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 speaks little English, and the nurse needs to explain a new procedure. What is the best way to communicate?
A patient has a chest drain for a pneumothorax. The nurse sees constant bubbling in the water-seal chamber. What does this most likely mean?
A patient has patient-controlled analgesia (PCA). A family member presses the button while the patient sleeps. What should the nurse explain?
A nurse caring for a patient with influenza on droplet precautions will assist with an aerosol-generating procedure, such as bronchoscopy. What change in PPE is needed?
A patient has weight loss, tremor and heat intolerance. Which thyroid test pattern fits Graves disease?
A health care worker's hepatitis B tests show: HBsAg negative, anti-HBs positive, anti-HBc positive. What does this mean?
患者に新たな混乱があり、呼吸数は 24 回/分、収縮期血圧は 95 mmHg です。まず何を疑うべきですか？
A nurse teaches a patient with a new ileostomy. Which statement shows a need for further teaching?
A patient has episodes of severe headache, sweating and palpitations with very high blood pressure. Which rare cause should be considered?
喘息の患者に、アスピリンの服用後に喘鳴を起こした既往があります。術後の痛みに対してイブプロフェンが処方されました。看護師はどうすべきですか？
A man starts finasteride for an enlarged prostate. Which statement is correct?
A patient with known back pain says they now cannot feel the skin between their legs and have not passed urine for 12 hours. What should happen?
Which advice is appropriate for a patient with a very low platelet count?
A surgical patient's MUST score is 3 and the wound is healing slowly. What is the most appropriate action?
答え: D · Use a professional medical interpreter
Professional interpreters give accurate, confidential translation of medical information. Family members, especially children, may leave things out and should not be used for important explanations.
答え: C · An air leak in the patient or the system that needs checking
Continuous bubbling in the water-seal chamber signals an air leak. The nurse checks the connections from the patient to the drain and reports a leak that cannot be fixed.
答え: B · Only the patient should press it, because this keeps the system safe
PCA is safe because a patient who becomes drowsy stops pressing the button. When others press it (“PCA by proxy”), sedation and respiratory depression can occur.
答え: D · Wear a fit-tested respirator (N95 or FFP3) and eye protection instead of a surgical mask
Aerosol-generating procedures can spread influenza in small particles that a surgical mask does not filter well. Staff wear a fit-tested respirator (N95 in the US, FFP3 in the UK), eye protection, gown and gloves, and the number of people in the room is kept low.
答え: D · Low TSH with a high free T4
In Graves disease, antibodies stimulate the thyroid to make too much hormone. The high free T4 suppresses TSH from the pituitary through negative feedback, so TSH is low. A high TSH with a low T4 fits primary hypothyroidism.確認に用いた資料: TSH test · MedlinePlus (NIH) (2026); Thyroxine (T4) Test · MedlinePlus (NIH) (2024); Graves disease · MedlinePlus (NIH) (2026)
答え: A · Past infection that has resolved, with immunity
The vaccine contains only surface antigen, so vaccination produces anti-HBs alone. A positive anti-HBc shows past or current infection; with HBsAg negative and anti-HBs positive, the infection has cleared and the person is immune.確認に用いた資料: Hepatitis Testing · MedlinePlus (NIH)
答え: D · 敗血症
この 3 つのサインは qSOFA の基準で、敗血症による転帰不良のリスクが高いことを示します。早急に報告・エスカレーションし、敗血症の対応手順を開始します。
答え: C · "My output will be firm and formed like before."
Ileostomy output is liquid to porridge-like because it bypasses the colon. The other statements describe correct care: good hydration, emptying the bag before it is too heavy and recognising a healthy stoma.
答え: B · Phaeochromocytoma
Phaeochromocytoma is a catecholamine-secreting tumour, usually of the adrenal medulla. Classic features are paroxysmal headache, sweating, palpitations and hypertension. It is diagnosed with plasma or urine metanephrines.
答え: A · 投与を保留し、代替薬を依頼する
NSAIDs過敏喘息（NSAID増悪性呼吸器疾患）では、アスピリンやほかのCOX-1阻害性NSAIDsが重度の気管支攣縮を誘発することがあります。アスピリンに反応した既往のある患者には、専門医の助言なしにほかのNSAIDsを投与してはいけません。通常量のパラセタモールは一般に耐容されます。
答え: A · It takes months to work; pregnant women must not handle broken tablets
Finasteride, a 5-alpha reductase inhibitor, reduces the conversion of testosterone to dihydrotestosterone and shrinks the prostate over several months. It can harm a male fetus, so pregnant women should avoid handling crushed or broken tablets.
答え: C · Urgent MRI and referral to the spinal surgeons
Saddle anaesthesia with urinary retention suggests cauda equina syndrome. Delay can lead to permanent bladder, bowel and sexual dysfunction. The patient needs an emergency MRI and surgical decompression if confirmed.
答え: A · Use a soft toothbrush and an electric razor
With thrombocytopenia, the nurse reduces bleeding risk: soft toothbrush, electric razor, no NSAIDs or aspirin, avoiding IM injections and rectal procedures, and reporting bleeding, bruising or blood in urine or stool.
答え: A · Refer to the dietitian, start a nutrition plan and monitor intake
A MUST score of 2 or more indicates high risk of malnutrition. Poor nutrition delays healing, so the nurse refers to the dietitian, starts a care plan with food charts and supplements as advised, and rescreens regularly.
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