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 woman calls to say her husband suddenly has a drooping face and slurred speech. What should the nurse advise?
Which nursing approach may raise intracranial pressure in a patient with a head injury?
A visitor with a cold wants to see a patient who has severe neutropenia. What should the nurse advise?
A patient arrives in the operating room for knee surgery, and the site has not been marked. What should happen?
In countries that screen all pregnant women (such as the US), a vaginal-rectal swab is taken at about 36–37 weeks. Which organism is it screening for?
A patient with diabetes and chronic kidney disease had a CT scan with IV contrast. Two days later, the creatinine has risen from 1.4 to 2.0 mg/dL (124 to 177 µmol/L). Which action is most appropriate?
When is a rapid-acting insulin such as insulin aspart usually given?
A nurse teaches a patient with asthma about a new inhaled steroid "preventer". Which statement shows a need for further teaching?
A patient taking simvastatin drinks a large glass of grapefruit juice every morning. Why is this a concern?
Three days after an MI, a patient faints on the commode while straining hard to open the bowels. The heart rate was 42/min at the time. What is the most likely mechanism?
A patient taking warfarin is diagnosed with an intracerebral haemorrhage. What is the priority treatment?
Why might a frail 88-year-old with type 2 diabetes have a less strict HbA1c target?
Which is a recognised risk of long-term proton pump inhibitor use?
A patient with suspected appendicitis says the pain suddenly eased, but an hour later has a temperature of 38.9 °C, a rigid abdomen and a pulse of 118/min. What does this suggest?
答え: C · Call emergency services now and note the time it started
Stroke is time-critical. Emergency services can begin assessment on the way and take the patient to a stroke center; the time of onset guides treatment.
答え: C · Doing suctioning, turning and bathing all at the same time
Clustering several stimulating activities can cause a sustained rise in intracranial pressure. Spacing care, keeping the neck straight and a calm environment help keep it down.
答え: C · Postpone the visit until the visitor is well
Patients with severe neutropenia cannot fight infections well. People with respiratory or other infections should not visit until they are well; other visitors perform hand hygiene.
答え: A · Do not start until the site is marked and verified with the patient
Wrong-site surgery is prevented by marking the site before the procedure, ideally with the awake patient’s involvement, and confirming it at the time-out. The procedure does not begin until this is done.
答え: C · Group B Streptococcus
Group B streptococci can colonize the vagina and rectum and can cause severe infection in newborns. Women who test positive receive IV antibiotics during labor to reduce transmission to the baby. The UK does not screen all women routinely; it uses a risk-based approach instead.
答え: B · Report it, monitor urine output and hold metformin until reviewed
A creatinine rise of 0.3 mg/dL or more within 48 hours meets the criteria for AKI, and contrast is a recognized risk factor, especially in CKD and diabetes. The nurse reports it, monitors fluid balance and holds metformin until kidney function is reviewed, as metformin can accumulate.
答え: A · Just before or with a meal
Rapid-acting insulins start working within minutes, so they are given with meals to match the glucose rise. Giving the dose without eating risks hypoglycaemia.
答え: D · "I will only use it when I'm wheezy."
Inhaled corticosteroids must be used regularly to reduce airway inflammation and prevent attacks. The short-acting reliever is used for symptoms.
答え: A · It raises statin levels and the risk of muscle damage
Grapefruit juice inhibits the CYP3A4 enzyme, increasing levels of drugs such as simvastatin and some calcium channel blockers. Higher statin levels raise the risk of myopathy. Patients are advised to avoid large amounts or choose a statin not affected.
答え: C · A vagal response to straining
Straining (the Valsalva manoeuvre) can cause a vagal bradycardia and a fall in cardiac output, leading to syncope. After an MI, stool softeners, adequate fluids and avoiding straining are advised. The event is still reported and the patient assessed for arrhythmia or ischaemia.
答え: A · Urgent reversal of the anticoagulant effect
Anticoagulants make the haematoma expand. Warfarin is reversed urgently, typically with prothrombin complex concentrate and IV vitamin K. Thrombolysis and antiplatelets are contraindicated in a bleed.
答え: D · To reduce the risk of hypos, falls and confusion
In frail older adults, tight control brings little long-term benefit and a high risk of hypoglycaemia, which can cause falls, fractures and confusion. Targets are individualised to balance safety and quality of life.
答え: D · Hypomagnesaemia
Long-term PPIs are linked with low magnesium, C. difficile infection, fractures and B12 deficiency. The need for continuing treatment should be reviewed regularly.
答え: C · Perforation with peritonitis
Brief relief can occur when an inflamed appendix ruptures, followed by spreading peritonitis with fever, rigidity and tachycardia. This is a surgical emergency needing urgent review, IV fluids and antibiotics.
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