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 coughs hard after abdominal surgery, and loops of bowel appear through the opened wound. What does the nurse do first?
A patient is admitted with inhalational anthrax. Which precautions are needed?
A nurse finds a used needle in a patient’s bed linen. What should the nurse do?
患者にヒドララジンが処方されましたが、薬局からヒドロキシジンが届きました。看護師はどうすべきですか？
A healthy patient has a mildly raised CK after running a marathon yesterday, without dark urine or symptoms. What is the most likely explanation?
A 68-year-old man has fatigue, a hemoglobin of 9.8 g/dL (98 g/L), an MCV of 72 fL and a low ferritin. He eats a normal diet. What is the most important next step?
A patient with DKA has an arterial blood gas showing a low pH and a low bicarbonate. Which disturbance is this?
A nurse teaches a patient with hypertension about their medicines. Which statement shows a need for further teaching?
A patient on furosemide has a serum potassium of 3.0 mmol/L (3.0 mEq/L). Which symptoms may this cause?
Seconds after an intramuscular injection, a patient becomes pale, sweaty and faint, with a heart rate of 48/min. There is no rash, wheeze or swelling, and they recover quickly when laid flat. What is the most likely cause?
脳卒中の静注血栓溶解療法の前に、一般に用いられる血圧の基準値はどれですか？
A patient with a subarachnoid haemorrhage develops a low sodium. Why is fluid restriction usually avoided in this patient?
Which statement about corticosteroids in inflammatory bowel disease is correct?
After surgery, a patient keeps asking for analgesia before it is due, watches the clock and rates pain 8/10. What is the most appropriate interpretation?
答え: C · Cover the wound with sterile dressings moistened with saline
Evisceration is a surgical emergency. The nurse covers the organs with sterile saline-moistened dressings, stays with the patient, positions them to reduce strain and calls the surgeon at once.
答え: C · Standard precautions, because it does not usually spread from person to person
Inhalational anthrax is not spread from person to person, so standard precautions are used. Contact precautions may be added for skin (cutaneous) anthrax with draining lesions.
答え: C · Pick it up by the hub or with forceps, put it in a sharps container and report it
A loose needle is a hazard to everyone who handles the linen. The nurse disposes of it safely without recapping, using an instrument if needed, and reports the incident so the cause can be addressed.
答え: B · 与薬せず、薬局に連絡して正しい薬を入手する
ヒドララジンは降圧薬で、ヒドロキシジンはそう痒や不安に用いる抗ヒスタミン薬です。違う薬を与えると投薬ミスになります。看護師は与薬を保留して正しい薬を入手し、調剤ミスを報告します。
答え: C · Strenuous exercise raised CK from skeletal muscle
Strenuous exercise, IM injections and muscle trauma can raise CK from skeletal muscle. A very high CK with dark urine suggests rhabdomyolysis, and heart damage is assessed with troponin, not CK.確認に用いた資料: Creatine Kinase · MedlinePlus (NIH) (2023); Creatine phosphokinase test · MedlinePlus (NIH) (2025)
答え: A · Look for a source of blood loss in the gut
Iron deficiency in an older man or a postmenopausal woman suggests chronic blood loss, often from the gastrointestinal tract, including colorectal cancer. Iron is started, but endoscopy or colonoscopy is needed to find the cause.
答え: A · Metabolic acidosis
In DKA, ketoacids consume bicarbonate, causing a metabolic acidosis. The patient breathes deeply and fast (Kussmaul breathing) to lower PaCO2 as compensation.
答え: D · "I'll stop my tablets once my readings are normal."
Hypertension usually needs long-term treatment; stopping because readings are normal often makes blood pressure rise again. Patients should discuss any changes with their prescriber.
答え: A · Muscle weakness, cramps and an irregular pulse
The adult reference range is about 3.5–5.0 mmol/L, so 3.0 mmol/L is low. Hypokalaemia causes weakness, cramps, constipation and arrhythmias, with flattened T waves and U waves on the ECG. Tingling lips and hand spasm suggest low calcium.
答え: C · A vasovagal reaction
Vasovagal reactions cause bradycardia, pallor, sweating and fainting, and resolve quickly when lying flat. Anaphylaxis usually causes tachycardia, airway or breathing problems and often skin changes, and does not settle on its own. If in doubt, treat as anaphylaxis.
答え: C · 約185/110 mmHg未満
多くのガイドラインは、血栓溶解療法の前に血圧が185/110 mmHg未満であること、その後24時間は180/105 mmHg未満であることを求めます。非常に高い血圧は出血性変化のリスクを高めるためです。それより高い値は、まず慎重に下げます。
答え: A · Low blood volume can worsen vasospasm and brain ischaemia
Hyponatraemia after subarachnoid haemorrhage may come from SIADH or cerebral salt wasting. Restricting fluid can cause hypovolaemia, which makes delayed cerebral ischaemia more likely. Sodium is usually corrected with fluids or salt under specialist advice.
答え: B · They are used to induce remission, not for maintenance
Steroids settle flares but are not effective or safe for maintenance because of side effects such as osteoporosis, diabetes and infection. Drugs such as aminosalicylates, immunomodulators or biologics maintain remission.
答え: A · Pain may be undertreated; reassess and ask for a review of the plan
Clock-watching often reflects inadequate analgesia. The nurse reassesses pain and function, considers multimodal options, and asks the prescriber to review the plan rather than labelling the patient.
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