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 drowsy patient has an arterial blood gas with pH 7.30, PaCO₂ 58 mmHg (7.7 kPa) and HCO₃⁻ 25 mEq/L (mmol/L). Which problem is the priority?
Which nursing approach may raise intracranial pressure in a patient with a head injury?
A patient with a respiratory infection has a raised procalcitonin level. What does this most suggest?
Which patient with a suspected infection meets at least two SIRS criteria?
A patient with chronic kidney disease has a potassium of 5.6 mEq/L. Which food should the nurse advise the patient to limit?
A patient's total calcium is 7.6 mg/dL and the albumin is 2.0 g/dL. Using the common correction (add 0.8 mg/dL for each 1 g/dL that albumin is below 4.0), what is the corrected calcium?
肝硬変の患者が混乱して眠そうになり、手に羽ばたき振戦があります。考えられる合併症は？
A patient rescued from a house fire has soot around the mouth, singed nasal hairs and a hoarse voice. What is the main concern?
A patient with an implantable cardioverter-defibrillator asks what to do if it fires. Which teaching is correct?
A patient with infective endocarditis is on IV gentamicin with another antibiotic. Which monitoring is most important?
Which symptoms are typical of hypokalaemia?
A nurse teaches a young adult with newly diagnosed epilepsy. Which statement shows a need for further teaching?
Why is IV hydration given with cisplatin?
A 60 kg adult with 25% TBSA burns arrives 2 hours after the injury, having had no IV fluids. Using the Parkland formula, what hourly rate is needed for the rest of the first 8 hours?
答え: D · Poor ventilation causing carbon dioxide to build up
A low pH with a high PaCO₂ and normal bicarbonate is respiratory acidosis. The patient is not breathing out enough carbon dioxide, so the priority is to support ventilation and escalate.
答え: B · Doing suctioning, turning and bathing all at the same time
Clustering several stimulating activities can cause a sustained rise in intracranial pressure. Spacing care, keeping the neck straight and a calm environment help keep it down.
答え: D · A bacterial rather than a viral infection
Procalcitonin rises mainly in bacterial infections and much less in viral ones. It is used with clinical judgement to help decide when antibiotics are needed or can be stopped.
答え: C · Temperature 38.6 °C and heart rate 112/min
SIRS criteria include a temperature above 38 °C or below 36 °C, heart rate above 90/min, respiratory rate above 20/min and a WBC above 12,000 or below 4,000/mm3. Only the first patient meets two.
答え: A · Bananas
Bananas, oranges, potatoes, tomatoes, dried fruit and beans are high in potassium. Apples, white rice and cabbage are lower-potassium choices that are commonly allowed on a potassium-restricted diet.確認に用いた資料: Potassium in diet · MedlinePlus (NIH) (2026); Chronic kidney disease · MedlinePlus (NIH) (2025)
答え: A · 9.2 mg/dL, within the normal range
Corrected calcium = 7.6 + 0.8 × (4.0 − 2.0) = 9.2 mg/dL, which is normal. Low albumin lowers the bound fraction of calcium; the correction is only an estimate, and an ionized calcium is more accurate when it matters.確認に用いた資料: Calcium blood test · MedlinePlus (NIH) (2025)
答え: B · 肝性脳症
肝性脳症は混乱と羽ばたき振戦を起こします。アンモニアの吸収を減らすためにラクツロースがよく使われ、感染や出血などの誘因を治療します。
答え: C · Airway swelling from inhalation injury
These signs suggest inhalation injury, which can cause rapid airway swelling and obstruction. Early senior anaesthetic review is needed, as early intubation may be required. Carbon monoxide poisoning must also be considered.
答え: A · One shock and well: contact the device clinic; repeated shocks or unwell: call emergency services
A single shock with full recovery usually needs a call to the device team. Several shocks in a short time, or a shock with chest pain, breathlessness or collapse, needs emergency help. Patients should not drive themselves after a shock.
答え: C · Drug levels, renal function and hearing or balance changes
Gentamicin is nephrotoxic and ototoxic. Levels are measured to guide dosing, renal function is checked regularly and patients are asked about tinnitus, hearing loss and dizziness. Risk is greater with loop diuretics, older age and longer courses.
答え: C · Muscle weakness, cramps and palpitations
Low potassium causes muscle weakness, cramps, constipation and arrhythmias. ECG changes include flattened T waves and U waves. Tingling and twitching suggest low calcium.
答え: B · "As long as I take my tablets, I can swim alone."
People with epilepsy should never swim alone, even if their seizures are well controlled. Showers are safer than baths. Telling friends about first aid and keeping a seizure diary are good practice.
答え: B · To protect the kidneys from damage
Cisplatin is nephrotoxic, so hydration and electrolyte replacement (especially magnesium) are given. It can also cause ototoxicity, neuropathy and severe nausea.
答え: A · 500 mL/h
Parkland gives 4 × 60 × 25 = 6000 mL in 24 hours, with 3000 mL due in the first 8 hours from the time of injury. With 6 hours left, 3000 ÷ 6 = 500 mL/h. Dividing by 8 (375 mL/h) ignores the delay. The rate is then adjusted to urine output.
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