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。
Which SBAR recommendation is the clearest?
A patient with SIADH has a serum sodium of 120 mEq/L and is newly confused. Which nursing action has priority?
A visitor with a cold wants to see a patient who has severe neutropenia. What should the nurse advise?
看護師が、患者の輸液ポンプの速度が処方の10倍に設定されていることに気づきました。患者は元気そうに見えます。最初の対応は何ですか？
Why must a blue-top (citrate) coagulation tube be filled to the correct level?
A patient has marked generalized edema. Results show heavy proteinuria, serum albumin 1.8 g/dL (18 g/L) and total cholesterol 340 mg/dL (8.8 mmol/L). Which condition fits best?
Which finding with a groin hernia needs urgent surgical review?
Why must blood samples for a cross-match be labelled at the bedside immediately after they are taken?
A patient has exercise-induced asthma. Which advice is most appropriate?
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?
Where is the zero point of an external ventricular drain usually levelled?
Two days after surgery, an 80-year-old woman is quiet, sleepy, slow to answer and eating little. Her daughter says she is "not herself". What should the nurse suspect?
How does sucralfate help a peptic ulcer heal?
食道静脈瘤が分かっている患者が、大量の新鮮血を吐いています。看護師が内視鏡検査の前に予測すべき治療はどれですか？
答え: C · “I would like you to see him within 15 minutes and consider a fluid bolus.”
A good recommendation is specific about the request and the time frame. Vague statements leave the provider unsure how urgent the problem is.
答え: D · Seizure precautions and close neurological checks
Severe hyponatremia can cause seizures and falls. The nurse keeps the patient safe and reports changes; free water is restricted rather than encouraged, as prescribed.
答え: A · 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 · 輸液を止めるか修正し、その後に患者をアセスメントする
投与される量を抑えるため、輸液は直ちに止めるか修正します。その後、看護師は患者をアセスメントし、指示者に連絡し、指示に従い、出来事を報告します。
答え: A · The blood-to-anticoagulant ratio must be right for accurate clotting times
Citrate tubes contain a set volume of anticoagulant. If the tube is underfilled, the extra citrate falsely prolongs the PT and aPTT, so the laboratory may reject the sample.
答え: B · Nephrotic syndrome
Nephrotic syndrome is heavy proteinuria with low albumin, edema and high lipids. Low albumin reduces oncotic pressure, causing edema, and the liver increases lipoprotein production. There is also a higher risk of clots and infection.確認に用いた資料: Nephrotic syndrome · MedlinePlus (NIH) (2025)
答え: C · The lump has become painful and tender and cannot be pushed back
An irreducible, painful, tender hernia, especially with vomiting, suggests incarceration or strangulation. This is a surgical emergency because the trapped bowel can become ischaemic.
答え: C · To prevent "wrong blood in tube" errors that can cause fatal reactions
A sample labelled with the wrong patient's details can lead to incompatible blood being issued. Labelling at the bedside after positive identification is a key transfusion safety step.
答え: C · Use the reliever inhaler shortly before exercise and warm up
A short-acting bronchodilator taken shortly before exercise, a gradual warm-up and covering the mouth in cold air help prevent symptoms. Frequent exercise symptoms may mean asthma is poorly controlled and preventer treatment needs review.
答え: C · 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: B · At the tragus of the ear
The EVD is levelled at the tragus, which approximates the foramen of Monro. If the head of the bed is changed, the drain must be re-levelled, because its height decides how much CSF drains.
答え: D · Hypoactive delirium
Hypoactive delirium presents with drowsiness, withdrawal and slowness rather than agitation, so it is often missed. It has a worse prognosis than the hyperactive form. A family report of a sudden change is important, and a screening tool such as the 4AT or the CAM (Confusion Assessment Method) can be used.
答え: C · It forms a protective coating over the ulcer base
Sucralfate binds to the ulcer base and forms a barrier against acid and pepsin. It works best on an empty stomach and can reduce the absorption of other drugs, so doses are separated.
答え: C · 蘇生中の、オクトレオチドまたはテルリプレシンと静注の抗菌薬
静脈瘤出血が疑われるときは、血管作動薬（米国ではオクトレオチド、承認されている地域ではテルリプレシン）が門脈圧を下げ、セフトリアキソンなどの予防的な抗菌薬が肝硬変における感染と死亡を減らします。門脈圧を上げないよう、蘇生は慎重に行います。内視鏡的バンド結紮が根治的な治療です。
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