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 on a continuous IV heparin infusion has new black, tarry stools and an aPTT well above the target range. What should the nurse do first?
A patient with a severe asthma attack had a PaCO₂ of 32 mmHg (4.3 kPa) on arrival. An hour later it is 46 mmHg (6.1 kPa), and the patient seems tired. What does this suggest?
Where is a gait belt placed when helping a patient to walk?
During a procedure, a nurse sees that the team is about to start without a time-out. What should the nurse do?
抗利尿ホルモン不適合分泌症候群（SIADH）の患者のナトリウムは 128 mEq/L です。看護師が予想する処方された対応はどれですか？
A patient has a hemoglobin of 11.2 g/dL (112 g/L), an MCV of 64 fL, a normal ferritin and a normal-to-high red cell count. What is the most likely cause?
Which equipment must always be kept at the bedside of a patient with a tracheostomy?
A patient is recognised by the team as being in the last days of life. Which approach is correct?
After an arterial blood gas sample is taken from the radial artery, what should the nurse do?
Four hours after abdominal surgery, a patient's heart rate has risen from 84 to 122/min and they are restless and pale. BP is still 118/76 mmHg, and the surgical drain is filling with blood. What should the nurse conclude?
特に最初の数回の治療で、頭痛、吐き気、落ち着きのなさ、ときにけいれんを起こす血液透析の合併症はどれですか？
A nurse teaches a patient with CKD and a high potassium about diet. Which statement shows a need for further teaching?
Which factor can precipitate hepatic encephalopathy in a patient with cirrhosis?
An 80-year-old has a fluid balance 3 L positive two days after surgery. They are now breathless, with crackles at both lung bases and swollen ankles. What should the nurse do?
答え: C · Stop the heparin infusion and inform the provider
Black, tarry stools suggest upper GI bleeding, and a high aPTT shows too much anticoagulation. The nurse stops the heparin, checks vital signs and informs the provider, who may prescribe protamine sulfate. Vitamin K reverses warfarin, not heparin.
答え: B · Respiratory muscle fatigue with possible impending respiratory failure
Early in an asthma attack, fast breathing lowers the PaCO₂. A rising, “normal” value in a tiring patient means they can no longer move enough air, which is a warning sign of respiratory failure.
答え: A · Around the patient’s waist, over clothing
The gait belt goes snugly around the waist over clothing, close to the center of gravity, with room for the nurse’s fingers underneath. Holding it gives control without pulling on the arms.
答え: B · Speak up clearly and stop the start until the time-out is done
The time-out is a key step to prevent wrong-patient, wrong-site and wrong-procedure errors. Any team member who sees it being skipped should speak up and halt the procedure until it is done.
答え: B · 水分制限
SIADH では、抗利尿ホルモンが多すぎて腎臓が水を保持し、ナトリウムが希釈されます。最初の対応は水分制限です。低張液や余分な水は、ナトリウムをさらに下げます。確認に用いた資料: Syndrome of inappropriate antidiuretic hormone secretion · MedlinePlus (NIH) (2025)
答え: B · Thalassemia trait
Thalassemia trait causes microcytosis from reduced globin production, often with a normal or high red cell count and normal ferritin. Iron deficiency has low ferritin. Iron supplements do not help thalassemia trait and can cause iron overload.確認に用いた資料: Thalassemia - Medical Encyclopedia · MedlinePlus (NIH) (2026); Red Blood Cell (RBC) Indices · MedlinePlus (NIH) (2024)
答え: B · Spare tracheostomy tubes, including one a size smaller, and working suction
Emergency equipment such as spare tubes (same size and one smaller), suction, oxygen and tracheal dilators must be at the bedside. This allows rapid management of a blocked or displaced tube.
答え: B · Review and stop treatments that no longer help, and focus on comfort
When dying is recognised, non-beneficial interventions are stopped and anticipatory medicines for symptoms such as pain, agitation and secretions are prescribed. Clear communication with the patient and family is essential.
答え: B · Apply firm pressure to the site for several minutes
Firm pressure for at least about 5 minutes (longer in patients on anticoagulants or with clotting problems) prevents a haematoma. The hand is checked for colour and circulation. The sample is processed promptly.
答え: D · Early haemorrhagic shock is likely, so escalate urgently
Rising heart rate, restlessness, pallor and visible bleeding are signs of compensated haemorrhagic shock. Waiting for hypotension delays treatment. The nurse escalates urgently, gives oxygen, ensures IV access and anticipates bloods, fluids or blood products and surgical review.
答え: A · 透析不均衡症候群
血液からの尿素の急速な除去は浸透圧勾配を作り、水が脳細胞に移動して脳浮腫を起こします。最初の治療を短く穏やかにすることで予防します。
答え: A · "I will use a salt substitute instead of ordinary salt."
Salt substitutes often contain potassium chloride, which can cause dangerous hyperkalaemia in CKD. Patients should reduce salt without using these products. Boiling vegetables and limiting high-potassium foods are correct.
答え: A · Constipation
Constipation, GI bleeding, infection, dehydration, low potassium and sedative drugs can trigger encephalopathy. Keeping the bowels open, for example with lactulose, reduces ammonia absorption.
答え: C · Stop the IV fluids, sit the patient up and escalate
Older patients and those with heart or kidney disease can develop fluid overload. The nurse stops fluids, sits the patient up, gives oxygen if needed and asks for medical review, often for diuretics.
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