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。
ESI を用いたとき、最も高い緊急度レベルになるのはどの患者ですか？
Two days after starting haloperidol, a patient suddenly develops painful neck twisting and the eyes roll upwards. What should the nurse anticipate?
錠剤を渡す前に、患者が「この薬はいつもの薬と見た目が違う」と言いました。看護師はどうすべきですか？
手首を抑制された混乱している患者の片手の指が冷たく蒼白で、同じ側の橈骨動脈の拍動が弱くなっています。看護師が最初にすべきことは何ですか？
A patient's eGFR has fallen to 24 mL/min/1.73 m². Which prescribed drug should the nurse question before giving it?
A patient's potassium is 7.2 mEq/L, and the monitor shows wide QRS complexes. Several treatments are prescribed. Which should be given first?
Which of these is one of the "4 Hs", the reversible causes of cardiac arrest?
A patient is recognised by the team as being in the last days of life. Which approach is correct?
Which investigation is most often used to confirm a pulmonary embolism?
Two days after coronary artery bypass surgery, a patient feels palpitations. The pulse is irregularly irregular at 140/min and BP is 112/70 mmHg. Which rhythm is most likely?
Several hours after a carotid endarterectomy, which finding needs the most urgent action?
A day after a total thyroidectomy, a patient has tingling lips, a positive Chvostek's sign and a corrected calcium of 1.85 mmol/L (about 7.4 mg/dL). What does the nurse expect?
Patients on immune checkpoint inhibitors may develop immune-related side effects. Which symptom should they report promptly?
A 60 kg adult with 25% TBSA burns arrives 2 hours after the injury, having had no IV fluids. Using the Parkland formula, what hourly rate is needed for the rest of the first 8 hours?
答え: C · 反応がなく、あえぐような不規則な呼吸をしている患者
反応がなく、死戦期呼吸の患者には、直ちに気道と呼吸の補助が必要で、ESI レベル 1 です。バイタルサインが正常な胸痛はハイリスク（レベル 2）で、ほかはより低いレベルです。
答え: C · An anticholinergic drug, such as benztropine or procyclidine, as prescribed
Acute dystonia is an early extrapyramidal effect of antipsychotics. It responds quickly to an anticholinergic drug; it can be frightening, and laryngeal spasm can threaten the airway.
答え: B · 投与前に手を止めて、指示と薬を再確認する
患者の懸念は安全確認のきっかけです。看護師は手を止め、指示、薬、用量、患者を確認し、必要なら薬局に連絡します。銘柄が違うだけのこともありますが、まず確認が必要です。
答え: C · その抑制具をゆるめ、手の循環をアセスメントする
抑制具より末梢の循環不良の徴候があれば、直ちに解除してアセスメントします。まだ必要な場合にのみ、指2本の確認をして正しく装着し直し、所見を報告・記録します。
答え: D · Metformin
Metformin is cleared by the kidneys, and it is contraindicated when the eGFR is below 30 mL/min/1.73 m² because of the risk of lactic acidosis. Insulin doses may also need adjustment, but insulin is not contraindicated.
答え: D · IV calcium gluconate (or chloride)
With ECG changes, IV calcium is given first to stabilize the cardiac membrane within minutes. It does not lower potassium, so insulin with glucose (and sometimes albuterol/salbutamol) follows to shift potassium into cells, then binders, diuretics or dialysis remove it.
答え: C · Hypoxia
The 4 Hs are hypoxia, hypovolaemia, hypo- or hyperkalaemia and other metabolic causes, and hypothermia. The 4 Ts are thrombosis, tension pneumothorax, tamponade and toxins.
答え: D · Review and stop treatments that no longer help, and focus on comfort
When dying is recognised, non-beneficial interventions are stopped and anticipatory medicines for symptoms such as pain, agitation and secretions are prescribed. Clear communication with the patient and family is essential.
答え: A · CT pulmonary angiography
CT pulmonary angiography (CTPA) shows filling defects in the pulmonary arteries. It uses iodinated contrast, so renal function and contrast allergy are checked. A ventilation–perfusion (V/Q) scan is an alternative, for example in pregnancy or renal impairment.
答え: C · Atrial fibrillation
New atrial fibrillation affects a large proportion of patients in the first days after cardiac surgery, often due to inflammation, electrolyte shifts and stress. Management includes a 12-lead ECG, checking potassium and magnesium, rate or rhythm control and considering anticoagulation.
答え: B · An expanding neck swelling with noisy breathing
A neck haematoma after carotid surgery can compress the airway quickly. It needs immediate senior help and may need the wound opened. Neurological checks for new stroke and cranial nerve damage are also part of routine care.
答え: C · IV calcium gluconate and monitoring for laryngospasm
Symptomatic hypocalcaemia is treated with IV calcium gluconate, followed by oral calcium and often vitamin D. Severe hypocalcaemia can cause laryngospasm, seizures and arrhythmias, so the airway and ECG are monitored.
答え: C · New diarrhoea or abdominal pain
Checkpoint inhibitors can cause immune-mediated colitis, pneumonitis, hepatitis, skin reactions and endocrine problems. Early reporting allows grading and treatment, often with corticosteroids.
答え: A · 500 mL/h
Parkland gives 4 × 60 × 25 = 6000 mL in 24 hours, with 3000 mL due in the first 8 hours from the time of injury. With 6 hours left, 3000 ÷ 6 = 500 mL/h. Dividing by 8 (375 mL/h) ignores the delay. The rate is then adjusted to urine output.
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