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 anxious patient is breathing very fast and has tingling fingers. The blood gas shows pH 7.51 and PaCO₂ 29 mmHg (3.9 kPa). What should the nurse do first?
患者が末梢ラインから塩化カリウムの点滴を受けており、刺入部の焼けるような痛みを訴え、その部分が赤くなっています。看護師が最初にすることは何ですか？
In the US (EPA/OSHA) hazmat system, which level of PPE gives the highest level of protection?
A patient on chemotherapy develops shingles over several areas on both sides of the body. Which precautions are needed?
A patient starts high-dose prednisone. Which laboratory change should the nurse expect?
A patient with chronic kidney disease stage 4 has a high phosphate, a low-normal calcium and a very high parathyroid hormone (PTH). What does this show?
A patient receives IV furosemide for fluid overload. Which findings show the treatment is working?
A patient with myasthenia gravis develops increasing difficulty swallowing and weak, shallow breathing. What is the main danger?
Which emergency equipment should be kept at the bedside of a patient with a tracheostomy?
A patient with a confirmed type A aortic dissection is hypertensive and tachycardic while awaiting surgery. Which drug class is usually given first to lower the heart rate and blood pressure?
A man starts finasteride for an enlarged prostate. Which statement is correct?
中枢性尿崩症の患者がデスモプレシンを開始しました。看護師が監視すべき合併症はどれですか？
手術後、創離開が最も起こりやすいのはどの時期ですか？
慢性腎臓病のある74歳の患者が、手術後に激しい痛みを訴えています。オピオイドに関して最も重要な問題はどれですか？
答え: C · Stay with the patient and coach slow, calm breathing
These results show respiratory alkalosis caused by hyperventilation. Calming the patient and coaching slower breathing lets carbon dioxide return to normal; the nurse also looks for physical causes.
答え: B · 点滴を止め、点滴の刺入部をアセスメントする
痛みと発赤は、静脈炎または浸潤を示唆します。看護師は点滴を止め、刺入部をアセスメントし、医療者に知らせます。点滴を続けたり速めたりすると、組織の障害が増します。
答え: C · Level A
Level A is a fully encapsulating, vapor-tight suit with self-contained breathing apparatus, used for unknown or highly toxic agents. Level D is ordinary work clothing with minimal protection.
答え: B · Airborne and contact precautions until all lesions are crusted
Lesions over several areas on both sides mean disseminated zoster, which can spread through the air like chickenpox. Airborne and contact precautions are used until all lesions are dry and crusted. Localized zoster in an immunocompromised patient also needs airborne and contact precautions, but only until dissemination is ruled out.
答え: B · A rise in blood glucose
Glucocorticoids raise blood glucose by increasing glucose production and reducing insulin sensitivity. They also tend to lower potassium, retain sodium and raise the white cell count by releasing neutrophils into the blood.確認に用いた資料: Blood Glucose Test · MedlinePlus (NIH) (2024)
答え: C · Secondary hyperparathyroidism from CKD
In CKD, phosphate retention and reduced activation of vitamin D lower calcium, which stimulates the parathyroid glands. The result is high PTH with high phosphate, causing bone disease. Phosphate binders, diet and active vitamin D are used.確認に用いた資料: Parathyroid Hormone (PTH) Test · MedlinePlus (NIH) (2023)
答え: B · Increased urine output, less breathlessness and a falling weight
Effective diuresis increases urine output and reduces congestion, so breathing improves and weight falls. Electrolytes, renal function and blood pressure are also monitored.
答え: A · Respiratory failure from a myasthenic crisis
In a myasthenic crisis, weakness of respiratory and bulbar muscles can cause aspiration and respiratory failure. Breathing function is monitored closely and ventilation may be needed.
答え: B · Spare tubes (same size and one smaller), suction and oxygen
Bedside equipment usually includes spare tracheostomy tubes (same size and one size smaller), an obturator if used, suction with catheters, oxygen, a bag-valve-mask and tracheal dilators where policy requires. It is checked at every shift.
答え: C · An intravenous beta-blocker
In acute dissection, IV beta-blockers are usually given first to reduce heart rate and the rate of rise of pressure, limiting extension of the tear. Vasodilators may follow once the heart rate is controlled. Antiplatelets, anticoagulants and thrombolytics are avoided. Type A dissection needs urgent surgery.
答え: B · It takes months to work; pregnant women must not handle broken tablets
Finasteride, a 5-alpha reductase inhibitor, reduces the conversion of testosterone to dihydrotestosterone and shrinks the prostate over several months. It can harm a male fetus, so pregnant women should avoid handling crushed or broken tablets.
答え: A · 低ナトリウム血症
デスモプレシンは合成ADH類似薬です。患者が大量の水を飲み続けると、水分貯留が低ナトリウム血症を起こし、頭痛、錯乱、けいれんを伴うことがあります。患者には口渇に応じて飲むよう助言し、ナトリウム、体重、水分出納をモニタリングします。
答え: A · 手術の約5～10日後
創離開は、創が縫合糸と初期のコラーゲンに依存している約5～10日目に最も多く起こります。危険因子には、肥満、低栄養、糖尿病、感染、ステロイドの使用、喫煙、咳、いきみがあります。
答え: C · モルヒネの代謝産物が蓄積するため、より低い用量か別のオピオイドが必要なことがある
モルヒネの活性代謝産物（モルヒネ-6-グルクロニドなど）は腎臓から排泄され、腎機能障害では蓄積して、鎮静と呼吸抑制を起こします。綿密なモニタリングのもと、より低い用量、より長い間隔、または代替のオピオイドを使うことがあります。高齢は感受性を高めます。
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