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 nurse sees a nursing assistant leave a confused patient’s bed in the highest position after care. What should the nurse do?
During surgery under general anesthesia, a patient develops rising end-tidal carbon dioxide, muscle rigidity and a rapidly increasing temperature. Which drug should the nurse anticipate?
Which household item is a strangulation risk for young children?
A patient weighs 180 kg and needs to be moved from bed to chair. The standard ceiling lift on the unit has a lower weight limit. What should the nurse do?
In the US, when is a pregnant woman without known risk factors usually screened for gestational diabetes?
A patient without symptoms has a finger-stick glucose of 340 mg/dL (18.9 mmol/L). The previous values were normal, and the patient has just peeled an orange. What should the nurse do first?
How does ulcerative colitis differ from Crohn's disease?
A patient faints during cannulation, with a slow pulse and pallor, and recovers quickly when laid flat. There is no rash, wheeze or swelling. What is most likely?
Before the first treatment dose of a low-molecular-weight heparin for a PE, what does the nurse need to make sure of?
ダビガトランを服用している患者が重篤な消化管出血を起こしました。使用してよい特異的な中和薬はどれですか？
A patient on ciclosporin or tacrolimus asks about grapefruit juice. Which advice is correct?
A patient on levothyroxine has palpitations, weight loss and poor sleep. TSH is suppressed, and free T4 is high. What is the most likely explanation?
Why are patients with large burns at risk of hypothermia?
During a nerve block, a patient reports a metallic taste and ringing in the ears, then has a seizure. Besides calling for help and supporting the airway, which specific treatment is given?
答え: D · Lower the bed now and remind the assistant why it matters
A high bed increases the risk of a serious fall, so the nurse corrects it at once and gives brief, clear feedback. Leaving it or delaying feedback leaves the patient at risk.
答え: D · Dantrolene
Malignant hyperthermia is a reaction to some anesthetic agents that causes hypermetabolism. The triggering drug is stopped and dantrolene is given, with active cooling and support.
答え: D · Looped cords on window blinds
Young children can become entangled in looped blind and curtain cords. Cordless blinds or cord tie-downs, and keeping cribs away from windows, prevent strangulation.
答え: D · Use bariatric-rated equipment and enough trained staff
Using equipment above its rated capacity can cause collapse and injury. Bariatric lifts, chairs and beds are used, with enough trained staff and a plan agreed in advance.
答え: B · At about 24–28 weeks of pregnancy
Placental hormones increase insulin resistance in the second half of pregnancy, so US guidance recommends screening all women at 24–28 weeks, with earlier testing for those with risk factors. In the UK, NICE recommends an oral glucose tolerance test at 24–28 weeks only for women with risk factors.確認に用いた資料: Glucose screening tests during pregnancy · MedlinePlus (NIH) (2026); Gestational diabetes · MedlinePlus (NIH) (2026)
答え: B · Have the patient wash and dry their hands, then repeat the test
Sugar residue on the fingers can give a falsely high finger-stick result. The hands are washed with soap and water and dried, and the test repeated. If the value is still high, it is confirmed and reported. Treating a false result could cause hypoglycemia.
答え: C · Ulcerative colitis affects only the colon, continuously from the rectum
Ulcerative colitis involves the mucosa of the colon, spreading continuously from the rectum. Crohn's disease can affect any part of the GI tract, is transmural and has skip lesions.
答え: C · Vasovagal syncope
Vasovagal syncope is a reflex drop in heart rate and blood pressure triggered by pain, fear or needles. Anaphylaxis would usually include skin, airway or breathing features and a fast pulse.
答え: C · An accurate, recent body weight is recorded
Treatment doses of LMWH are based on body weight, so an accurate measured weight is essential. Renal function and platelet count are also checked before starting. Guessing the weight can lead to under- or overdosing.
答え: C · イダルシズマブ
イダルシズマブはダビガトランに結合し、数分でその作用を打ち消します。第Xa因子阻害薬には、アンデキサネットアルファ（利用できない場合はプロトロンビン複合体濃縮製剤）を用います。プロタミンはヘパリンを、ビタミンKはワルファリンを拮抗します。トラネキサム酸は止血を助けるかもしれませんが、中和薬ではありません。
答え: D · Avoid it, because it can raise the drug levels
Grapefruit inhibits the CYP3A4 enzyme and can raise ciclosporin and tacrolimus levels, leading to toxicity. Patients are advised to avoid it, and to check before starting any new medicine or supplement.
答え: A · The dose is too high
A suppressed TSH with raised free T4 and hyperthyroid symptoms in a patient on levothyroxine suggests over-replacement. The prescriber usually lowers the dose. Long-term over-replacement increases the risk of atrial fibrillation and bone loss.
答え: A · Loss of skin reduces their ability to keep in heat
Burned skin loses heat and water through evaporation. Cooling the burn is limited to the wound, the rest of the patient is kept warm, and fluids and the environment are warmed.
答え: D · IV lipid emulsion
These are signs of local anaesthetic systemic toxicity. The injection is stopped, help is called, the airway is secured and seizures are treated. IV lipid emulsion is the specific treatment, especially if the circulation is affected.
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