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 with a head injury is being monitored. Which set of findings suggests rising intracranial pressure?
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？
When should blood specimen tubes be labeled?
A flexible bronchoscope contacts mucous membranes but does not enter sterile tissue. Which level of processing is required at a minimum between patients?
A patient has started parenteral nutrition (PN) through a central line. Which test is monitored most frequently in the first days?
A patient without diabetes in the ICU with sepsis has a glucose of 260 mg/dL (14.4 mmol/L) and an HbA1c of 5.2%. What is the best interpretation?
A patient on the ward has shingles with open blisters. Which people are most at risk from contact?
A patient admitted after a fall takes many regular medicines. Which safety step on admission helps prevent medication errors?
A nurse measures blood pressure on a large upper arm using a cuff that is too small. What effect will this have?
胸腔ドレーンの抜去について、一般に教えられている方法はどれですか？
Why is levodopa combined with carbidopa (or benserazide)?
An older man was found on the floor after lying there for many hours. His urine is dark brown, and his creatine kinase is very high. What is the main kidney risk and the key treatment?
回腸ストーマのある患者で、徐放性や腸溶性の錠剤がうまく効かないことがあるのはなぜですか？
An older patient on regular opioids has small amounts of liquid stool leaking all day, but has not had a formed bowel movement for 6 days. What is the most likely cause?
答え: A · Rising systolic pressure, slow pulse and irregular breathing
Cushing’s triad (high systolic pressure with a widening pulse pressure, bradycardia and irregular respirations) is a late sign of raised intracranial pressure and needs urgent escalation.
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: C · At the bedside, in front of the patient, right after collection
Labeling tubes at the bedside, using two patient identifiers and in the patient’s presence, prevents wrong-patient specimens. Pre-labeled or later-labeled tubes are easily mixed up.
答え: B · High-level disinfection
Items that touch mucous membranes or non-intact skin are semi-critical and need at least high-level disinfection after thorough cleaning. Inadequate reprocessing of endoscopes has caused outbreaks.
答え: B · Blood glucose
PN contains concentrated dextrose, so hyperglycemia is common, especially at the start; glucose is checked frequently and insulin may be needed. Electrolytes, including phosphate, magnesium and potassium, are also monitored for refeeding syndrome.
答え: B · Stress hyperglycemia from acute illness
Stress hormones and inflammation raise glucose in acute illness, even without diabetes. A normal HbA1c shows that glucose was normal over the previous months. Stress hyperglycemia is still treated, usually with insulin, because it worsens outcomes.
答え: A · Pregnant women and immunocompromised people who have not had chickenpox
Someone who has never had chickenpox can catch chickenpox from contact with shingles blisters. Non-immune pregnant and immunocompromised people are at particular risk, so lesions are covered and precautions followed.
答え: D · Medicines reconciliation against reliable sources, such as primary care records
Medicines reconciliation compares several sources to produce an accurate medication list. It finds omissions, duplications and errors, and is especially important in older people with polypharmacy.
答え: C · The reading will be falsely high
A cuff that is too small needs a higher pressure to compress the brachial artery, giving a falsely high reading. A cuff that is too large can give a falsely low reading. The bladder should encircle most of the arm, so cuff size is chosen by arm circumference.
答え: B · 息を止めているときか呼気中に抜去し、その後に部位を密閉する
多くのガイドラインは、胸腔内圧が陽圧になるよう、深呼吸の終わりに息を止めた状態（バルサルバ）または呼気中にチューブを抜去することを勧めています。創は縫合または閉鎖性ドレッシングで閉じ、気胸の再発について患者をモニタリングし、適応があれば胸部X線を撮影します。事前の鎮痛は望ましい実践です。
答え: B · To stop levodopa being converted to dopamine outside the brain
Carbidopa blocks the enzyme that converts levodopa to dopamine in the periphery. More levodopa reaches the brain, so a lower dose works, and side effects such as nausea and low blood pressure are reduced.
答え: D · AKI from rhabdomyolysis, treated with generous IV fluids
Prolonged pressure damages muscle (rhabdomyolysis), releasing myoglobin, which is toxic to the tubules, as well as potassium. Early, generous IV fluids with close monitoring of urine output, potassium and creatinine help protect the kidneys.
答え: D · 通過が速いため、薬が放出される前に排出される可能性があるから
結腸がないと腸の通過が速くなるため、徐放性やコーティングされた製剤は吸収が悪くなることがあります。パウチの中に錠剤の残りが見えることもあります。薬剤師が、代わりの剤形を提案できます。
答え: A · Faecal impaction with overflow
Overflow diarrhoea occurs when liquid stool leaks around impacted faeces. Antidiarrhoeal drugs would worsen it; the nurse escalates for assessment, and treatment includes laxatives or enemas and review of the opioids.
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