ACNS信息資訊,ACNS最新考古題
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下載ACNS信息資訊表示您已在通過ANCC Adult Health Clinical Nurse Specialist Certification (ACNS)的路上
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最新的 Nursing ANCC ACNS 免費考試真題 (Q103-Q108):
問題 #103
You are providing care to a patient who presented with extreme fatigue and weakness. His hair is dry and coarse. He reports having difficulty losing some recently gained weight in spite of regular exercise and a healthy diet. He also says that he gets very cold easily. This patient is displaying symptoms of which of the following?
- A. Hypothyroidism.
- B. Addison's disease.
- C. Cushing's syndrome.
- D. Hyperthyroidism.
答案:A
解題說明:
The patient described in the question is exhibiting several classic symptoms that suggest a diagnosis of hypothyroidism. Hypothyroidism is a common endocrine disorder where the thyroid gland does not produce sufficient amounts of thyroid hormones. These hormones, primarily thyroxine (T4) and triiodothyronine (T3), are crucial for regulating metabolism, body temperature, and overall energy management.
The symptoms of hypothyroidism can vary widely depending on the severity of the hormone deficiency. In this case, the patient reports extreme fatigue and weakness, which are indicative of the body's slowed metabolic rate due to low thyroid hormone levels. Additionally, the patient's difficulty in losing weight despite regular exercise and a healthy diet is a hallmark of hypothyroidism, where decreased levels of thyroid hormones lead to a slower metabolism.
Other symptoms noted, such as dry, coarse hair, and an increased sensitivity to cold, align well with hypothyroidism. These occur because thyroid hormones significantly influence skin and hair health, and their deficiency can lead to changes in hair texture and skin dryness. The sensation of being unusually cold is also a common complaint in hypothyroidism, as thyroid hormones help to regulate thermogenesis - the body's heat production.
While other conditions like hyperthyroidism, Cushing's syndrome, and Addison's disease can also affect metabolism and exhibit some overlapping symptoms, the specific combination of weight gain, cold intolerance, dry skin, and fatigue strongly points towards hypothyroidism. Hyperthyroidism, for example, typically presents with symptoms opposite to those of hypothyroidism, such as weight loss and heat intolerance. Cushing's syndrome often involves symptoms such as weight gain primarily in the trunk and face, muscle weakness, and sometimes excessive hair growth or acne, not typically the hair and skin changes described here. Addison's disease might share some symptoms like fatigue but is usually associated with other distinctive signs such as hyperpigmentation and low blood pressure.
Given these considerations, the patient's symptom profile is most consistent with hypothyroidism, and further evaluation through blood tests measuring levels of thyroid-stimulating hormone (TSH) and free T4 would be a prudent next step. These tests help confirm the diagnosis by showing elevated TSH and low T4 levels, typical of hypothyroidism. Treatment often involves thyroid hormone replacement therapy, which can alleviate symptoms and help manage the condition effectively.
問題 #104
The Adult Clinical Nurse Specialist working in an emergency department will see many patients with chest pain. Which of the following would the ACNS expect to find with the patient presenting with an acute myocardial infarction (MI)?
- A. severe and localized pain that has persisted for 3 hours
- B. Five-minute episodes of chest tightness brought on by stair climbing, lawn mowing, and brisk walking
- C. chest pressure that occurs at rest and last around 10 minutes
- D. diffuse, retrosternal pain for 30 minutes accompanied by diaphoresis
答案:D
解題說明:
Choice B is the right answer. The chest pain associated with MI or myocardial ischemia is substernal or retrosternal and is a compression or crushing pain. There is pressure, tightness, heaviness, cramping, and/or an aching sensation. Often, these patients have unexplained indigestion, belching, and epigastric pain as well. Diaphoresis, dyspnea, and nausea and vomiting are common. Chest pressure that occurs at rest and last around 10 minutes (choice A) is not descriptive of an MI, more of unstable angina. Sever localized pain that has persisted for 3 hours (choice C) is more pulmonary related. Five-minute episodes of chest tightness brought on by stair climbing, lawn mowing, and brisk walking (choice D) describes stable angina.
問題 #105
Which of the following would NOT be a question you would ask during a patient's cultural assessment?
- A. How many people live in your household?
- B. Do you have medical insurance?
- C. Can you tell me a little bit about what your daily routine looks like?
- D. What foods do you eat in a typical day?
答案:B
解題說明:
A cultural assessment in healthcare settings is a critical component of understanding a patient's background, which includes their social practices, language, norms, and values that could influence their health behaviors and outcomes. The purpose of conducting a cultural assessment is to obtain insights that enable healthcare providers to deliver culturally competent care, which takes into account the patient's beliefs, practices, and cultural needs.
