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 taking warfarin has an INR of 5.2 and no signs of bleeding. What should the nurse do?
A marathon runner is confused, with a temperature of 41 °C and hot skin. What is the priority?
How is a urine specimen for culture obtained from an indwelling catheter?
A patient with pulmonary tuberculosis has been on treatment. Which findings usually allow airborne isolation to end?
A patient on levothyroxine has palpitations, weight loss and a TSH of 0.05 mIU/L. What is the most likely explanation?
A patient with diabetes had a glucose of 58 mg/dL (3.2 mmol/L), took 15 g of fast-acting carbohydrate and, 15 minutes later, the glucose is 64 mg/dL (3.6 mmol/L). The patient is alert. What should the nurse do next?
Which features suggest Cushing's syndrome?
体表面積 30% の熱傷患者が入院しました。最初の 24 時間で最も懸念される早期合併症は？
A patient has a prosthetic heart valve. Which teaching best reduces the risk of infective endocarditis?
After a fall onto the chest, part of a patient's chest wall moves inward when they breathe in and outward when they breathe out. What does this indicate?
A patient with migraine takes painkillers or triptans on most days and now has a headache almost every day. What is the likely problem?
CKDの患者のヘモグロビンが92 g/Lで、赤血球造血刺激因子製剤（ESA）を開始します。看護師は何をモニタリングすべきですか？
Why is the time a surgical limb tourniquet is inflated carefully recorded?
体表面積35%の熱傷の患者が、過代謝期に入ろうとしています。最も適切な栄養計画はどれですか？
答え: A · Hold the warfarin dose and inform the provider
An INR well above target raises the risk of serious bleeding. The nurse holds the dose, informs the provider and watches for bleeding. Without bleeding, holding warfarin is usually enough at this level; vitamin K is mainly used for very high INRs or bleeding.
答え: C · Rapid cooling while supporting airway and circulation
Heat stroke is an emergency in which body temperature rises and the brain is affected. Rapid cooling, for example with cold water or ice, is the priority; antipyretics do not work for heat stroke.
答え: C · From the sampling port, after cleaning it, using aseptic technique
Urine in the bag is old and may contain extra bacteria, and disconnecting the system lets organisms in. The sample is taken from the sampling port with a sterile syringe after disinfecting the port.
答え: C · Three negative sputum smears, clinical improvement and continued therapy
Airborne precautions usually continue until the patient is on effective therapy, is improving clinically and has three negative sputum smears for acid-fast bacilli, according to policy.
答え: A · The levothyroxine dose is too high
A very low TSH with symptoms of excess thyroid hormone suggests over-replacement. The dose is usually reduced, because long-term over-replacement raises the risk of atrial fibrillation and bone loss, especially in older adults.確認に用いた資料: TSH test · MedlinePlus (NIH) (2026)
答え: C · Give another 15 g of fast carbohydrate and recheck
The "15-15 rule" is repeated until the glucose is at least 70 mg/dL (3.9 mmol/L); UK guidance uses 4.0 mmol/L and 15–20 g of carbohydrate. Then a snack or meal with complex carbohydrate and protein is given if the next meal is not soon, to prevent recurrence.
答え: A · Weight gain around the trunk, a rounded face and thin, easily bruised skin
Excess cortisol causes central obesity, a moon face, thin skin, purple striae, muscle weakness and high glucose. The other options describe hyperthyroidism, Addison's disease and acromegaly.
答え: C · 体液喪失による循環血液量減少性ショック
広範囲熱傷では体液が循環から移動するため、公式に基づいた輸液蘇生と尿量の観察が鍵です。気道熱傷も早期の危険の一つです。
答え: A · Keep teeth and gums healthy with regular dental check-ups
Oral bacteria often enter the blood and can settle on prosthetic valves. Good oral hygiene and regular dental care are key. Patients should also report unexplained fever and avoid body piercing or tattoos where possible. Antibiotic prophylaxis policies differ between countries.
答え: A · A flail chest from ribs broken in more than one place
A flail segment occurs when adjacent ribs are fractured in two or more places, so the segment moves paradoxically. It is often associated with lung contusion and respiratory failure. Management includes oxygen, strong analgesia and sometimes ventilation or surgical fixation.
答え: D · Medication overuse headache
Frequent use of painkillers or triptans can cause medication overuse headache. Treatment involves withdrawing the overused drug under guidance and starting a preventive treatment if needed.
答え: C · 血圧とヘモグロビン。上がりすぎると血栓のリスクが高まるため
ESAは高血圧を起こすことがあり、ヘモグロビンが高くなりすぎると血栓症や脳卒中のリスクを高めます。ヘモグロビンは、中程度の範囲（一般に約100～120 g/L）を目標とします。鉄欠乏は反応を制限するため、鉄貯蔵量を確認します。
答え: D · Long inflation can cause nerve and muscle damage
A tourniquet creates a bloodless field but causes limb ischaemia. Inflation time and pressure are recorded and the surgeon is told at set intervals, as long inflation can damage nerves and muscle.
答え: A · エネルギーとタンパク質が豊富な、早期の経腸栄養
大きな熱傷は、筋肉の喪失を伴う、長引く過代謝・異化の状態を起こします。高エネルギー、高タンパク質で、微量栄養素を加えた早期の経腸栄養（しばしば24時間以内）は、創傷治癒と免疫を支え、腸のバリアの保護を助けます。体重と摂取量をモニタリングします。
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