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 at 35 weeks of pregnancy with high blood pressure calls the clinic. Which symptom needs urgent assessment?
A dehydrated child is to receive IV fluids with added potassium. Which finding should the nurse confirm first?
Neisseria meningitidis 感染症の患者の飛沫予防策は、通常いつ中止しますか？
導尿カテーテルが明らかに必要な場合に、カテーテル関連尿路感染症を最もよく予防する方法はどれですか？
A pregnant woman's blood type is O Rh-negative, and her antibody screen (indirect Coombs test) is negative. What is usually offered at about 28 weeks?
The nurse teaches a patient who is starting warfarin. Which statement shows a need for further teaching?
2 型糖尿病の患者が急に具合が悪くなり、強い脱水があり、血糖は 40 mmol/L ですが、ケトンはほとんどありません。最も考えられる診断は？
A patient with back pain develops numbness around the anus and genitals and new difficulty passing urine. Which condition should be suspected?
長時間のフライト中や手術後のDVT予防に役立つ助言はどれですか？
An 84-year-old with heart failure becomes breathless with new crackles and a rising blood pressure during a blood transfusion. What should the nurse suspect?
A patient has just started levetiracetam. Which side effect should the nurse teach them to report?
A patient with trigeminal neuralgia has lost weight and has poor oral hygiene. Which plan is most appropriate?
Which advice is appropriate for a patient with a very low platelet count?
After a high-voltage electrical injury, a patient's urine is dark red-brown. What does this suggest and what is the usual aim?
答え: D · A severe headache with blurred vision
A severe headache and visual changes can be signs of severe pre-eclampsia and a risk of eclampsia. Mild ankle swelling, backache and frequent urination are common in late pregnancy.
答え: C · That the child is passing urine
Potassium is not added to IV fluids until the child is passing urine, because poor kidney function can let potassium build up to dangerous levels.
答え: C · 有効な抗菌薬による治療を24時間行った後
有効な抗菌薬を24時間投与した後は、患者はもう感染性があるとはみなされないため、地域の方針に従って飛沫予防策を中止できます。
答え: A · 無菌的な挿入、閉鎖式システム、必要性の毎日の見直し
CAUTIの予防には、無菌的な挿入、バッグを膀胱より低く保ち流れを妨げない閉鎖式システム、不要になり次第抜去できるようにする毎日の見直しが含まれます。頻回な交換や閉鎖式システムを開放すると、感染のリスクが高まります。
答え: D · Anti-D immunoglobulin (Rho(D) immune globulin)
An Rh-negative mother can form anti-D antibodies if Rh-positive fetal blood enters her circulation, which can cause hemolytic disease in a later pregnancy. Anti-D immunoglobulin at about 28 weeks and after delivery of an Rh-positive baby prevents this sensitization.確認に用いた資料: Red Blood Cell Antibody Screen · MedlinePlus (NIH) (2025); Hemolytic disease of the newborn · MedlinePlus (NIH) (2025)
答え: B · "If I miss a dose, I will take two tablets the next day"
Doubling a missed warfarin dose can raise the INR and cause bleeding; the patient should follow the prescriber's instructions, usually taking the missed dose the same day or skipping it. A steady vitamin K intake, regular INR checks and telling other providers are correct.確認に用いた資料: Warfarin (drug information) · MedlinePlus (NIH) (2026)
答え: C · 高浸透圧高血糖状態
HHS は通常 2 型糖尿病の人に起こります。数日かけて、著しい高血糖、脱水、高浸透圧が生じますが、ケトーシスはわずかです。
答え: D · Cauda equina syndrome
Saddle anaesthesia, bladder or bowel dysfunction and leg symptoms with back pain suggest cauda equina syndrome. It needs an emergency MRI and surgical review to prevent permanent loss of function.
答え: D · 足首の運動を定期的に行い、十分に水分をとる
ふくらはぎの筋肉の活動、水分補給、そして適応がある場合は、正しく装着された弾性ストッキングや薬剤による予防が、静脈うっ滞と血栓形成を減らします。脚を組むことやきついバンドは静脈還流を妨げ、脱水は血液の粘度を高めます。
答え: D · Transfusion-associated circulatory overload
Transfusion-associated circulatory overload causes breathlessness, crackles, raised BP and JVP during or soon after transfusion, especially in older people and those with heart or kidney disease. The transfusion is stopped or slowed, the patient sat up and given oxygen, and diuretics may be prescribed. Slow rates and single units with reassessment reduce the risk.
答え: D · Changes in mood, such as irritability, low mood or anger
Levetiracetam is widely used and has few drug interactions, but it can cause mood changes, irritability, depression and, rarely, suicidal thoughts. Patients and families should report these. Gum overgrowth is linked to phenytoin.
答え: A · Offer soft, lukewarm food and advise chewing on the unaffected side
Patients may avoid eating and brushing their teeth because these trigger attacks. Soft, lukewarm food, chewing on the unaffected side, gentle oral care and effective drug treatment help maintain nutrition and hygiene.
答え: C · Use a soft toothbrush and an electric razor
With thrombocytopenia, the nurse reduces bleeding risk: soft toothbrush, electric razor, no NSAIDs or aspirin, avoiding IM injections and rectal procedures, and reporting bleeding, bruising or blood in urine or stool.
答え: D · Myoglobin from muscle damage; a higher urine output target
Electrical injury can cause extensive muscle breakdown, releasing myoglobin that can damage the kidneys. A higher urine output target is set, with fluids titrated and creatine kinase and kidney function monitored.
これは独自の練習教材です。ExamProblems はこの試験を実施する団体とは提携しておらず、その承認も受けていません。試験名は内容を説明するためにのみ使用しています。 NCLEX®, NCLEX-RN® and NCLEX-PN®はthe National Council of State Boards of Nursing, Inc. (NCSBN)の商標です。同団体はExamProblemsと提携しておらず、推奨も正確性の保証もしていません。
ExamProblems · examproblems.com/courses/nclex-style-prioritization-and-delegation