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 conscious patient with hypoglycemia drank juice 15 minutes ago. The glucose is now 62 mg/dL (3.4 mmol/L). What should the nurse do next?
Weeks after a kidney transplant, a patient has a fever, less urine and tenderness over the new kidney. What should the nurse suspect?
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 nurse has worked three long shifts in a row and feels exhausted. The manager asks the nurse to stay for another shift. What is the most appropriate response?
A patient has taken hydrochlorothiazide for several years. Which laboratory change is a recognized effect of this drug?
A patient on warfarin with an INR of 3.6 fell and hit their head an hour ago. They now report a worsening headache and drowsiness. What is the priority?
For a patient in skin traction on the leg, which is correct?
Why is a large pleural effusion drained slowly rather than all at once?
高血圧の患者がアムロジピンを服用しています。看護師が最も観察しやすい副作用はどれですか？
心房細動でワルファリンを服用している患者のINRが8.5ですが、出血はありません。最も考えられる管理はどれですか？
A conscious patient with a glucose of 3.1 mmol/L (56 mg/dL) can swallow safely. Which is the best first treatment?
A patient with Addison's disease has been vomiting for a day. They are confused, with BP 78/40 mmHg, sodium 126 mmol/L and potassium 6.0 mmol/L. What is the priority?
Why is the "whoosh" test no longer used to check nasogastric tube position?
In recovery, an awake and anxious patient cannot lift their head, and their breaths are shallow and weak. What is the most likely cause?
答え: B · Give another serving of fast-acting carbohydrate and recheck in 15 minutes
If the glucose is still below the hypoglycemia threshold after treatment (70 mg/dL in US guidance, 4.0 mmol/L in UK guidance), the fast-acting carbohydrate is repeated and the glucose rechecked. Once it is normal, a snack or meal helps keep it stable.
答え: B · Rejection of the transplant
Fever, falling urine output and graft tenderness are signs of possible rejection. The nurse reports promptly, because early treatment can save the kidney.
答え: D · 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: B · Explain that fatigue would make care unsafe and decline the extra shift
Long hours and fatigue increase errors and injuries. Nurses have a professional responsibility to judge whether they are fit to work safely and to say so clearly.
答え: B · 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.確認に用いた資料: Hydrochlorothiazide · StatPearls (NCBI Bookshelf) (2026)
答え: D · Report urgently for imaging and possible reversal
A head injury in an anticoagulated patient, with worsening headache and drowsiness, suggests intracranial bleeding. The provider is told at once, neurological checks are done often, urgent imaging is arranged, and warfarin reversal (vitamin K and a prothrombin complex concentrate) may be prescribed.確認に用いた資料: Taking warfarin (Coumadin, Jantoven) - what to ask your doctor · MedlinePlus (NIH) (2025); Prothrombin Time Test and INR (PT/INR) · MedlinePlus (NIH) (2024)
答え: C · The weights hang freely and do not rest on the bed or floor
Weights must hang freely so the pull is continuous and in line. Nurses also check the skin, circulation and sensation of the limb.
答え: C · Rapid drainage can cause re-expansion pulmonary oedema
Draining a large volume quickly can cause re-expansion pulmonary oedema, with cough, chest tightness and hypoxia. Drainage is controlled, and the patient is watched closely.
答え: C · 足首の腫れ
アムロジピンなどのジヒドロピリジン系カルシウム拮抗薬は細動脈を拡張させ、毛細血管圧を上げて、末梢の浮腫、顔面紅潮、頭痛を起こします。乾性咳嗽はACE阻害薬に、喘鳴は喘息における非選択的β遮断薬に典型的です。
答え: C · ワルファリンを保留し、指示者に連絡して、早めにINRを再検査する
出血を伴わない非常に高いINRは、通常、ワルファリンを保留し、指示者に連絡して、INRを再検査することで管理します。INRと施設のプロトコルによっては、少量のビタミンKの経口投与が処方されることもあります（英国のガイダンスではINRが8を超える場合、米国のガイダンスでは主に10を超える場合や出血リスクが高い場合に投与します）。プロトロンビン複合体濃縮製剤と静注のビタミンKは、大出血に用います。プロタミンはヘパリンを拮抗します。上昇の理由（新しい薬、病気、食事）を調べる必要があります。
答え: B · Glucose tablets or a small glass of fruit juice
About 15–20 g of fast-acting carbohydrate, such as glucose tablets or juice, raises glucose quickly. Chocolate and milk contain fat, which slows absorption. Glucose is rechecked after about 15 minutes.
答え: C · IV hydrocortisone straight away, plus IV fluids
An adrenal crisis is life-threatening. IV or IM hydrocortisone is given immediately, without waiting for tests, together with IV saline and checks of glucose and electrolytes. Vomiting prevents tablets from being absorbed.
答え: C · Air can be heard even when the tube is in the lung
Auscultation of injected air cannot distinguish the stomach from the lungs or oesophagus, and misplaced tubes have caused deaths. pH testing of aspirate or X-ray is used instead.
答え: B · Residual neuromuscular blockade
Remaining muscle relaxant causes weakness, poor head lift and shallow breathing in an awake patient. The nurse supports breathing, gives oxygen and calls the anaesthetist, who may give a reversal agent.
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