NCLEX 形式の練習問題（RN）：直前対策パック

A patient's blood pressure is much higher than in all previous readings. What is the best first step?

1. ATell the patient they are having a stroke
2. BRecord it and give an extra dose of the blood pressure tablet
3. CIgnore it, as it must be a machine error
4. DRecheck it, making sure the technique and cuff size are correct

A urine culture reports a mixed growth of several organisms. What is the most likely explanation?

1. AThe laboratory used the wrong test
2. BThe sample was contaminated during collection
3. CThe patient is resistant to all antibiotics
4. DThe patient has several serious infections at once

A parent will give a liquid antibiotic to a child at home. Which teaching is best?

1. AEstimate the dose by pouring into a cup
2. BUse any teaspoon or tablespoon from the kitchen drawer at home
3. CUse a tablespoon for doses over 5 mL
4. DUse the oral syringe or dosing cup that comes with the medicine

無菌的な中心静脈カテーテルのドレッシング交換中に、同僚が開いた滅菌野の上に腕を伸ばしてテープを手渡しました。看護師はどうすべきですか？

1. A同僚は滅菌物に触れていないので、続ける
2. B滅菌タオルで滅菌野を覆い、その上で続ける
3. C腕が上を通った場所に最も近い物だけを取り除く
4. D滅菌野は汚染されたとみなし、新しく準備し直す

Which newborn finding needs prompt reporting?

1. AMild jaundice that first appears on the third day
2. BMilia (small white spots) on the nose
3. CJaundice that appears within the first 24 hours
4. DBluish hands and feet in the first hours

A patient with a head injury has a pupil on one side that is now large and does not react to light. What should the nurse do?

1. AReport it at once, as it may mean the brain is being compressed
2. BDocument it, because pupils often differ slightly after a head injury
3. CRecheck it at the next routine observation in four hours
4. DDim the room lights so the pupil can get smaller

ACE 阻害薬を開始した患者に持続する空咳が出ました。考えられる原因は？

1. Aβ遮断薬による喘息
2. B肺塞栓症
3. C最近投与したペニシリンへのアレルギー反応
4. DACE 阻害薬の既知の副作用

A patient two days after abdominal surgery coughs and says something "gave way". The wound has opened and bowel is visible. What should the nurse do first?

1. AApply dry gauze tightly and ask the patient to keep coughing
2. BSit the patient fully upright and offer a hot drink
3. CGently push the bowel back into the abdomen and tape the wound edges firmly closed
4. DCover the wound with sterile, saline-moistened dressings and get urgent surgical help

A patient is starting atorvastatin. Which laboratory test is usually checked at baseline?

1. ABlood cultures
2. BSerum lipase
3. CThyroid antibodies
4. DLiver enzymes

During surgery under general anesthesia, a patient develops a rising end-tidal CO₂, muscle rigidity and tachycardia, then a high potassium and a rising temperature. Which condition is most likely?

1. AAcute hemolytic transfusion reaction
2. BMalignant hyperthermia
3. CHypoglycemia from fasting
4. DHypovolemic shock

A patient is starting lisinopril. Which rare but serious adverse effect should the nurse teach the patient to report immediately?

1. ADarker skin after exposure to sunlight
2. BAn increase in appetite in the evening
3. CA harmless rash on the palms of the hands
4. DSwelling of the lips, tongue or face

A patient receiving a phenylephrine infusion has a rise in blood pressure and a fall in heart rate. What is the best explanation?

1. AAlpha-1 vasoconstriction raises blood pressure and causes reflex bradycardia
2. BThe fall in heart rate shows phenylephrine toxicity of the AV node
3. CPhenylephrine stimulates muscarinic receptors
4. DPhenylephrine directly blocks beta-1 receptors in the heart's conduction system

Which investigation is most often used to confirm a pulmonary embolism?

1. APeak flow measurement
2. BCT pulmonary angiography
3. CAbdominal ultrasound
4. DSputum culture

A patient is going home after a spontaneous pneumothorax treated with a chest drain. Which advice is correct?

1. AStop smoking and do not fly until a doctor confirms full resolution
2. BExpect it never to happen again, so no follow-up is needed
3. CTake up scuba diving to strengthen the lungs
4. DFly home as soon as possible so they can recover in comfort there

Which long-term risk should a kidney transplant recipient be taught to reduce with sun protection?

1. AKidney stones
2. BSkin cancer
3. CGout
4. DHair loss

The nurse has four urology patients. Which one needs to be seen first?

1. AA patient with a nephrostomy who has rigors and a BP of 86/50 mmHg
2. BA patient with stress incontinence asking about pelvic floor exercises
3. CA patient with a suprapubic catheter due for a routine change
4. DA patient after TURP with light pink drainage and mild discomfort

A patient is starting regular oral morphine. Which bowel advice is most appropriate?

1. AStart a regular laxative at the same time
2. BStop eating fibre completely
3. CWait until there has been no stool for a week
4. DTake a bulk-forming laxative only with very little water

Which preoperative blood result should the nurse report to the team before elective surgery?

1. AFasting glucose 5.4 mmol/L (97 mg/dL)
2. BSodium 139 mmol/L
3. CHaemoglobin 138 g/L (13.8 g/dL) in a man
4. DPotassium 2.9 mmol/L

Which woman on the antenatal unit should the nurse see first?

1. AAt 38 weeks: irregular Braxton Hicks contractions
2. BAt 34 weeks: severe headache, BP 164/110 mmHg
3. CAt 30 weeks: mild ankle swelling in the evening
4. DAt 28 weeks: due for routine anti-D

A nurse is teaching a mother how to prevent shaken baby syndrome. Which statement shows a need for further teaching?

