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 teaches a patient about sublingual nitroglycerin tablets. Which statement shows a need for further teaching?
新たに気管切開をした患者が咳き込み、ぜいぜいした呼吸をしており、SpO₂ が 86 % に低下しました。最初の行動は何ですか？
輸液ポンプの薬剤ライブラリが、設定した用量が安全限界を超えていると警告しました。看護師はどうすべきですか？
Why can a patient with severe neutropenia have a serious infection but little redness, swelling or pus?
A patient takes low-dose methotrexate weekly for rheumatoid arthritis. Which laboratory tests are monitored regularly?
増殖の速いリンパ腫への化学療法のあとで、腫瘍崩壊症候群を示唆する結果のパターンはどれですか？
A patient taking a statin reports unexplained muscle pain and weakness. What should the nurse do?
Which nursing measure helps reduce raised intracranial pressure?
Why is aspirin chewed rather than swallowed whole in a suspected acute coronary syndrome?
A patient on spironolactone and an ACE inhibitor has a potassium of 6.8 mmol/L (6.8 mEq/L) with peaked T waves. What is usually given first to protect the heart?
Which statement about giving IV potassium is correct?
Why may HbA1c be unreliable in a patient with haemolytic anaemia or a recent large blood transfusion?
Why do patients usually have a dental review before radiotherapy to the head and neck?
While a central line is disconnected, a patient suddenly becomes breathless with chest pain and hypotension. Air embolism is suspected. What should the nurse do first?
答え: D · “I will swallow the tablet with a glass of water.”
Sublingual tablets dissolve under the tongue and are absorbed quickly there. Sitting down reduces falls from low blood pressure, the tablets are protected from light and moisture, and headache is a common side effect.
答え: B · 気管切開部を吸引する
気管切開患者のぜいぜいした呼吸、咳、低下する SpO₂ は、チューブ内の分泌物を示唆します。吸引で気道を開通させます。それでも気道が閉塞している場合は、緊急時の気管切開アルゴリズムに従い、応援を呼びます。
答え: C · まず指示、計算、ポンプの設定を再確認する
スマートポンプの限界値は、設定や計算の誤りを見つけるために定められています。看護師は、無視してよいか判断する前に、指示、濃度、用量、速度を確認します。
答え: B · There are too few neutrophils to produce the usual inflammatory signs
Classic signs of infection come from the inflammatory response, which depends on white blood cells. With very few neutrophils, fever may be the only early sign, so it must be taken seriously.
答え: A · Complete blood count, liver tests and kidney function
Methotrexate can cause bone marrow suppression, liver toxicity and, as it is cleared by the kidneys, toxicity when kidney function falls. The CBC, liver tests and creatinine are checked regularly, and folic acid is usually given to reduce adverse effects.確認に用いた資料: Methotrexate · StatPearls (NCBI Bookshelf) (2024)
答え: A · 高カリウム、高リン酸、高尿酸、低カルシウム
多くの腫瘍細胞が崩壊すると、カリウム、リン酸、核酸（尿酸になる）が血液中にあふれます。リン酸はカルシウムと結合するため、カルシウムは低下します。リスクには、不整脈と急性腎障害があります。確認に用いた資料: Tumor Lysis Syndrome (StatPearls) · StatPearls (NCBI Bookshelf) (2024)
答え: D · Report it, as statins can cause muscle damage
Statins can cause myopathy and, rarely, rhabdomyolysis. Unexplained muscle symptoms should be reported so creatine kinase can be checked and the drug reviewed.
答え: A · Raising the head of the bed to about 30° with the head kept midline
Head elevation and a midline neck position help venous drainage from the brain. Neck flexion, tight tube ties, coughing, straining and unnecessary suctioning can all raise intracranial pressure.
答え: C · Chewing speeds absorption, giving a faster antiplatelet effect
Aspirin irreversibly inhibits platelet cyclo-oxygenase, reducing thromboxane A2 and platelet aggregation. Chewing a non-enteric-coated tablet speeds absorption. It reduces mortality in acute coronary syndromes and is given unless there is a true allergy.
答え: B · Intravenous calcium gluconate or chloride
Severe hyperkalaemia with ECG changes is an emergency. IV calcium stabilises the myocardium within minutes. Insulin with glucose and nebulised salbutamol shift potassium into cells, and the cause (here spironolactone and the ACE inhibitor) is stopped. Cardiac monitoring is essential.
答え: C · It is diluted and given through an infusion pump, never as a bolus
Concentrated potassium given quickly can cause fatal arrhythmias. IV potassium is given in a diluted, ready-made solution through an infusion pump at a controlled rate, with monitoring of potassium and, at higher rates, the ECG.
答え: A · It depends on how long red blood cells survive in the blood
HbA1c reflects glucose exposure over the lifespan of red cells. If red cells are destroyed early, or donor cells are added, the result may not match true average glucose. Glucose monitoring or other tests may be used instead.
答え: B · It causes dry mouth and raises the risk of decay and jaw damage
Head and neck radiotherapy damages salivary glands, causing xerostomia and dental decay, and can cause osteoradionecrosis of the jaw after extractions. Dental treatment is done first, with careful oral hygiene and fluoride.
答え: D · Clamp the line, lie the patient left side down, head low; give oxygen
Air can enter an open central line. Clamping stops more air entering; the left lateral, head-down position may keep air in the right heart away from the pulmonary outflow. High-flow oxygen and emergency help are given.
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