Questions typically asked during a cultural assessment focus on areas such as the patient's ethnicity, religious beliefs, family dynamics, dietary habits, and daily routines. For example, asking about the number of people living in a household can provide information on the patient's living conditions and social support, which are relevant to their health and well-being. Inquiring about daily routines helps in understanding the patient's lifestyle, which might include physical activity levels or exposure to stress. Questions about dietary habits are also relevant as they provide insights into possible nutritional deficiencies or culturally specific foods that might impact health conditions like diabetes or heart disease.
On the other hand, asking a patient if they have medical insurance, while undoubtedly important for logistical and billing purposes, does not contribute to understanding their cultural background. Insurance-related questions are primarily administrative and are aimed at facilitating the payment process and determining eligibility for certain medical services. These questions do not provide insights into how cultural factors influence the patient's health or how healthcare should be tailored to meet their cultural needs.
Therefore, in the context of a cultural assessment, the correct answer to the question about what would NOT be typically asked is "Do you have medical insurance?" This question is unrelated to the cultural factors that the assessment aims to uncover. While it's an essential part of the overall patient intake process, it does not contribute directly to understanding the cultural aspects that might affect a patient's health care and outcomes.
問題 #106
You are providing care to a patient who has undergone heart surgery. He will be discharged soon. Which of the following is NOT appropriate patient education regarding wound care for this patient?
- A. Some redness, oozing, and swelling around the incision will be normal.
- B. The patient should keep the incision clean and dry.
- C. The patient should contact his doctor immediately if there is redness or oozing around the incision.
- D. The patient should wash the incision with warm water and plain soap.
答案:A
解題說明:
The correct answer for the question on what is NOT appropriate patient education regarding wound care for a patient who has undergone heart surgery is: "Some redness, oozing, and swelling around the incision will be normal." This statement is incorrect because any redness, oozing, or swelling around a surgical incision is potentially indicative of an infection or other complications that should be promptly assessed by a healthcare provider. It is essential to educate patients and their caregivers to recognize these signs early and seek medical advice, rather than assuming they are normal post-surgical reactions.
Post-operative wound care is crucial for the prevention of infection and ensuring proper healing of the surgical site. The key points of proper care should include keeping the incision clean and dry, regularly changing dressings as instructed by the healthcare provider, and monitoring the wound for any signs of infection. These signs can include increased redness, swelling, warmth around the incision, pus or other discharge, worsening pain, or fever.
Instructing a patient to wash the incision with warm water and plain soap can be appropriate if advised by their healthcare provider. However, it is important to follow specific instructions regarding how often to clean the incision and what products to use, as harsh chemicals can irritate the wound.
Furthermore, advising the patient to keep the incision clean and dry is typically appropriate advice, as moisture can be a breeding ground for bacteria that may lead to infection.
In summary, it is not appropriate to educate the patient that some redness, oozing, and swelling around the incision will be normal after heart surgery. Instead, patients should be informed that these are signs of possible complications and should prompt immediate contact with their healthcare provider. Proper wound care education is essential to prevent infection and promote healing following surgery.
問題 #107
When counseling a patient on side effects of her medication, a question comes up. What is the best way to manage and alleviate a common side effect of trazodone?
- A. Take this medication at bedtime.
- B. Drink a big glass of water with each dose.
- C. Eat more fiber while on this medication.
- D. Take this medication in the morning
答案:A
解題說明:
Trazodone is a medication primarily used to treat depression, but it is also commonly prescribed off-label to manage insomnia due to its sedative effects. One of the most common side effects of trazodone is drowsiness or sedation. To effectively manage this side effect, it is recommended that trazodone be taken at bedtime.
By taking trazodone at bedtime, patients can utilize the drowsiness it induces to help them fall asleep, which can be particularly beneficial for those with sleeping difficulties. This timing aligns the peak period of the medication's sedative effects with the patient's sleep schedule, thereby not only maximizing the therapeutic benefit for sleep disturbances but also minimizing the impact of drowsiness on daytime activities and overall quality of life.
Other common side effects of trazodone, such as dizziness or lightheadedness, are also better managed when the medication is taken at night, allowing the patient to sleep through these potentially uncomfortable experiences. Furthermore, taking trazodone with food can help reduce gastrointestinal side effects like nausea or stomach upset, though this is separate from the timing related to its sedative effects.
It is important for healthcare providers to counsel patients on the correct timing of trazodone administration and to tailor this advice based on individual patient needs and lifestyle. For instance, patients who work night shifts or have irregular sleeping patterns might require specific guidance on how to best use trazodone to align with their unique schedules.
In summary, the optimal management of trazodone's side effect of drowsiness is to take the medication at bedtime. This approach not only helps to mitigate the impact of sedation during waking hours but also aids in improving the quality of sleep, thereby enhancing overall treatment outcomes for conditions like insomnia and depression.
問題 #108
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