1. A"I can call someone to help when I feel overwhelmed."
2. B"If I feel very angry, it is fine to shake him a little to stop the crying."
3. C"Crying often increases in the first weeks, and that can be normal."
4. D"If I get too frustrated, I will put him in his cot and step away for a few minutes."

A newborn is still wet a few minutes after birth. Which heat-loss mechanism is the main concern, and how is it prevented?

1. AConduction; place the baby on a cold firm surface
2. BRadiation; move the cot close to an outside window
3. CConvection; leave the baby uncovered in a draught
4. DEvaporation; dry the baby straight away, including the head

A sexually active 17-year-old has no symptoms and asks why chlamydia testing is offered. What is the best answer?

1. AChlamydia always causes severe pain, so testing is only a formality
2. BChlamydia can only be caught from shared towels and toilet seats
3. CTesting is required by law before any young person can see a nurse or doctor for any reason
4. DChlamydia often causes no symptoms but can lead to pelvic inflammatory disease and infertility

A patient stopped paroxetine suddenly a few days ago. She now has dizziness, irritability, flu-like symptoms and brief "electric shock" feelings. What is the most likely cause?

1. ASerotonin syndrome
2. BNeuroleptic malignant syndrome
3. CAntidepressant discontinuation syndrome
4. DA relapse of her depression into a severe psychotic depression

The parent of a child recently diagnosed with autism asks, "Did his vaccines cause this?" What is the most accurate response?

1. A"We don't know, so it is best to stop all of his other vaccines."
2. B"Yes, the MMR vaccine is a proven cause of autism."
3. C"Autism is caused by cold and distant parenting styles in early childhood."
4. D"Large studies have found no link between vaccines and autism."

練習問題（数値は架空のもので、臨床上の指針ではありません）。 ある新生児の体重は 9 lb 2 oz です。1 lb = 16 oz と 1 kg = 2.2 lb を使って、体重 m をキログラムで求めてください。小数第2位に丸めてください。

練習問題（数値は架空のもので、臨床上の指針ではありません）。 ある患者が1勤務帯の間に 4 tbsp / 液体サプリメント, 2 tsp / 咳止めシロップ, 1½ カップ / お茶 を摂取しました。与えられた換算値を使って、経口摂取量の合計 V を mL で求めてください。

患者の体重は 15 kg です。指示量は 1 日 2 mg/kg で、3 回に等分して投与します。1 回あたり何 mg D 投与しますか？

処方は 3800 単位で、薬は 5000 単位/mL で供給されます。1 mL の注射器に用量を吸い上げます：何 mL V を投与しますか？

10 滴/mL の輸液セットで 500 mL を 3 時間かけて投与します。滴下速度 R を 1 分あたりの滴数で求めなさい。 最も近い整数に丸めてください。

500 mL を 8 時間で投与するよう指示されています。5 時間後、バッグにまだ 220 mL 残っていることがわかりましたが、予定どおりの時間に終える必要があります。 元のポンプ速度を何パーセント Δ 上げる必要がありますか？

練習問題（数値は架空のもので、臨床上の指針ではありません）。 バッグには 250 mL 中にヘパリン 25 000 単位が含まれています。体重 55 kg の患者に 15 単位/kg/h の指示が出ています。ポンプの流量 R を何 mL/h に設定しますか？ 小数第 1 位まで四捨五入してください。

練習問題（数値は架空のもので、臨床上の指針ではありません）。 バッグには dopamine 400 mg が 250 mL 中に含まれています。体重 78 kg の患者に 3 mcg/kg/min の指示が出ています。ポンプの流量 R を何 mL/h に設定しますか？ 小数第 1 位まで四捨五入してください。

練習問題（数値は架空のもので、臨床上の指針ではありません）。 記録は、ある患者の 12 時間勤務帯 1 回分の摂取量と排泄量を示しています。点滴は勤務帯の間ずっと表示の流量で投与されました。水分出納 B = 摂取量 − 排泄量 を mL で求めてください（負の答えは正味の喪失を意味します）。 氷片は体積の半分として数えます。

練習問題（数値は架空のもので、臨床上の指針ではありません）。 1000 mL のバッグを 13:30 に開始し、ポンプで 120 mL/h で投与しています。17:00 の時点でバッグには何 mL V 残っていますか？

練習問題（数値は架空のもので、臨床上の指針ではありません）。 次の観察結果に NEWS2 チャート（SpO₂ スケール1）を使います：呼吸数 25/分、SpO₂ 97%（室内気吸入）、血圧 100/60 mmHg、脈拍 38/分、意識清明、体温 36.4 °C。NEWS2 の合計点はいくつですか。

練習問題（数値は架空のもので、臨床上の指針ではありません）。 ある成人の体重は 135 kg、身長は 159 cm です。BMI を計算し、WHO の体重区分をクリックしてください。

1. 1低体重（やせ）
2. 2普通体重
3. 3過体重
4. 4肥満クラスI
5. 5肥満クラスII
6. 6肥満クラスIII

練習用の値：Na⁺ は 146 mmol/L、グルコースは 5.3 mmol/L、尿素は 20.4 mmol/L です。血清浸透圧 Osm = 2·Na⁺ + グルコース + 尿素 を、最も近い整数まで計算してください。

練習用の血液ガスは、HCO₃⁻ 35 mmol/L の代謝性アルカローシスを示しています。期待される PaCO₂ = 0.7·HCO₃⁻ + 21 を使って、期待される PaCO₂ を求めてください。

このII誘導のストリップは心房粗動を示しています。QRS 波1つあたり QRS 1つあたりの粗動波 は何個ですか（n:1 伝導の n）。

このII誘導のストリップは房室ブロックを示しており、心房と心室は異なるレートで拍動しています。QRS 波は整です。心室レート（拍/分、1500法、整数）を求めてください。