NCLEX 形式の優先順位の決定と委任：直前対策パック

A patient is admitted with diabetic ketoacidosis. Which prescribed treatment is usually started first?

1. ASubcutaneous long-acting insulin only, given once
2. BA high-carbohydrate meal
3. CIV isotonic fluid such as 0.9% sodium chloride
4. DOral potassium tablets

An adult has burns over 40% of the body with no signs of airway injury. Which treatment is the priority during the first hours?

1. AApplying antibiotic cream to all the burns before anything else
2. BStarting physiotherapy to prevent contractures straight away
3. CLarge-volume IV fluids with close monitoring of urine output
4. DGiving a high-protein meal to support healing

Which PPE does a nurse wear when giving an IV chemotherapy drug?

1. AOne pair of standard latex gloves, changed after the infusion is started
2. BTwo pairs of chemotherapy-tested gloves and a disposable impermeable gown
3. CA reusable cloth gown and one pair of gloves
4. DA surgical mask and no gloves

A nurse teaches a patient with neutropenia about preventing infection at home. Which statement shows a need for further teaching?

1. A“I can clean the cat’s litter box if I wear a face mask.”
2. B“I will check my temperature and call if I have a fever.”
3. C“I will wash my hands often and ask visitors to do the same.”
4. D“I will avoid crowds and people who have colds.”

心房細動のためにワルファリンを服用している患者の INR が 5.2 で、出血はありません。看護師の最もよい対応はどれですか？

1. A今日から緑色の野菜を食べるのをやめるよう助言する
2. B2 倍量を投与する
3. Cワルファリンの投与を保留し、処方者に知らせる
4. D通常の用量を投与し、1 か月後に再検査する

血小板数が 35 × 10³/µL の患者に、筋肉内注射が処方されました。看護師はどうすべきですか？

1. A処方どおりに注射し、部位を強くマッサージする
2. Bほかの経路を使えないか、処方者に確認する
3. Cより長い針で注射する
4. D注射して、温罨法を当てる

A patient with Guillain–Barré syndrome has weakness spreading upwards from the legs. Which monitoring is most important?

1. AVisual acuity
2. BBlood glucose, measured once a day before breakfast
3. CBreathing function, such as forced vital capacity
4. DWeekly weight

A patient with several days of vomiting and diarrhoea has low blood pressure, low urine output and a rising creatinine. Which description fits best?

1. AIntrinsic kidney injury from glomerulonephritis, treated with high-dose steroids
2. BPre-renal acute kidney injury from poor perfusion, treated by restoring fluid volume
3. CPost-renal acute kidney injury from obstruction, treated with a catheter
4. DChronic kidney disease, treated with long-term dialysis three times a week

患者のB型ナトリウム利尿ペプチド（BNPまたはNT-proBNP）が上昇しています。これは主に何を反映していますか？

1. A心室の伸展と圧負荷
2. Bうっ血による肝臓の炎症
3. C転倒後の骨格筋の損傷
4. D心筋の虚血性障害

A patient with a COPD exacerbation has been on NIV for two hours. They are now more drowsy, and the pH has fallen further despite a good mask fit. What should the nurse do?

1. ARemove the mask and give nebulised bronchodilators only from now on
2. BEscalate urgently for review of intubation or a ceiling of care
3. CGive a sedative to help the patient tolerate the mask
4. DContinue NIV unchanged and repeat the blood gas tomorrow morning

ダパグリフロジン（SGLT2阻害薬）を服用している患者が嘔吐しており、血中ケトンは4.5 mmol/Lですが、血糖は11 mmol/Lにすぎません。何を疑うべきですか？

1. A嘔吐による低血糖
2. B高血糖高浸透圧状態
3. C対応が不要な、正常な副作用
4. D正常血糖ケトアシドーシス

Two days after surgery, an 80-year-old woman is quiet, sleepy, slow to answer and eating little. Her daughter says she is "not herself". What should the nurse suspect?

1. AHypoactive delirium
2. BNormal tiredness after an operation
3. CSimple low mood about being in hospital
4. DThe start of Alzheimer's disease

Which instruction is important during bowel preparation for colonoscopy?

1. AAvoid all fluids for 24 hours before the test
2. BDrink plenty of clear fluids while taking the preparation
3. CTake the preparation only if the bowels have not opened
4. DEat a high-fibre meal the evening before the test

On day 5 after bowel resection, a patient has a fever, tachycardia and worsening abdominal pain, and the drain contains brown, faeculent fluid. What is most likely?

1. AAn anastomotic leak
2. BA normal day 5 recovery
3. CPostoperative constipation
4. DA urinary tract infection