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 patient on a medical unit tells the nurse he has a plan to end his life and has saved tablets at home. What is the priority action?
患者が中心静脈ラインから静脈栄養を受けています。直ちに対応が必要な所見はどれですか？
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?
A patient was harmed by a medication error and asks the nurse what happened. Which approach is best?
A patient has taken hydrochlorothiazide for several years. Which laboratory change is a recognized effect of this drug?
A patient on IV gentamicin has a trough level above the target, and the creatinine has risen since yesterday. The next dose is due. What is the best action?
慢性腎臓病の患者が食事で通常制限すべきものは？
A patient has a single hot, swollen, very painful knee and a fever. Why is urgent joint aspiration important?
In heart failure, why does activation of the renin–angiotensin–aldosterone system worsen symptoms over time?
A patient with severe sepsis becomes increasingly breathless over 24 hours. SpO₂ stays low despite high-flow oxygen, and the chest X-ray shows bilateral infiltrates. The heart function is normal. Which condition is most likely?
DKAに静注インスリンを投与するとき、カリウムを注意深くモニタリングしなければならないのはなぜですか？
An 84-year-old man became more confused a week after starting oxybutynin. Infection has been ruled out. What should the nurse suspect?
Which treatment often relieves pain from a bone metastasis?
Which group of signs suggests that a patient is entering the last days of life?
答え: A · Ensure constant observation and remove anything he could use to harm himself
A patient with a plan and means is at high risk. Safety comes first: constant observation, removal of means and urgent referral. A “no-harm promise” does not protect the patient.
答え: A · 点滴が予期せず止まったあとの、発汗、ふるえ、血糖 62 mg/dL（3.4 mmol/L）
静脈栄養は多くのブドウ糖を含み、体は高いインスリン濃度で反応します。点滴が突然止まると、反跳性低血糖が起こることがあります。看護師はプロトコルに従って低血糖を治療し、医療者に知らせ、点滴が中断した場合の方針に従います。軽度に上昇した血糖、剥がれていないドレッシング、わずかな体重の変化は、予測されるか軽微なものです。
答え: A · 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: A · Be honest that an error occurred and involve the provider and team in disclosure per policy
Open, honest disclosure of errors is an ethical duty and part of a safety culture. The nurse follows policy, which usually involves the provider and risk team, and does not hide or blame.
答え: D · A rise in serum uric acid
Thiazides reduce uric acid excretion and can trigger gout. They also tend to lower potassium, sodium and magnesium, raise calcium (by reducing its excretion) and raise blood glucose and lipids.
答え: D · Hold the dose and report the results to the prescriber
A high aminoglycoside trough with rising creatinine means the drug is accumulating, which increases the risk of kidney damage and hearing loss. The nurse holds the dose, reports to the prescriber and asks about hearing changes and tinnitus. Only the prescriber or pharmacist changes the regimen.
答え: C · カリウムとリン
弱った腎臓はカリウムとリンをうまく排泄できないため、塩分、場合によっては水分やたんぱく質とあわせて食事制限が必要になることが多いです。
答え: B · To rule out septic arthritis, which can rapidly destroy the joint
Septic arthritis can destroy cartilage within days. Aspiration allows microscopy and culture, and helps distinguish infection from crystal arthritis such as gout.
答え: A · It causes sodium and water retention and vasoconstriction
Reduced cardiac output activates RAAS and the sympathetic system. Angiotensin II constricts vessels (raising afterload) and aldosterone retains sodium and water (raising preload and congestion). ACE inhibitors, ARBs, mineralocorticoid antagonists and beta-blockers block these harmful loops.
答え: C · Acute respiratory distress syndrome
ARDS is acute, non-cardiogenic pulmonary oedema caused by widespread inflammation, triggered by sepsis, pneumonia, trauma or pancreatitis. It causes severe hypoxaemia that responds poorly to oxygen, with bilateral infiltrates not explained by heart failure. Treatment includes lung-protective ventilation and often prone positioning.
答え: B · インスリンはカリウムを細胞内に移動させるため、値が急速に低下しうるから
DKAの患者は、血清カリウムが最初は正常または高値でも、体全体のカリウムが大きく不足しています。インスリンはカリウムを細胞内に移動させ、危険な低カリウム血症を起こしうります。カリウムを頻回に確認し、処方に従って輸液に加えます。非常に低い場合は、補充を始めるまでインスリンを遅らせることもあります。
答え: B · Anticholinergic side effects of the drug
Anticholinergic drugs such as oxybutynin can cause confusion and worsen cognition in older people. The prescriber should review the medicine and the patient's overall anticholinergic burden.
答え: B · Palliative radiotherapy to the area
A single fraction or short course of radiotherapy relieves pain from bone metastases in many patients. Analgesia, including NSAIDs where suitable, and bone-targeted drugs are also used.
答え: D · Reduced intake, mottled skin and changes in breathing
Signs include increasing drowsiness, reduced intake, mottled cool peripheries, changes in breathing such as pauses, and noisy secretions. Recognising them allows care to focus on comfort and family support.
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