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 parent of a child with influenza talks with the nurse. Which statement shows a need for further teaching?
Two patients on the unit have the same surname. What should the nurse do before giving a medication?
Which practice is safe when transferring a patient from a bed to a stretcher?
A hospital will introduce new infusion pumps and wants to find out how the process could fail before any harm occurs. Which method fits best?
フロセミドを服用している患者のカリウムが 2.9 mEq/L です。看護師が予想する所見はどれですか？
Two weeks after a sore throat, a child develops dark (cola-colored) urine, puffy eyes and high blood pressure. Urinalysis shows red cell casts and protein. Which condition is most likely?
A patient is receiving IV fluids for several days. Which monitoring is essential?
Which route and site are recommended for the first dose of adrenaline (epinephrine) in anaphylaxis on a ward?
How does digoxin help a patient with atrial fibrillation and heart failure?
A fit 24-year-old marathon runner has a resting heart rate of 46/min on admission for minor surgery. He has no dizziness, chest pain or breathlessness, and his BP is 118/70 mmHg. What is the appropriate response?
Why is propranolol given to a patient with hyperthyroidism?
After a TURP, a patient on bladder irrigation has bladder spasms. The drainage has slowed and contains clots, and the bag holds less than the irrigant given. What should the nurse do first?
急性の上部消化管出血の患者が、到着時に正常なヘモグロビン値であることが、誤解を招きうるのはなぜですか？
A competent adult who is a Jehovah's Witness refuses blood transfusion before major surgery. What should the nurse do?
答え: D · “I will give my child aspirin to bring the fever down.”
Aspirin in children with viral illnesses such as influenza or chickenpox is linked to Reye syndrome. Fluids, rest at home and reporting breathing trouble are correct.
答え: C · Check two identifiers against the wristband and the medication record
The nurse uses at least two identifiers, such as full name and date of birth, checked against the wristband and record. Open questions (“Please tell me your name”) are safer than yes/no questions.
答え: A · Lock the wheels of both the bed and the stretcher before moving the patient
Both surfaces are locked and at the same height before the transfer, a slide sheet is used and enough staff help. Side rails are raised on the stretcher during transport.
答え: C · Failure mode and effects analysis (FMEA)
FMEA is a proactive method that looks at each step of a process, asks how it could fail and what the effect would be, and changes the process in advance. Root cause analysis is used after an event has happened.
答え: B · 筋力低下と下肢のこむら返り
低カリウムは、筋力低下、こむら返り、腸の動きの低下（便秘、さらにはイレウス）、不整脈を起こします。尖った T 波は高カリウム血症で、口の周りのピリピリ感は低カルシウムを示唆します。確認に用いた資料: Heart failure - fluids and diuretics · MedlinePlus (NIH); Low blood potassium · MedlinePlus (NIH) (2025)
答え: D · Post-streptococcal glomerulonephritis
Red cell casts show bleeding from the glomeruli, which is typical of glomerulonephritis. After a streptococcal infection, immune complexes inflame the glomeruli, causing hematuria, proteinuria, edema and hypertension. Cystitis and stones do not cause red cell casts.確認に用いた資料: Strep A Test · MedlinePlus (NIH) (2024)
答え: C · Fluid balance, regular weights and urea, creatinine and electrolytes
IV fluids can cause overload or electrolyte imbalance. Fluid balance charts, weight, clinical assessment and blood tests guide the prescription.
答え: D · Intramuscular injection into the anterolateral thigh
IM adrenaline into the outer thigh is absorbed quickly and is the first-line route. IV adrenaline is reserved for experienced specialists with full monitoring because of the risk of arrhythmias.
答え: B · It slows AV node conduction and increases contractility
Digoxin inhibits the Na⁺/K⁺-ATPase, raising intracellular calcium and contractility, and increases vagal tone, slowing AV conduction and the ventricular rate. It controls symptoms but does not reduce stroke risk, so anticoagulation is still needed in AF.
答え: A · Document and report it, as this is often normal in an athlete
Endurance training increases vagal tone and stroke volume, so resting rates in the 40s can be normal. Without symptoms or haemodynamic compromise, no treatment is needed, though it is recorded and the team informed. Symptomatic bradycardia is treated.
答え: D · To ease tremor and palpitations while other treatment starts
A beta-blocker quickly controls adrenergic symptoms such as tachycardia, tremor and anxiety. It does not lower hormone production, so a thionamide, radioactive iodine or surgery is still needed.
答え: A · Suspect a clot in the catheter and follow the protocol
Clots blocking the catheter make the bladder distend, causing pain and spasms. The nurse checks for kinks, adjusts the irrigation rate per protocol, performs a bladder washout if trained and escalates if not cleared.
答え: B · 体液の移動や静注輸液が血液を希釈した後でないと低下しないから
急性出血では、赤血球と血漿が一緒に失われるため、最初は濃度が変わりません。組織から循環へ水分が移動し、静注輸液が行われると低下します。バイタルサインと臨床徴候のほうが、早期の信頼できる指標です。
答え: A · Respect the decision, document it and inform the team
An informed refusal by a competent adult must be respected. The team discusses which products and alternatives (such as cell salvage or iron) the patient accepts, documents the decision and plans to reduce blood loss.
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