公式集、全トピックの解法の要点、14 問の演習問題。完全な解答は巻末にあります。
An arterial blood gas shows pH 7.28, PaCO₂ 40 mmHg (5.3 kPa) and HCO₃⁻ 16 mEq/L (mmol/L). How should the nurse interpret it?
Which patient with cirrhosis should the nurse see first?
A nurse who never had BCG vaccine has a positive tuberculin skin test for the first time. The chest x-ray is clear and there are no symptoms. What does this most likely mean?
看護師のどの行動が、手指衛生の5つのタイミングが守られていることを示していますか？
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 1.4 です。これは何を意味しますか？
A woman who is 34 weeks pregnant has high blood pressure, right upper abdominal pain, a platelet count of 70 × 10³/µL, raised ALT and AST, and a raised LDH. Which condition fits best?
Why is blood pressure monitored closely in a patient with an epidural infusion?
A nurse teaches a patient with hypertension about their medicines. Which statement shows a need for further teaching?
末梢動脈疾患の患者が夜間に脚の痛みを訴えています。楽になる可能性のある体位はどれですか？
A patient with pneumonia has a temperature of 39 °C, pain and a sinus tachycardia of 122/min. BP is normal. What is the best way to manage the heart rate?
A patient with gout has recurrent uric acid kidney stones. Which treatment helps prevent them?
A 74-year-old falls forward and hits their chin. Their arms are much weaker than their legs, and they have burning pain in the hands. Which injury is most likely?
After a spinal anaesthetic, which nursing check is particularly important?
A 60 kg adult with 25% TBSA burns arrives 2 hours after the injury, having had no IV fluids. Using the Parkland formula, what hourly rate is needed for the rest of the first 8 hours?
答え: B · Metabolic acidosis
The pH is low (acidosis), the PaCO₂ is normal and the bicarbonate is low, so the cause is metabolic. Causes include diabetic ketoacidosis, sepsis and kidney failure.
答え: C · Vomiting bright red blood, heart rate 120/min
Vomiting blood with a fast pulse suggests bleeding esophageal varices, which can quickly be fatal. The other findings are chronic or stable.
答え: D · Latent TB infection, which is not contagious
A positive skin test with no symptoms and a normal chest x-ray suggests latent TB infection. The person cannot spread TB but should be evaluated for treatment to prevent active disease later.
答え: B · ベッド柵に触れた後に手指を清潔にする
柵やテーブルなど患者の周囲環境に触れると手が汚染されるため、その後に手指衛生が必要です。手袋は患者ごとに交換し、手指衛生は手が汚れて見えるかどうかにかかわらず必要です。
答え: D · 抗凝固が目標を下回っており、血栓と脳卒中が起こりやすくなっている
目標範囲を下回る INR は、この適応にとって血液が凝固しやすすぎることを意味します。処方者に知らせ、用量と、飲み忘れや相互作用などの可能性のある原因を見直します。
答え: C · HELLP syndrome
HELLP stands for Hemolysis (raised LDH, falling hemoglobin), Elevated Liver enzymes and Low Platelets. It is a severe form of preeclampsia that can cause liver rupture and bleeding, and it usually requires delivery.
答え: A · The local anaesthetic can block sympathetic nerves and cause hypotension
Epidural local anaesthetic can cause vasodilation and hypotension. Nurses also monitor sedation, respiratory rate, block height, motor function and the catheter site.
答え: D · "I'll stop my tablets once my readings are normal."
Hypertension usually needs long-term treatment; stopping because readings are normal often makes blood pressure rise again. Patients should discuss any changes with their prescriber.
答え: A · ベッドの端から脚を下に垂らす
虚血性の安静時痛は、脚を下げると、重力により動脈血流が改善して、しばしば和らぎます。挙上は虚血を悪化させます。重大な動脈疾患では圧迫は禁忌で、直接の熱は、感覚が鈍く虚血した皮膚にやけどを負わせるおそれがあります。
答え: A · Treat the fever, pain and possible dehydration, then reassess
Sinus tachycardia is usually a physiological response to fever, pain, hypovolaemia, anxiety, hypoxia or sepsis. Treating the cause (antipyretics, analgesia, fluids, oxygen if needed) is appropriate, while watching for sepsis. Rate-slowing drugs can be harmful by masking compensation.
答え: D · Allopurinol and making the urine less acidic
Uric acid stones form when urine is acidic and rich in uric acid. High fluid intake, alkalinising the urine (for example with potassium citrate) and allopurinol reduce the risk. Purine-rich foods are limited.
答え: A · Central cord syndrome
Central cord syndrome often follows hyperextension of an arthritic neck. The central fibres, which serve the arms, are affected most, so the arms are weaker than the legs. It is the most common incomplete cord syndrome.
答え: A · Return of leg sensation and movement, and passing urine
The nurse monitors the level of the block, recovery of leg movement and sensation, BP and bladder function. Urinary retention is common, and early mobilisation is only safe once motor function returns.
答え: D · 500 mL/h
Parkland gives 4 × 60 × 25 = 6000 mL in 24 hours, with 3000 mL due in the first 8 hours from the time of injury. With 6 hours left, 3000 ÷ 6 = 500 mL/h. Dividing by 8 (375 mL/h) ignores the delay. The rate is then adjusted to urine output.
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