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。
A nursing assistant tells the RN that a patient’s IV pump is alarming. What is the best response?
LPN/LVN への割り当てとして最も適切なものはどれですか？
看護師が、HIV陽性と分かっている患者から針刺し事故を受けました。直ちに報告することが重要なのはなぜですか？
A patient on an anticoagulant falls and hits their head but says they feel fine. What should the nurse do?
A patient with hyperkalemia is prescribed an oral potassium binder such as patiromer or sodium zirconium cyclosilicate. How does this drug lower potassium?
A patient with suspected Cushing syndrome takes dexamethasone at night. The next morning, the cortisol is still high. What does this suggest?
A patient taking a statin reports unexplained muscle pain and weakness. What should the nurse do?
During a general anaesthetic, a patient develops a rapidly rising temperature, muscle rigidity and rising carbon dioxide levels. What should be suspected?
Why are IV fluids given cautiously to a patient with heart failure?
An older patient with three rib fractures is breathing shallowly and refuses to cough because of pain. What is the priority intervention?
Several hours after a carotid endarterectomy, which finding needs the most urgent action?
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?
麻酔中の悪性高熱症で、最も早く現れる徴候としてよくみられるのはどれですか？
股関節手術の3日後、高齢の患者が急に錯乱し、注意が変動して興奮しています。看護師が最初にすべきことは何ですか？
答え: D · “I will come and check the pump and the IV site now.”
An alarm may mean an occlusion, air in the line or infiltration. The nurse checks the pump and site; the assistant should not adjust the pump or silence alarms.
答え: B · 定時の吸入気管支拡張薬と経口薬が必要な、安定した COPD の患者
日常的な治療を受ける安定した COPD の患者は、予測可能なケアです。集中治療室からの最近の転入と、新たに開始した静脈内のレートコントロールの点滴には RN によるアセスメントが必要で、新たなハイアラート薬についての最初の指導は RN が行います。
答え: C · 曝露後予防投与は、数時間以内に開始するのが最も効果的だから
傷を石けんと流水で洗った後、曝露を評価できるよう直ちに報告します。HIVの曝露後予防投与は、できるだけ早く、理想的には数時間以内に、遅くとも72時間以内に開始します。
答え: A · Notify the provider and start neurological observations, because a brain bleed may develop
Head injury in a patient on anticoagulants can cause bleeding inside the skull that shows signs later. The provider is told at once, imaging may be needed and neurological checks are done closely.
答え: B · It binds potassium in the gut so it leaves in the stool
Potassium binders exchange potassium in the gut for another ion, so potassium is removed from the body in the stool. They act over hours, so they are not used alone for emergencies; calcium protects the heart, and insulin with glucose shifts potassium into cells quickly.確認に用いた資料: High potassium level · MedlinePlus (NIH) (2025)
答え: A · Cortisol is being produced without normal feedback control
Dexamethasone normally suppresses ACTH and lowers morning cortisol. Failure to suppress suggests autonomous cortisol excess (Cushing syndrome). Further tests then find the source, such as a pituitary or adrenal tumor.
答え: C · Report it, as statins can cause muscle damage
Statins can cause myopathy and, rarely, rhabdomyolysis. Unexplained muscle symptoms should be reported so creatine kinase can be checked and the drug reviewed.
答え: C · Malignant hyperthermia
Malignant hyperthermia is a hypermetabolic reaction triggered by volatile anaesthetics or suxamethonium (succinylcholine) in susceptible people. It is treated urgently with dantrolene, cooling and stopping the trigger.
答え: D · Extra volume can quickly cause pulmonary oedema
In heart failure, the ventricle cannot cope with large increases in preload, so IV fluids can raise filling pressures and cause pulmonary oedema. When fluids are needed, smaller volumes are given with close reassessment of breathing, crackles, JVP, weight and fluid balance.
答え: B · Effective analgesia so they can breathe deeply and cough
Pain from rib fractures causes shallow breathing and poor coughing, leading to atelectasis and pneumonia, especially in older adults. Good analgesia (sometimes regional blocks), deep breathing, coughing with support and early mobilisation are key. Chest strapping restricts breathing and is not used.
答え: A · An expanding neck swelling with noisy breathing
A neck haematoma after carotid surgery can compress the airway quickly. It needs immediate senior help and may need the wound opened. Neurological checks for new stroke and cranial nerve damage are also part of routine care.
答え: D · 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: D · 原因不明の呼気終末CO₂の上昇
悪性高熱症は、揮発性麻酔薬とスキサメトニウムに対する遺伝性の反応です。初期の徴候には、呼気終末CO₂の上昇、頻脈、筋強直（しばしば咬筋）があり、高体温はしばしば後期の徴候です。治療は、誘発薬の中止とダントロレンの投与です。
答え: C · 低酸素、感染、痛み、薬などの原因を探し、上申する
注意が変動する急な錯乱は、せん妄を示唆します。これは医学的な緊急事態で、低酸素、敗血症、痛み、（オピオイドや抗コリン薬を含む）薬、尿閉、便秘、脱水、電解質の問題など、多くの原因が考えられます。原因を治療し、薬以外の方法を用い、鎮静は最後の手段としてのみ用います。
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