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。
看護師が看護助手に「患者の痛みをアセスメントして、追加の薬が必要か判断して」と頼みました。違反している委任の正しさはどれですか？
An older patient with heart failure is receiving a second unit of blood. She becomes breathless, with crackles in both lungs and a rising blood pressure. What is most likely happening?
Why must visible dirt be removed from equipment before it is disinfected?
According to the “Swiss cheese” model of error, why do errors reach patients?
In the US, when is a pregnant woman without known risk factors usually screened for gestational diabetes?
A patient taking isoniazid for latent TB reports nausea, loss of appetite and dark urine. The ALT is five times the upper limit of normal. What is the best action?
A patient with pneumonia is breathless and coughing up thick sputum. Which nursing measure helps most with breathing?
Which route and site are recommended for the first dose of adrenaline (epinephrine) in anaphylaxis on a ward?
A patient on theophylline develops nausea, vomiting, a fast heart rate and restlessness. What should the nurse suspect?
心不全の患者が、安静時にも息苦しく、末梢が冷たく、収縮期血圧が80 mmHgで、尿量が減っています。これは何を示唆しますか？
Why must Parkinson's medicines be given on time in hospital?
A patient is being assessed for brain death (brainstem death). Which condition must be excluded before testing?
What is achalasia?
During burn resuscitation, a 70 kg adult's urine output has been 120 mL/h for 3 hours, and the face and limbs are very oedematous. What should the nurse do?
答え: D · 正しい業務
患者のアセスメントと治療の判断には看護の判断が必要なため、業務そのものを補助者に委任することはできません。助手は患者の言うことを報告できますが、アセスメントと判断は RN が行います。
答え: B · Transfusion-associated circulatory overload
Breathlessness, crackles and hypertension during a transfusion in a patient with heart failure suggest circulatory overload. The nurse stops the transfusion, sits the patient up, gives oxygen as prescribed and informs the provider, who may prescribe a diuretic.
答え: B · Organic matter can shield organisms and weaken the disinfectant
Blood, secretions and soil protect organisms and can inactivate disinfectants. Cleaning is always done first, followed by disinfection or sterilization as required.
答え: D · Weaknesses in several layers of defense line up at the same time
Reason’s Swiss cheese model shows that each safety layer, such as prescribing, dispensing, checking and scanning, has weaknesses. Harm happens when the holes in several layers line up, so safety improvement focuses on strengthening the system.
答え: C · At about 24–28 weeks of pregnancy
Placental hormones increase insulin resistance in the second half of pregnancy, so US guidance recommends screening all women at 24–28 weeks, with earlier testing for those with risk factors. In the UK, NICE recommends an oral glucose tolerance test at 24–28 weeks only for women with risk factors.確認に用いた資料: Glucose screening tests during pregnancy · MedlinePlus (NIH) (2026); Gestational diabetes · MedlinePlus (NIH) (2026)
答え: A · Hold the isoniazid and report the findings to the prescriber at once
Isoniazid can cause hepatitis, which may be severe. Symptoms such as nausea, loss of appetite and dark urine with a markedly raised ALT mean the drug should be held and the prescriber informed. Patients are taught to avoid alcohol and report these symptoms early.
答え: D · Sitting the patient upright and supporting them to clear secretions
An upright position improves lung expansion, and adequate fluids, deep breathing and coughing help clear sputum. Oxygen is given to target saturations if needed.
答え: C · Intramuscular injection into the anterolateral thigh
IM adrenaline into the outer thigh is absorbed quickly and is the first-line route. IV adrenaline is reserved for experienced specialists with full monitoring because of the risk of arrhythmias.
答え: B · Theophylline toxicity
Theophylline has a narrow therapeutic window. Toxicity causes nausea, vomiting, tachycardia, arrhythmias, agitation and seizures. Levels are monitored, and many drugs and smoking status change its clearance. The nurse should hold the dose and report.
答え: D · 組織灌流の低下を伴う心原性ショック
心原性ショックは、低血圧と低灌流（冷たい皮膚、乏尿、錯乱、乳酸の上昇）を伴うポンプ不全で、肺うっ血を伴うことも多いものです。集中治療の緊急の診察が必要です。慎重なアセスメントに基づかない大量の輸液ボーラスは、うっ血を悪化させうります。
答え: A · Late doses can soon cause stiffness, falls and poor swallowing
People with Parkinson's disease often take doses at exact times. A delay of even 30 minutes or so can cause rigidity, immobility, falls and unsafe swallowing. Many hospitals treat these drugs as time-critical.
答え: A · Effects of sedative drugs or severe hypothermia
Before brain death (brainstem) testing, reversible causes of coma must be excluded, including sedatives and neuromuscular blockers, hypothermia, and severe metabolic or endocrine disturbance. Only then can absent reflexes be interpreted reliably.
答え: D · Failure of the lower oesophageal sphincter to relax on swallowing
In achalasia, peristalsis is lost and the lower oesophageal sphincter does not relax, causing dysphagia to both solids and liquids, regurgitation and weight loss. Treatments include dilatation and surgical myotomy.
答え: C · Discuss reducing the fluid rate with the team
An output of about 1.7 mL/kg/h suggests over-resuscitation. Excess fluid ("fluid creep") worsens oedema and can cause pulmonary oedema and compartment syndromes, so the rate is reviewed and reduced under the burn protocol.
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