NCLEX 形式の優先順位の決定と委任：直前対策パック

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?

1. ALoss of bicarbonate from the bowel through severe diarrhea
2. BToo much bicarbonate from antacids
3. CHyperventilation caused by anxiety
4. DPoor ventilation causing carbon dioxide to build up

START 法のトリアージで、歩けない成人が 1 分間に 28 回呼吸し、橈骨動脈の脈を触れず、毛細血管再充満時間が 4 秒です。どの区分になりますか？

1. A呼吸数が 30 回/分未満なので、黄（待機可能）
2. B黒（救命困難）
3. C緑（軽症）
4. D赤（最優先）

A patient with a fever and a cough arrives in a crowded clinic waiting room. What should the nurse do?

1. ADo nothing until the patient is seen by the provider
2. BGive the patient a mask and seat them apart from others
3. CGive everyone else in the waiting room a mask instead
4. DAsk the patient to wait outside in the car park

A nurse has worked three long shifts in a row and feels exhausted. The manager asks the nurse to stay for another shift. What is the most appropriate response?

1. AAgree and drink extra coffee to stay alert
2. BAgree without telling anyone about the fatigue
3. CAgree, but skip the independent medication checks to save energy on the shift
4. DExplain that fatigue would make care unsafe and decline the extra shift

When is a peak level for an IV aminoglycoside such as gentamicin usually drawn?

1. AExactly 24 hours after the first dose
2. BAt any time convenient for the patient
3. CJust before the next dose is started
4. DAbout 30 minutes after the infusion ends

A patient has eaten very little for 2 weeks and has received broad-spectrum antibiotics. The INR is now 2.3 without warfarin, and the platelets are normal. What is the most likely cause?

1. AImmune thrombocytopenia
2. BIron-deficiency anemia
3. CVitamin K deficiency
4. DHemophilia A

What happens in third-degree (complete) heart block?

1. ANo impulses from the atria reach the ventricles, so they beat independently
2. BThe atria beat chaotically with no P waves, and the ventricular rate is irregular
3. CEvery impulse reaches the ventricles, but each one is slightly delayed
4. DThe ventricles beat very fast and regularly

A patient admitted after a fall takes many regular medicines. Which safety step on admission helps prevent medication errors?

1. APrescribing only the medicines that the patient can remember taking
2. BMedicines reconciliation against reliable sources, such as primary care records
3. CStopping all regular medicines until the day the patient is discharged
4. DDoubling the doses to make up for any missed while at home

心筋梗塞の2日後に、患者が突然の息切れ、ラ音、新たな大きな収縮期雑音を起こしました。どの合併症を疑うべきですか？

1. Aストレスで誘発された安定狭心症の新たな発作
2. B長期臥床による肺塞栓症
3. C乳頭筋断裂による急性僧帽弁閉鎖不全
4. D心膜摩擦音を伴う梗塞後心膜炎

喘息の患者のピークフローが自己最良値の40%、呼吸数が28/分で、文章を最後まで話せません。SpO₂は94%です。この発作はどう分類されますか？

1. A中等度の喘息増悪
2. B致死に近い喘息
3. C生命を脅かす喘息
4. D急性重症喘息

患者が自分で気道を守れないかもしれないことを、通常示唆するグラスゴー・コーマ・スケール（GCS）のスコアはどれですか？

1. A15
2. B13以下
3. C8以下
4. D11以上

A patient had a witnessed tonic-clonic seizure. Afterwards their left arm is weak, and the weakness improves over the next few hours. What is the best interpretation?

1. ACertainly a stroke, so the seizure can be ignored
2. BNormal postictal tiredness that needs no further assessment or imaging at all
3. CPossible postictal (Todd's) paresis, but a stroke must still be excluded
4. DA sign that the patient is pretending to be weak

Which change suggests that a burn wound is becoming infected?

1. ADry, healing skin with mild itching
2. BThe wound becoming pink and a little smaller at each dressing change
3. CLess exudate on each dressing change
4. DA partial-thickness burn becoming deeper, with new discolouration

On day 3 after admission, a patient with alcohol dependence becomes confused, with hallucinations, sweating, tremor, fever and tachycardia. What is the most likely cause?

1. AHepatitis A caught on the ward
2. BNormal anxiety about being in hospital
3. CAn allergic reaction to hospital food
4. DDelirium tremens from alcohol withdrawal