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 nurse has called the rapid response team for a deteriorating patient. What should the nurse do while waiting for the team?
An older patient with heart failure is receiving a second unit of blood. She becomes breathless, with crackles in both lungs and a rising blood pressure. What is most likely happening?
密封小線源の放射性インプラントを入れた患者の担当にしてはいけない看護師は誰ですか？
A patient on an anticoagulant falls and hits their head but says they feel fine. What should the nurse do?
In the US, when is a pregnant woman without known risk factors usually screened for gestational diabetes?
A patient's results: sodium 140 mEq/L, chloride 100 mEq/L, bicarbonate 12 mEq/L. What is the anion gap, and what does it suggest?
Compared with a colostomy, a patient with an ileostomy is at greater risk of:
A patient with long-standing COPD has an arterial blood gas with pH 7.37, a raised PaCO2 and a raised bicarbonate. How is this best described?
患者がDVTのためにワルファリンを開始します。最初の数日間、ヘパリンや低分子ヘパリンも併用するのはなぜですか？
After a car crash, a patient is severely breathless with absent breath sounds on the right, a deviated trachea, distended neck veins and BP 76/40 mmHg. What is the immediate management?
Which approach helps most when talking to a patient with expressive aphasia?
Which statement correctly distinguishes spinal shock from neurogenic shock?
Why is an ankle-brachial pressure index (ABPI) measured before compression bandaging for a leg ulcer?
A patient arrives in recovery with a temperature of 35.2 °C and is shivering. What is the most appropriate action?
答え: D · Stay with the patient, give oxygen as prescribed and have recent vital signs ready
The nurse stays with the patient, starts basic support such as oxygen as prescribed and prepares a clear handover. Leaving the patient or giving unrelated medications is unsafe.
答え: B · Transfusion-associated circulatory overload
Breathlessness, crackles and hypertension during a transfusion in a patient with heart failure suggest circulatory overload. The nurse stops the transfusion, sits the patient up, gives oxygen as prescribed and informs the provider, who may prescribe a diuretic.
答え: A · 妊娠中の看護師
妊娠中の職員や面会者は、放射性インプラントのある患者の担当にしません。ほかの職員は、患者のそばにいる時間を制限し、距離をとり、遮蔽を使い、線量計を着用します。
答え: C · Notify the provider and start neurological observations, because a brain bleed may develop
Head injury in a patient on anticoagulants can cause bleeding inside the skull that shows signs later. The provider is told at once, imaging may be needed and neurological checks are done closely.
答え: D · At about 24–28 weeks of pregnancy
Placental hormones increase insulin resistance in the second half of pregnancy, so US guidance recommends screening all women at 24–28 weeks, with earlier testing for those with risk factors. In the UK, NICE recommends an oral glucose tolerance test at 24–28 weeks only for women with risk factors.確認に用いた資料: Glucose screening tests during pregnancy · MedlinePlus (NIH) (2026); Gestational diabetes · MedlinePlus (NIH) (2026)
答え: A · 28 mEq/L, a high anion gap
The anion gap is 140 − (100 + 12) = 28 mEq/L; a typical normal value is about 8–12 mEq/L when potassium is not included. A high anion gap metabolic acidosis suggests unmeasured acids, for example ketones in DKA or lactate in shock.確認に用いた資料: Anion Gap Blood Test · MedlinePlus (NIH) (2024)
答え: D · Dehydration and electrolyte loss from liquid output
Ileostomy output is liquid because it bypasses the colon, which normally absorbs water and salts. Patients must drink enough and watch for signs of dehydration, especially in hot weather or illness.
答え: D · Compensated respiratory acidosis
Chronic CO2 retention is offset by the kidneys retaining bicarbonate, bringing the pH back to normal. A normal pH with high PaCO2 and high bicarbonate is a compensated respiratory acidosis.
答え: A · ワルファリンは十分な効果が出るまでに数日かかるから
ワルファリンはビタミンK依存性凝固因子の合成を減らしますが、既存の因子が消えるには数日かかり、開始直後は一時的に凝固傾向を強めることもあります。ヘパリンまたは低分子ヘパリンは、少なくとも5日間、かつINRが（通常2以上の）目標範囲に少なくとも24時間入るまで併用します。
答え: A · Urgent needle or finger decompression of the right chest
These signs indicate a tension pneumothorax, which causes obstructive shock. It is decompressed immediately (needle or finger thoracostomy) without waiting for an X-ray, followed by a chest drain. The nurse gives high-flow oxygen and calls for senior help.
答え: C · Ask questions that can be answered with yes, no or a gesture
In expressive aphasia, comprehension is largely preserved. Short, closed questions, extra time, gestures and picture or word boards help. Shouting does not help, and constantly finishing sentences can frustrate the patient.
答え: D · Spinal shock is lost reflexes; neurogenic shock is low BP and slow pulse
Spinal shock is the temporary loss of reflexes and tone below the injury. Neurogenic shock is hypotension and bradycardia caused by loss of sympathetic tone, usually with injuries at T6 or above. The two can occur together.
答え: D · To exclude significant arterial disease
ABPI compares ankle and arm systolic pressures. A low ABPI suggests arterial disease, where compression could cause ischaemia, so assessment is needed before compression therapy.
答え: D · Start active warming and monitor the temperature
Hypothermia increases the risk of bleeding, infection and cardiac events, and shivering increases oxygen use. Active warming with warmed fluids if needed is started, and the patient stays in recovery until temperature is acceptable.
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