.

E,There is a decreased response to stimuli in the older individual.

Client Need:Health Promotion and Maintenance;

Cognitive Level:Analysis;

Nursing Process:Planning/Implementation;

Reference:Ch5,The Middle-Older and Old-Older Adults, Data Base


2.Answer: A, C.

A,Cerumen (ear wax) becomes drier and harder as a person ages.

B,There is no greater incidence of tympanic tears caused by the aging process.

C,Generally,female voices have a higher pitch than male voices;older adults with presbycusis

(hearing loss caused by the aging process) have more difficulty hearing higherpitched sounds.

D,The hair in the auditory canal increases, not decreases.

E,The epithelium of the lining of the ear becomes thinner and drier.

Client Need:Health Promotion and Maintenance;

Cognitive Level:Analysis;

Nursing Process:Assessment/Analysis;

Reference:Ch5,General Nursing Care of Middle-Older and Old-Older Adults


3.C 

Aged clients may display psychomotor retardation and need more time to complete the tasks associated with the activities of daily living; mealtimes should be relaxing and social.

A,Supplemental drinks should augment meals and be offered between meals,not as a substitute for meals.

B,Clients should be encouraged to feed themselves to remain as independent as possible; spoon feeding may not mirror the pace of eating preferred by the client, and forcing the client to eat all of the food may precipitate anxiety, frustration, and agitation.

D,Placement of a gastrostomy tube is premature.

Client Need:Health Promotion and Maintenance;

Cognitive Level:Application;

Nursing Process:Planning/Implementation;

Reference:Ch5, General Nursing Care of Middle-Older and Old-Older Adults


4.B 

With aging there is a decreased vasomotor response and diminished elasticity of blood vessels that do not respond quickly to changes from horizontal to vertical;orthostatic hypotension may occur. Changing positions slowly allows the body to adjust, which prevents dizziness and loss of balance.

A,Usual fluid intake patterns can be maintained.

C,Furosemide (Lasix) should be taken with meals to prevent gastric irritation.It is best to take it in the morning rather than at night so that sleep is not interrupted with the need to void.

D,There is no link between furosemide and skin breakdown.

Client Need:Health Promotion and Maintenance;

Cognitive Level:Application;

Nursing Process:Planning/Implementation;

Reference:Ch5,General Nursing Care of Middle-Older and Old-Older Adults


5.The heart’s apex is between the fifth and sixth ribs at the midclavicular line.It is closest to the chest wall here,so auscultation is easier.


Client Need:Reduction of Risk Potential;

Cognitive Level:Analysis;

Nursing Process:Assessment/Analysis;

Reference:Ch6,Review of Anatomy and Physiology,Heart

小编寄语:最初的梦想,一定会实现!Fighting!


时间:2019-07-04 15:27:00
 
上一篇:ISPN考试模拟试题(四十一)                          下一篇:ISPN考试模拟试题(四十三)  
 
  
邮箱:cgfnscn2012@126.com   法律声明 Copyright 2012   版权所有  All Rights Reserved