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 swimmer is found unresponsive after diving into shallow water. Which method should the nurse use to open the airway?
A patient with untreated hyperthyroidism has surgery and develops a temperature of 40 °C, a heart rate of 160/min and severe agitation. What is most likely happening?
A person in scrubs without a hospital ID badge asks to take a newborn to the nursery. What should the nurse do?
A nurse teaches a patient with active pulmonary tuberculosis who is going home on treatment. Which statement shows a need for further teaching?
Why is a baseline platelet count taken before starting heparin therapy?
A patient taking an SGLT2 inhibitor has nausea and fast breathing. Glucose 190 mg/dL (10.5 mmol/L), pH 7.15, bicarbonate 10 mEq/L, blood ketones high. What is the most likely diagnosis?
Which of these is one of the "4 Hs", the reversible causes of cardiac arrest?
Why is hypokalaemia particularly dangerous in a patient taking digoxin?
Why are IV fluids given cautiously to a patient with heart failure?
看護師が4人の患者のケアを計画しています。最初にアセスメントすべき患者はどれですか？
Why are tacrolimus blood levels checked regularly?
A patient in thyroid storm has a temperature of 40 °C (104 °F). Which measure for the fever is usually avoided?
大手術の後の最初の数日間、「必要時」の投与より定期的（スケジュール化）な鎮痛が好まれることが多いのはなぜですか？
2か月前に冠動脈ステントを留置してアスピリンとクロピドグレルを服用している患者が、下血で受診し、現在は安定しています。抗血小板薬に対する最も適切な対応はどれですか？
答え: A · Jaw thrust, keeping the head and neck in line
A diving injury may damage the cervical spine. A jaw thrust opens the airway with little neck movement; if it fails, the airway still takes priority.
答え: C · Thyroid storm
Thyroid storm is a life-threatening surge of thyroid hormone, with fever, tachycardia and agitation or confusion. It needs urgent treatment; myxedema coma is the opposite extreme of hypothyroidism.
答え: B · Refuse, keep the baby with the mother and alert security
Infants are only handed to staff with proper identification, as set out in the infant security policy. Suspicious behavior is reported to security at once, and parents are taught to do the same.
答え: C · “I can stop taking the pills once I feel better.”
TB treatment lasts several months, and stopping when symptoms improve can lead to relapse and drug-resistant TB. Covering coughs and attending follow-up for sputum tests are correct.
答え: A · So a later fall from heparin-induced thrombocytopenia is detected
Heparin-induced thrombocytopenia is diagnosed partly by a fall of about 50% or more from the baseline count, usually 5–14 days after starting. A baseline count and regular checks make this possible.確認に用いた資料: Heparin-Induced Thrombocytopenia · StatPearls (NCBI Bookshelf) (2023)
答え: B · Euglycemic diabetic ketoacidosis
SGLT2 inhibitors can cause DKA with only mildly raised glucose because glucose is lost in the urine. Ketones and acidosis must be checked in any unwell patient on these drugs, even with a near-normal glucose.確認に用いた資料: Ketones blood test · MedlinePlus (NIH) (2025)
答え: D · Hypoxia
The 4 Hs are hypoxia, hypovolaemia, hypo- or hyperkalaemia and other metabolic causes, and hypothermia. The 4 Ts are thrombosis, tension pneumothorax, tamponade and toxins.
答え: A · Low potassium increases the risk of digoxin toxicity
Digoxin binds to the sodium–potassium ATPase at the site potassium normally uses. When potassium is low, digoxin binds more, raising the risk of toxicity and arrhythmias.
答え: C · 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: C · SpO₂が90%から83%に低下し、新たな傾眠があるCOPDの患者
飽和度の低下と新たな傾眠は、高二酸化炭素血症を伴う可能性のある急性呼吸不全を示唆し、直ちにアセスメントが必要です。ほかの患者は安定しており、ニーズは少し待てます。
答え: B · Too high harms the kidney; too low risks rejection
Tacrolimus has a narrow therapeutic range and many interactions. High levels can cause nephrotoxicity, tremor and high glucose, while low levels risk rejection. Trough levels are taken before the morning dose.
答え: D · Aspirin
Aspirin (salicylates) displaces thyroid hormone from binding proteins, raising free hormone levels. Paracetamol (acetaminophen) and external cooling are used instead, together with treatment for the storm itself.
答え: A · 薬の濃度が安定し、激しい痛みのピークを防げるから
予測できる持続的な術後の痛みは、定期的な多角的鎮痛（例えばパラセタモールと、安全な場合はNSAID）で管理し、突出痛には頓用の用量を併用するのが最善です。痛みと副作用は引き続き定期的にアセスメントします。
答え: A · 出血を報告する。チームが循環器科の意見を得て、出血とステント血栓症のバランスをとって決める
冠動脈ステント留置後の早期に2剤併用抗血小板療法を中止すると、ステント血栓症や心筋梗塞のリスクが高く、続けると出血が増えます。判断は、できれば循環器科と消化器科の意見を得て、医療チームが行います。出血の重症度と内視鏡所見に応じて、アスピリンを続け、2つ目の薬を一時的に休薬するか続けることが多くあります。
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