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。
患者が看護助手に、新しい薬の副作用について尋ねました。助手はどうすべきですか？
チームに RN、LPN/LVN、看護助手がいます。最も適切な割り当てはどれですか？
A patient with poorly controlled seizures asks about activities at home. Which advice is most important?
看護師が間違った患者に薬を与えてしまいました。患者は元気そうに見えます。最優先は何ですか？
A patient taking empagliflozin (an SGLT2 inhibitor) has glucose in the urine but a normal blood glucose. What is the best interpretation?
A patient taking isoniazid for latent TB reports nausea, loss of appetite and dark urine. The ALT is five times the upper limit of normal. What is the best action?
A patient has a continuous stream of bubbles in the water seal chamber of their chest drain. What does this most likely indicate?
長期間の飢餓の後に経腸栄養を始めた患者に、低リン血症、低カリウム血症、不整脈が起こりました。最も考えられるのは？
患者が咳をしていないときでも、胸腔ドレーンの水封室で泡立ちが続いています。これは何を示唆しますか？
After positive end-expiratory pressure (PEEP) is increased on a ventilated patient, the blood pressure falls. What is the most likely reason?
Why is pyridostigmine often taken about 30–60 minutes before meals by patients with myasthenia gravis?
A nurse teaches a carer to give buccal midazolam for prolonged seizures. Which statement shows a need for further teaching?
Which liver function test pattern suggests bile duct obstruction?
A patient with a severe flare of ulcerative colitis develops abdominal distension, fever and tachycardia, and the stool frequency has dropped. What should the nurse suspect?
答え: D · 看護師が答えにくると伝え、看護師に知らせる
薬に関する患者指導は看護師の責任です。助手は質問を看護師に伝え、患者が自分の状況に合った正確な情報を得られるようにします。
答え: D · RN：新規入院、LPN/LVN：安定した患者への与薬、助手：清潔ケア
RN はアセスメントと複雑なケアを行い、LPN/LVN は安定した患者のケアと定型的な与薬を行い、助手は定型的な清潔ケアと測定を行います。ほかの選択肢は、その人の範囲外の業務を割り当てています。
答え: D · Never swim or bathe alone
People with uncontrolled seizures are advised not to swim alone, to shower rather than bathe and to follow local laws on driving. Most normal activities can continue with sensible precautions.
答え: A · 患者をアセスメントし、薬の作用を観察する
最優先は患者の安全です。アセスメントと観察を行い、治療を判断する指示者に連絡します。その後、病院のシステムを通じて誤りを報告し、方針に従って患者に伝えます。
答え: A · An expected effect of the drug
SGLT2 inhibitors block glucose reabsorption in the proximal tubule, so glycosuria is expected even with normal blood glucose. Urine glucose cannot be used to monitor control in these patients. The drugs also raise the risk of genital infections and DKA.確認に用いた資料: Ketones blood test · MedlinePlus (NIH) (2025)
答え: D · Hold the isoniazid and report the findings to the prescriber at once
Isoniazid can cause hepatitis, which may be severe. Symptoms such as nausea, loss of appetite and dark urine with a markedly raised ALT mean the drug should be held and the prescriber informed. Patients are taught to avoid alcohol and report these symptoms early.
答え: B · An air leak, from the lung or from the drainage system
Bubbling with breathing in a drain for pneumothorax shows air is leaving the pleural space. Continuous bubbling can also mean a leak in the connections, so the system is checked and the finding reported.
答え: D · リフィーディング症候群
リフィーディング症候群は、栄養の再開時にリン、カリウム、マグネシウムが急速に細胞内に移動することで起こります。リスクの高い患者は、電解質を観察しチアミンを投与しながら、ゆっくり開始します。
答え: D · 肺またはドレナージシステムからの空気漏れ
気胸が排液されている間は、呼気時や咳のときの断続的な泡立ちは予想されます。持続的な泡立ちは、肺からの持続的な空気漏れ（気管支胸膜瘻など）や、接続のゆるみ、チューブの抜けを示唆します。患者側からシステムを確認し、報告します。
答え: C · Higher chest pressure reduces venous return to the heart
PEEP keeps alveoli open and improves oxygenation, but higher intrathoracic pressure impedes venous return, reducing preload and cardiac output, especially in hypovolaemic patients. The team may give fluid or adjust PEEP. High pressures also risk barotrauma.
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 · "I will put something between his teeth so he does not bite his tongue."
Nothing should ever be put between the teeth during a seizure. Buccal midazolam is given between the gum and cheek, so the mouth does not need to be forced open. Timing the seizure and following the emergency care plan are correct.
答え: C · High bilirubin with a markedly raised ALP and GGT
Cholestasis raises alkaline phosphatase and gamma-GT, with conjugated bilirubin. Hepatocellular injury, such as hepatitis, mainly raises ALT and AST.
答え: D · Toxic megacolon
Toxic megacolon is dilatation of the inflamed colon with systemic toxicity and a high risk of perforation. Antimotility drugs and opioids are avoided, an abdominal X-ray is done and the surgical team is involved.
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