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 nurse has given rapid-acting insulin, and then learns that the patient’s meal tray will be 45 minutes late. What should the nurse do?
頭部外傷と下肢の骨折のある患者をモニタリングしています。優先すべき所見はどれですか？
An adult with hepatitis A is incontinent of stool. Which precautions are used?
A nurse calls a provider using SBAR about a patient with falling blood pressure. Which statement is the “Recommendation”?
A patient has taken hydrochlorothiazide for several years. Which laboratory change is a recognized effect of this drug?
A patient stopped long-term prednisone suddenly a week ago. Now: blood pressure 78/46 mm Hg, sodium 128 mEq/L, potassium 4.6 mEq/L, glucose 58 mg/dL (3.2 mmol/L). Which condition is most likely?
A patient who injects drugs has a fever, a new heart murmur and small dark lines under the nails. What is the likely diagnosis?
長期間の飢餓の後に経腸栄養を始めた患者に、低リン血症、低カリウム血症、不整脈が起こりました。最も考えられるのは？
A patient taking simvastatin drinks a large glass of grapefruit juice every morning. Why is this a concern?
A patient has been on continuous NIV via a full-face mask for two days. Which nursing measure helps prevent the most common complication?
A patient with Graves' eye disease has gritty eyes and swelling around them in the morning. Which advice is most appropriate?
血液透析の患者が、透析の間の水分をなぜ制限しなければならないのかと尋ねました。正しい説明はどれですか？
Which advice helps a person with diabetes prevent foot ulcers?
患者の回腸ストーマの周囲の皮膚が赤くただれて滲出しており、パウチがよく漏れます。最も考えられる原因はどれですか？
答え: C · Get the patient some carbohydrate food now and check the glucose
Rapid-acting insulin starts working within minutes, so a long delay before eating risks hypoglycemia. The nurse arranges food or carbohydrate now and monitors the glucose.
答え: D · グラスゴー・コーマ・スケールのスコアが 15 から 12 に低下した
GCS の低下は、頭蓋内圧の上昇を示唆し、致死的になりうるため、緊急のエスカレーションが必要です。骨折の痛みも治療が必要ですが、同じようには生命を脅かしません。
答え: D · Contact precautions in addition to standard precautions
Hepatitis A spreads through fecal contamination. For a patient who is incontinent or in diapers, contact precautions are added to standard precautions to prevent spread on hands and surfaces.
答え: C · “I think he needs to be assessed now. Can you come within the next 15 minutes?”
In SBAR, the situation names the problem, the background gives the history, the assessment shares the nurse’s findings and judgement, and the recommendation states a clear request with a time frame.
答え: B · A rise in serum uric acid
Thiazides reduce uric acid excretion and can trigger gout. They also tend to lower potassium, sodium and magnesium, raise calcium (by reducing its excretion) and raise blood glucose and lipids.確認に用いた資料: Hydrochlorothiazide · StatPearls (NCBI Bookshelf) (2026)
答え: D · Acute adrenal insufficiency (adrenal crisis)
Long-term glucocorticoids suppress the body's own cortisol production; stopping them suddenly can cause adrenal crisis. Lack of cortisol causes hypotension, hyponatremia and hypoglycemia. Aldosterone is usually still made, so potassium is often normal; high potassium suggests primary adrenal failure. Treatment is IV hydrocortisone and fluids as prescribed.
答え: C · Infective endocarditis
Infective endocarditis causes fever and a new or changing murmur, sometimes with splinter haemorrhages. Several sets of blood cultures are taken before long-course IV antibiotics.
答え: D · リフィーディング症候群
リフィーディング症候群は、栄養の再開時にリン、カリウム、マグネシウムが急速に細胞内に移動することで起こります。リスクの高い患者は、電解質を観察しチアミンを投与しながら、ゆっくり開始します。
答え: B · It raises statin levels and the risk of muscle damage
Grapefruit juice inhibits the CYP3A4 enzyme, increasing levels of drugs such as simvastatin and some calcium channel blockers. Higher statin levels raise the risk of myopathy. Patients are advised to avoid large amounts or choose a statin not affected.
答え: C · Check mask fit and protect the bridge of the nose
Pressure injury over the bridge of the nose is common with NIV masks. Correctly sized masks, avoiding overtightening (allowing a small gap under the straps), protective dressings and regular skin checks reduce it. Other problems include eye irritation, dryness and gastric distension.
答え: B · Use lubricating drops and sleep with the head raised
Lubricating drops protect the cornea, raising the head at night reduces swelling, and sunglasses help with light sensitivity. Smoking strongly worsens thyroid eye disease, so stopping is advised.
答え: D · 余分な水分がたまり、血圧を上げて、透析中の息切れやけいれんを起こすから
残存尿量が少ない患者は、透析の間に水分がたまります。大きな増加は高血圧、肺水腫、心臓への負担を起こし、透析中に大量の水分を素早く除去すると、低血圧とけいれんを起こします。水分と（口渇を促す）塩分を制限することで、増加を管理できる範囲に保てます。
答え: B · Check the feet every day and never walk barefoot
Peripheral neuropathy and poor circulation mean injuries can go unnoticed. Daily inspection, well-fitting footwear, checking water temperature and regular podiatry help prevent ulcers.
答え: A · 皮膚に付着した排出物。多くは装具が合っていないことによる
漏れた排出物による刺激性皮膚炎は、特に回腸ストーマで、最も多いストーマ周囲の皮膚の問題です。ストーマを測り直し、できればストーマ看護師の関与のもと、開口部と装具（凸面の面板やシールなど）を調整し、皮膚保護を行います。ただれた皮膚は装具の接着も悪くするため、漏れが悪化します。
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