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。
An arterial blood gas shows pH 7.28, PaCO₂ 40 mmHg (5.3 kPa) and HCO₃⁻ 16 mEq/L (mmol/L). How should the nurse interpret it?
A patient takes lithium. Which statement shows a need for further teaching?
A nurse gives part of a dose of an opioid from a vial and must discard the rest. What is correct?
A nursing student describes how they remove PPE (gown, gloves and a mask worn for splash protection) at the doorway before leaving a contact precautions room. Which statement shows a need for further teaching?
A patient taking furosemide has a potassium of 3.3 mEq/L and is told to eat more potassium-rich foods. Which snack is the best choice?
A patient's bedside glucose meter shows "HI" (above its measuring range). The patient is drowsy. What should the nurse do?
A patient with anaphylaxis is hypotensive but has no breathing difficulty. How should they be positioned?
A patient taking regular ibuprofen suddenly develops severe upper abdominal pain, a rigid abdomen and becomes tachycardic. What is most likely?
Why is active tuberculosis treated with several drugs for at least six months?
After a pneumonectomy, how is the patient usually positioned?
A patient is starting lamotrigine. Which teaching point is most important?
A haemodialysis patient missed their last two sessions. They are breathless, with crackles, and the potassium is 6.9 mmol/L. What is the priority?
Which check is routinely made for a patient with a burn wound?
小腸閉塞の患者の経鼻胃管から1日2 Lが排液されています。最も重要な看護の焦点はどれですか？
答え: A · Metabolic acidosis
The pH is low (acidosis), the PaCO₂ is normal and the bicarbonate is low, so the cause is metabolic. Causes include diabetic ketoacidosis, sepsis and kidney failure.
答え: D · “I will take ibuprofen every day for my headaches.”
NSAIDs such as ibuprofen can raise lithium levels and cause toxicity. Steady fluid and salt intake and regular blood tests help keep levels safe.
答え: A · Discard it in front of a second licensed (registered) nurse, who witnesses and documents it
Wasting controlled substances requires a witness, usually another licensed nurse, and both document the waste. This prevents and detects drug diversion.
答え: A · “I take off my mask first, and then I take off my gloves.”
Gloves are the most contaminated item and are removed first, so dirty gloves do not touch the face or mask. Gown and gloves are taken off at the doorway before leaving the room, and hand hygiene follows. The other steps are correct.
答え: D · Dried apricots
Dried fruits such as apricots, raisins and prunes are rich in potassium, as are bananas, oranges, potatoes, beans and tomatoes. Refined grain products such as white bread and crackers are low in potassium.確認に用いた資料: Potassium in diet · MedlinePlus (NIH) (2026)
答え: D · Send a venous sample to the lab and inform the provider at once
"HI" means the glucose exceeds the meter's range, so the true value is unknown and may be very high, as in DKA or HHS. A laboratory sample is sent, the provider is informed promptly, and the patient is assessed for dehydration and ketones.確認に用いた資料: Blood Glucose Test · MedlinePlus (NIH) (2024); Diabetic ketoacidosis - Medical Encyclopedia · MedlinePlus (NIH) (2025)
答え: D · Lying flat, with the legs raised
Lying flat with the legs raised supports circulation in anaphylactic shock. Patients with breathing difficulty may prefer to sit up, but should not stand or walk, as this can cause collapse.
答え: C · A perforated peptic ulcer
Sudden severe pain with a board-like abdomen suggests perforation and peritonitis. The patient needs nil by mouth, IV access, analgesia and urgent surgical review.
答え: A · To kill slow-growing bacteria and prevent drug resistance
Mycobacterium tuberculosis grows slowly and has resistant mutants in any large population. A combination (for example rifampicin, isoniazid, pyrazinamide and ethambutol at first) kills susceptible and resistant bacteria and prevents resistance. Stopping early risks relapse and multidrug-resistant TB.
答え: D · On the back or the operated side, not fully on the remaining lung
After a pneumonectomy, the remaining lung needs room to expand, and the mediastinum must not shift. Patients usually lie on their back or on the operated side, semi-upright. Lying fully on the non-operated side can compress the remaining lung. Chest drains, if present, are managed per surgical instructions.
答え: A · Report any skin rash promptly, especially in the first weeks
Lamotrigine can cause serious skin reactions such as Stevens–Johnson syndrome, most often in the first weeks or with rapid dose increases. Any new rash needs prompt review.
答え: D · Urgent dialysis, with cardiac monitoring meanwhile
Missing dialysis causes fluid overload and hyperkalaemia, both of which can be fatal. The patient needs cardiac monitoring, emergency treatment of the potassium and urgent dialysis to remove fluid and potassium.
答え: C · Tetanus immunisation status
Burns can be contaminated, so tetanus status is checked and a booster or immunoglobulin given if needed, according to guidelines.
答え: D · 静注による補充と電解質チェックを伴う、正確な水分出納
経鼻胃管からの大量の喪失は、脱水、低カリウム血症、低クロール性の代謝性アルカローシスを起こします。吸引量を測定して記録し、処方に従って（しばしばカリウムを含む晶質液で）静注により補充し、尿素、クレアチニン、電解質を少なくとも毎日確認します。経口の水分は喪失と嘔吐のリスクを増やします。
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