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。
内科の混合病棟で、看護師が最初に診るべき患者はどれですか？
A patient in hypovolemic shock is receiving IV fluids. Which finding best shows that the treatment is working?
A patient in bed has a generalized tonic-clonic seizure. What should the nurse do?
看護師が、同僚が手指衛生をせずに患者から次の患者へ移るのを目にしました。最善の対応はどれですか？
When should a blood sample for a digoxin level be drawn to be interpreted correctly?
A patient in DKA is receiving IV fluids and insulin. The glucose has fallen to about 220 mg/dL (12.2 mmol/L), but the anion gap is still high. What change would the nurse expect?
Which equipment must always be kept at the bedside of a patient with a tracheostomy?
An older man has sudden severe abdominal and back pain, is hypotensive and has a pulsating mass in the abdomen. What should be suspected?
A patient takes both digoxin and furosemide. Why does the nurse watch the potassium level closely?
An older patient with three rib fractures is breathing shallowly and refuses to cough because of pain. What is the priority intervention?
A patient with diabetic neuropathy has an ulcer on the ball of the foot. Which measure is most important for healing?
A nurse teaches the family of a patient on insulin how to manage a severe hypo. Which statement shows a need for further teaching?
Which is a recognised risk of long-term proton pump inhibitor use?
Which medicine commonly needs enteral feeds paused before and after each dose because the feed reduces its absorption?
答え: C · 持ち物を人にあげ、自殺の計画をもっている、うつ病の患者
持ち物を人にあげることと計画があることは、自殺の警告サインで、差し迫った安全上の脅威です。ほかの患者は安定しており、ニーズは待てます。
答え: A · Urine output at least 0.5 mL/kg/h and clearer thinking
Improving urine output, mental state and heart rate show better tissue perfusion. A rising heart rate and cool skin suggest ongoing shock, and new crackles may mean fluid overload.
答え: D · Turn the patient on their side and protect them from injury without restraining
The nurse stays with the patient, turns them to the side to keep the airway clear, moves hard objects away and times the seizure. Objects in the mouth and restraint can cause injury.
答え: D · すぐに同僚へ丁寧に注意を促す
速やかで丁重な注意は、次の患者の害を防ぎます。多くの病院はすべての職員に手指衛生について声を上げるよう奨励しており、これは安全文化の一部です。
答え: C · At least 6–8 hours after a dose, often just before the next one
Digoxin distributes slowly from blood to tissues, so a sample taken too soon after a dose is falsely high. Levels are drawn at least 6–8 hours after a dose, commonly as a trough before the next dose.
答え: C · Add dextrose to the IV fluids and continue the insulin
The glucose usually falls before the ketoacidosis resolves. Dextrose is added so insulin can continue, clearing ketones without causing hypoglycemia, until the anion gap closes. Stopping insulin too early lets ketoacidosis return.
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: C · A ruptured abdominal aortic aneurysm
A ruptured AAA classically presents with pain, shock and a pulsatile mass. It is a surgical emergency needing immediate senior help and transfer to theatre.
答え: B · Low potassium increases the risk of digoxin toxicity
Digoxin binds to the Na⁺/K⁺-ATPase pump at the site potassium normally uses. When potassium is low, more digoxin binds, so toxicity and arrhythmias become more likely. Loop diuretics commonly cause hypokalaemia, so the combination needs monitoring.
答え: A · Effective analgesia so they can breathe deeply and cough
Pain from rib fractures causes shallow breathing and poor coughing, leading to atelectasis and pneumonia, especially in older adults. Good analgesia (sometimes regional blocks), deep breathing, coughing with support and early mobilisation are key. Chest strapping restricts breathing and is not used.
答え: A · Taking pressure off the ulcer
Offloading (removing pressure) is essential for healing a neuropathic ulcer, along with infection control, good blood supply and specialist foot team care. Hot soaks risk burns because sensation is reduced.
答え: B · "If she is unconscious, I will pour juice into her mouth."
An unconscious person cannot swallow safely, so fluids in the mouth can be aspirated. The family should put the person in the recovery position, give glucagon if trained and call for help. Once awake and able to swallow, the person eats a longer-acting carbohydrate.
答え: B · Hypomagnesaemia
Long-term PPIs are linked with low magnesium, C. difficile infection, fractures and B12 deficiency. The need for continuing treatment should be reviewed regularly.
答え: C · Phenytoin
Enteral feeds bind phenytoin and lower its levels, risking seizures. Feeds are usually paused around doses, as advised by the pharmacist, and drug levels are monitored.
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