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?
A patient taking an MAO inhibitor antidepressant is taught about diet. Which statement shows a need for further teaching?
A parent calls because a toddler has swallowed some household cleaner. The child is awake and breathing normally. What should the nurse advise first?
空気予防策中の患者が緊急のCT検査を必要としています。正しい計画はどれですか？
A patient's potassium is 7.0 mEq/L. Which ECG change would the nurse expect?
A patient on lithium has had vomiting and diarrhea for 3 days and has been taking ibuprofen. They now have a coarse tremor and confusion. The lithium level is 2.2 mEq/L. What is the best interpretation and action?
ワルファリンを使用中の患者の INR が目標範囲を大きく超え、あざができています。作用を拮抗するために処方されうる薬は？
A patient due a blood transfusion is not wearing an identity band. What should the nurse do?
A patient who had a leg amputation says they feel burning pain in the missing foot. What is the best response?
During a thrombolytic infusion for an MI, the patient develops a sudden severe headache, vomiting and new confusion. What should the nurse do first?
Why is pyridostigmine often taken about 30–60 minutes before meals by patients with myasthenia gravis?
A patient with an insulin pump is admitted with nausea, a glucose of 19 mmol/L (342 mg/dL) and blood ketones of 3.1 mmol/L. What is the priority?
In the UK National Early Warning Score (NEWS2), what does an aggregate score of 5 or more usually trigger?
A patient with a platelet count of 8 × 109/L (8,000/µL) develops a sudden severe headache and confusion. What should the nurse suspect?
答え: C · 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 · “I can still eat aged cheese and cured salami.”
MAO inhibitors with tyramine-rich foods, such as aged cheese and cured meats, can cause a hypertensive crisis. Patients avoid these foods, check medicines with a pharmacist and report a severe headache.
答え: B · Contact the local poison advice service now for specific advice
A poison advice service (poison control in the US, or NHS 111 in the UK) can give advice for the exact product. Inducing vomiting is not recommended, because corrosive products can burn the esophagus again and vomit can be aspirated. Emergency services are called if the child has trouble breathing or is drowsy.
答え: B · 患者にマスクを着け、事前にCT室へ連絡し、職員は呼吸用防護具を着用する
緊急の検査は遅らせませんが、患者は粒子を封じ込めるためサージカルマスクを着用し、経路を計画し、受け入れ側の職員に連絡して自分自身と他の患者を守れるようにします。
答え: B · Tall, peaked T waves
Hyperkalemia first causes tall, peaked T waves, then a prolonged PR interval, loss of P waves and a wide QRS, which can lead to ventricular fibrillation or asystole. U waves and flat T waves are signs of hypokalemia.確認に用いた資料: High potassium level · MedlinePlus (NIH) (2025); Potassium test · MedlinePlus (NIH) (2025)
答え: D · Lithium toxicity; hold lithium and report urgently
A level of 2.2 mEq/L with coarse tremor and confusion is lithium toxicity. Fluid loss and NSAIDs both reduce lithium excretion by the kidneys. The dose is held, the provider is informed at once, and fluids and close monitoring are expected; severe cases may need dialysis.
答え: D · ビタミン K
ワルファリンはビタミン K 依存性凝固因子を阻害します。ビタミン K、大出血ではプロトロンビン複合体製剤がこれを拮抗します。プロタミンはヘパリンを拮抗します。
答え: D · Not start until a correct identity band is in place and identity is confirmed
Positive patient identification, using an identity band checked against the blood unit and prescription, is essential before every transfusion. Wrong blood incidents can cause fatal ABO incompatibility reactions.
答え: B · Explain that phantom limb pain is real and arrange treatment
Phantom limb pain is common after amputation and arises from changes in nerves and the brain. It is real and treated with analgesia, including drugs for neuropathic pain, plus measures such as mirror therapy. It does not mean infection.
答え: B · Stop the infusion and call for urgent medical help
Sudden neurological change during or after thrombolysis suggests intracranial haemorrhage. The infusion is stopped immediately, help is called, and urgent CT and reversal are considered. Neurological observations continue.
答え: A · To improve the strength of chewing and swallowing at mealtimes
Pyridostigmine inhibits acetylcholinesterase, so more acetylcholine is available at the neuromuscular junction. Timing it before meals gives the best muscle strength for chewing and swallowing, which lowers the risk of aspiration.
答え: C · Suspect failed insulin delivery and give insulin by another route
Rising ketones in a pump user suggest that insulin delivery has failed, for example from a kinked cannula or an empty reservoir. Insulin must be given by pen or IV, and DKA treatment started if criteria are met. The site and pump are checked.
答え: B · An urgent review by a clinician skilled in acute illness
NEWS2 scores respiratory rate, SpO₂, oxygen use, BP, pulse, consciousness or new confusion, and temperature. A score of 5–6 needs an urgent response, and 7 or more an emergency response.
答え: A · Intracranial bleeding
Severe thrombocytopenia carries a risk of spontaneous intracranial haemorrhage. Sudden headache, confusion or neurological change need emergency review, neurological observations and usually urgent imaging and platelet transfusion.
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