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 has taken prednisone (prednisolone in many countries) for several months. Which statement shows a need for further teaching?
A chemical cleaning fluid splashes into a patient’s eye. What should the nurse do first?
Which IV fluid can be given with packed red blood cells in the same line?
A nurse discovers that an insulin infusion was programmed using the wrong drug concentration in the pump library. What should the nurse do first?
When is a peak level for an IV aminoglycoside such as gentamicin usually drawn?
A stable patient's hemoglobin has been 13–14 g/dL for days. Today's result is 8.2 g/dL, but the patient feels well, the vital signs are normal and there is no bleeding. What should the nurse suspect first?
A dying patient can no longer drink and has a dry mouth. What is the most appropriate nursing care?
看護師が、ハイリスク薬の処方量が正しいかどうか確信が持てません。最も安全な行動は？
What is the purpose of cardiac resynchronisation therapy (a biventricular pacemaker)?
Hours after surgery to restore blood flow to an ischaemic leg, the patient has severe calf pain that is worse when the toes are moved passively, and the calf feels tense. What should the nurse suspect?
What does a positive pronator drift test show?
A patient with an insulin pump is admitted with nausea, a glucose of 19 mmol/L (342 mg/dL) and blood ketones of 3.1 mmol/L. What is the priority?
多角的（マルチモーダル）鎮痛について正しい記述はどれですか？
A patient has had a large terminal ileum resection for Crohn's disease. Which long-term problems should the nurse anticipate?
答え: C · “I will stop the tablets as soon as I feel better.”
Stopping long-term corticosteroids suddenly can cause adrenal crisis, so they are tapered as prescribed. Taking them with food, telling other prescribers and reporting infection are correct.
答え: A · Flush the eye with plenty of water or saline straight away
Chemical eye injuries are treated by immediate, continuous irrigation with large amounts of water or saline. Delay, rubbing or a patch allows more damage.
答え: C · 0.9% sodium chloride
Only 0.9% sodium chloride is compatible with blood. Dextrose (glucose) solutions can cause red cells to clump and break down, and the calcium in lactated Ringer’s (Hartmann’s) can cause clotting.
答え: D · Stop the infusion and check the patient’s blood glucose
A concentration error means the dose delivered was wrong. The nurse stops the infusion, assesses the patient including blood glucose, treats as needed, notifies the prescriber and reports the event.
答え: B · About 30 minutes after the infusion ends
Peak aminoglycoside levels are usually drawn about 30 minutes after a 30-minute infusion ends, to confirm the level is high enough to kill bacteria. Troughs, drawn just before the next dose, check for accumulation. Local protocols may differ, especially with once-daily dosing.
答え: A · A sample taken from the wrong patient
A sudden large change with no clinical change suggests a specimen error, such as wrong blood in the tube or dilution with IV fluid. The nurse assesses the patient, informs the provider and arranges a repeat sample with careful identification, while staying alert for true bleeding.
答え: C · Frequent mouth care that keeps the lips and mouth moist
Regular mouth care with moist swabs, water sprays and lip balm relieves a dry mouth in the last days of life. Families can be shown how to help.
答え: D · 投与を保留し、まず処方者か薬剤師に確認する
看護師は投与するどの薬についても理解していなければなりません。量が誤っていると思われる場合は、処方者か薬剤師に確認し、その対応を記録すべきです。
答え: C · To make both ventricles contract together and more efficiently
In heart failure with a wide QRS (often left bundle branch block), the ventricles contract out of step. Pacing both ventricles restores coordinated contraction, improving symptoms and survival. Many devices also include a defibrillator.
答え: D · Compartment syndrome from reperfusion swelling
When blood flow returns to ischaemic muscle, swelling can raise pressure in a fascial compartment. Pain out of proportion and pain on passive stretch are early signs; pulses may remain until late. It is reported urgently, as fasciotomy may be needed. The limb is kept at heart level, not raised high.
答え: A · Subtle weakness in one arm
When a weak arm drifts down and turns palm-down (pronates), it suggests a mild upper motor neuron weakness, for example from a stroke. It can detect weakness that is not obvious on routine testing.
答え: B · Suspect failed insulin delivery and give insulin by another route
Rising ketones in a pump user suggest that insulin delivery has failed, for example from a kinked cannula or an empty reservoir. Insulin must be given by pen or IV, and DKA treatment started if criteria are met. The site and pump are checked.
答え: A · 作用の異なる薬を組み合わせて、オピオイドの必要量を減らす
多角的鎮痛は、薬と手技（パラセタモール、安全な場合のNSAID、局所麻酔薬のブロック、オピオイド）を組み合わせて、疼痛緩和を改善し、オピオイドの副作用を減らします。数種類のオピオイドの併用は、多角的ではありません。
答え: C · Vitamin B12 deficiency and bile-acid diarrhoea
The terminal ileum absorbs vitamin B12 and bile acids. After resection, B12 replacement may be needed, and unabsorbed bile acids reaching the colon cause diarrhoea.
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