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 patient with diabetes is unresponsive and has a blood glucose of 40 mg/dL (2.2 mmol/L). What should the nurse do first?
A toddler with tetralogy of Fallot becomes very blue and breathless while crying. What should the nurse do first?
看護師が火災に消火器を使ってよいのはどのようなときですか？
重度の認知症の患者が夜間に一人でベッドから出て、2回転倒しています。最も適切な計画はどれですか？
How often is the INR usually checked when warfarin is first started?
手術後、大量の低張性輸液を受けている患者に、頭痛、悪心、錯乱が現れました。これを最もよく説明する結果はどれですか？
When a patient returns to the ward from theatre, what should the nurse assess first?
腸切除術の 2 日後、患者の痛みが強まり、発熱と頻脈があり、創部ドレーンに便のような排液がみられます。最も考えられるのは？
A patient is starting long-term amiodarone. Which teaching and monitoring are most important?
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?
A patient with multiple sclerosis has had worse leg weakness for one day, together with a fever and burning on passing urine. What is the most likely explanation?
重症急性膵炎で起こりうる電解質異常はどれですか？
A nurse teaches a patient with chronic pancreatitis. Which statement shows a need for further teaching?
答え: B · Give IV dextrose or glucagon as prescribed
An unconscious patient must not be given anything by mouth because of aspiration risk. IV dextrose or glucagon raises the glucose quickly.
答え: C · Place the child in a knee-to-chest position
In a hypercyanotic (“tet”) spell, the knee-chest position raises systemic vascular resistance and sends more blood to the lungs. Oxygen and prescribed medication follow.
答え: A · 火が小さく、警報が発せられ、出口が確保されているときだけ
職員は、人々の安全が確保され、警報が発せられた後なら、背後に出口を確保したうえで、小さく限局した火を消そうとしてもかまいません。そうでなければドアを閉めて避難します。
答え: D · 低いベッド、ベッドアラーム、排泄誘導の巡回、常夜灯、滑り止め付き靴下
複数の対策を組み合わせると転倒を最もよく減らせます。低いベッド、アラーム、時間を決めた巡回と排泄誘導、十分な照明、滑り止めの履物です。4本のベッド柵、日常的な鎮静薬、抑制は、損傷のリスクを高めます。
答え: D · Every few days, until it is stable
When warfarin is started or its dose changes, the INR is checked frequently (often every few days) until it is stable in the target range. After that, the interval can be extended, often up to every 4 weeks or longer if very stable.
答え: D · ナトリウム 126 mEq/L
手術のストレスは抗利尿ホルモンを増加させ、低張性輸液は自由水を加えるため、ナトリウムが低下します。低ナトリウム血症は、頭痛、悪心、錯乱を起こします。ほかの値は正常です。
答え: B · Airway, breathing, circulation and level of consciousness
Early postoperative assessment checks the airway, breathing, oxygen saturation, circulation, consciousness, pain, wound and drains. This detects anaesthetic and surgical complications early.
答え: C · 縫合不全
縫合不全では腸の内容物が腹腔内に漏れ、腹膜炎と敗血症を起こします。至急の診察が必要な外科的緊急事態です。
答え: B · Protect skin from sunlight and have thyroid, liver and lung checks
Amiodarone causes photosensitivity, thyroid dysfunction (it contains iodine), liver toxicity, pulmonary fibrosis and corneal deposits. Patients use high-factor sunscreen and have regular thyroid and liver tests and reviews for cough or breathlessness. It also interacts with warfarin and digoxin.
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: D · 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: A · A pseudo-relapse caused by infection
Infection and fever can temporarily worsen existing MS symptoms without new damage (a pseudo-relapse). The infection, here probably a UTI, is treated first. Steroids for a true relapse are considered only if the infection is excluded.
答え: A · 低カルシウム血症
脂肪壊死は、カルシウムと結合する脂肪酸を放出し（鹸化）、血清カルシウムを低下させます。低カルシウム血症は重症度の指標で、テタニーや不整脈を起こしえます。一方、高カルシウム血症は膵炎の原因になることがあります。
答え: A · "I'll take my enzyme capsules at bedtime."
Pancreatic enzymes must be taken with meals and snacks to digest them. Alcohol must be avoided, steatorrhoea suggests under-replacement, and thirst or polyuria can signal diabetes from loss of islet cells.
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