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 mild dysphagia after a stroke is eating. Which technique helps make swallowing safer?
A nurse returns to the station to find four messages. Which one is answered first?
A patient needs to be moved up in bed and cannot help much. Which approach is safest?
A patient with suspected sepsis has orders for blood cultures and an IV antibiotic. What is the correct order of actions?
A patient on levothyroxine has palpitations, weight loss and a TSH of 0.05 mIU/L. What is the most likely explanation?
A patient with advanced chronic kidney disease has a mildly raised troponin that has stayed the same on several tests over months. There is no chest pain and the ECG is unchanged. What is the best interpretation?
During a red cell transfusion, when are serious acute reactions most likely to start?
A patient suddenly develops a painful red eye with blurred vision, haloes around lights and vomiting. What should be suspected?
A pulse oximeter on a patient's finger gives an unreliable, flickering reading. Which factor is the most likely cause?
A patient who injects drugs has a fever, a new heart murmur and splinter haemorrhages. Before antibiotics are started, what is most important?
脳卒中の静注血栓溶解療法の後、最初の24時間で最も重要な観察はどれですか？
At bedtime, a patient was given their rapid-acting insulin by mistake instead of their long-acting insulin. What should the nurse do?
Why are patients with diabetes often placed early on the operating list?
During bowel preparation, an older patient becomes dizzy and confused. Blood tests show sodium 127 mmol/L. What should the nurse do?
答え: B · Sitting upright with the chin tucked down while swallowing
Sitting upright and tucking the chin narrows the airway entrance and helps food pass into the esophagus. The nurse follows the speech therapist’s plan, which may include thickened fluids.
答え: B · The laboratory is calling with a critical potassium result of 2.6 mEq/L
A critical potassium of 2.6 mEq/L can cause life-threatening arrhythmias, so it is acted on first: the nurse assesses the patient and informs the provider. The other calls can wait.
答え: D · Use a friction-reducing sheet with enough staff, with the bed flat if tolerated
Lowering the head of the bed, if the patient tolerates it, and using a slide sheet with two or more staff reduces the force needed. Pulling on arms can injure shoulders, and dragging damages skin.
答え: B · Draw the blood cultures first, then give the antibiotic without delay
Cultures are drawn before the first antibiotic dose so the organism can still be grown and identified. The antibiotic is then given promptly, because delay increases the risk of death in sepsis.
答え: C · The levothyroxine dose is too high
A very low TSH with symptoms of excess thyroid hormone suggests over-replacement. The dose is usually reduced, because long-term over-replacement raises the risk of atrial fibrillation and bone loss, especially in older adults.
答え: D · A chronic stable rise; infarction needs a rising or falling pattern
Troponin is often chronically raised in CKD and other conditions. Acute infarction is diagnosed by a rise and/or fall in troponin together with symptoms or ECG changes, so serial results are compared with the patient's baseline.
答え: B · In the first 15 minutes
Severe reactions such as ABO incompatibility and anaphylaxis usually begin early. The patient should be watched closely in the first 15 minutes, with observations repeated as per local policy.
答え: D · Acute angle-closure glaucoma
Acute angle-closure glaucoma causes a rapid rise in eye pressure, with pain, visual disturbance, haloes and vomiting. It is an emergency that can cause permanent sight loss without urgent treatment.
答え: D · Cold hands with poor peripheral circulation
Poor perfusion (cold, shock, vasoconstriction), movement, dark nail varnish or bright ambient light can make readings unreliable. The nurse checks the waveform, warms the hand or uses an ear probe, and compares the reading with the clinical picture.
答え: D · Take several sets of blood cultures from separate sites
Suspected infective endocarditis requires multiple sets of blood cultures taken with careful aseptic technique, ideally before antibiotics, to identify the organism and guide weeks of IV therapy. Echocardiography looks for vegetations but should not delay cultures or, in a very sick patient, antibiotics.
答え: C · 頻回の神経学的チェックと血圧
血栓溶解療法の後は、神経学的観察、血圧、出血のチェックを頻回に行います。新たな頭痛、嘔吐、GCSの低下、血圧の上昇は出血を示すことがあります。抗血小板薬と抗凝固薬は、通常24時間は避けます。
答え: B · Tell the prescriber and check glucose often overnight
Rapid-acting insulin without a meal can cause hypoglycaemia. The nurse informs the prescriber, monitors glucose closely, offers carbohydrate, follows advice about the missed basal dose and reports the incident.
答え: D · To shorten fasting and reduce swings in blood glucose
Shorter fasting reduces the risk of hypoglycaemia and makes it easier to restart normal eating and medicines. Glucose is monitored, and a variable-rate insulin infusion may be used for longer fasts.
答え: C · Stop the preparation and escalate to the medical team
Bowel preparation can cause dehydration and electrolyte disturbance, including hyponatraemia, especially in older people. Confusion with low sodium needs prompt medical review, and further prep is withheld until assessed.
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