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 wants to leave the hospital against medical advice. What should the nurse do?
START 法のトリアージで、歩けない成人が 1 分間に 28 回呼吸し、橈骨動脈の脈を触れず、毛細血管再充満時間が 4 秒です。どの区分になりますか？
A patient has orthostatic hypotension. Which teaching helps to prevent falls?
A nurse has worked three long shifts in a row and feels exhausted. The manager asks the nurse to stay for another shift. What is the most appropriate response?
A patient scheduled for surgery this morning has a potassium of 3.0 mEq/L on pre-operative tests. What should the nurse do?
アルコール使用障害の患者が、2 日間の補充にもかかわらず、カリウムが 3.0 mEq/L です。マグネシウムは 0.9 mEq/L です。次に行う最も適切な対応はどれですか？
Which finding with a groin hernia needs urgent surgical review?
A day after surgery, a patient's haemoglobin has fallen from 125 g/L to 85 g/L (12.5 to 8.5 g/dL) and their heart rate has risen to 118/min. What is the priority?
How big should a suction catheter be compared with the tracheostomy or endotracheal tube?
A nurse teaches a patient with heart failure who takes ramipril and spironolactone. Which statement shows a need for further teaching?
A patient with atrial fibrillation has had an ischaemic stroke. Which long-term medicine type most reduces the risk of another stroke?
A patient taking an SGLT2 inhibitor is booked for major surgery. Which statement is correct?
A patient had an upper GI endoscopy with a local anaesthetic throat spray. What must the nurse check before giving a drink?
An older patient with atrial fibrillation has sudden severe abdominal pain, but the abdomen is soft with little tenderness. Lactate is raised. What should the nurse suspect?
答え: C · Inform the provider, explain the risks and document the discussion
A competent adult has the right to leave. The nurse informs the provider, makes sure the patient understands the risks and documents it; holding the patient against their will may be false imprisonment.
答え: D · 赤（最優先）
30 回/分未満は呼吸の確認に合格しますが、橈骨動脈の脈の欠如、または 2 秒を超える毛細血管再充満時間は灌流の確認に不合格となり、傷病者は最優先（赤）です。呼吸の確認で止めてしまうことが落とし穴です。
答え: A · Sit on the edge of the bed for a short time before standing up slowly
Changing position slowly, dangling the legs first and getting up with help give the circulation time to adjust. Rapid standing, heat and dehydration make orthostatic hypotension worse.
答え: D · Explain that fatigue would make care unsafe and decline the extra shift
Long hours and fatigue increase errors and injuries. Nurses have a professional responsibility to judge whether they are fit to work safely and to say so clearly.
答え: C · Report it to the surgical team before surgery
Hypokalemia increases the risk of arrhythmias during anesthesia and can prolong muscle weakness. Abnormal pre-operative results are reported to the surgeon and anesthetist, who decide whether to correct it or delay surgery.確認に用いた資料: Hypokalemia · StatPearls (NCBI Bookshelf) (2025)
答え: A · マグネシウムを補充する。低マグネシウムは、腎臓からカリウムが失われ続ける原因になる
低マグネシウムは腎臓からのカリウム喪失を起こすため、マグネシウムを補充するまで低カリウム血症は補正されません。どちらもアルコール使用障害でよくみられます。確認に用いた資料: Low blood potassium · MedlinePlus (NIH) (2025); Magnesium Blood Test · MedlinePlus (NIH) (2023)
答え: B · The lump has become painful and tender and cannot be pushed back
An irreducible, painful, tender hernia, especially with vomiting, suggests incarceration or strangulation. This is a surgical emergency because the trapped bowel can become ischaemic.
答え: D · Escalate urgently, as the patient may be bleeding
A large fall in haemoglobin with tachycardia suggests ongoing blood loss. The nurse assesses the patient with ABCDE, checks wounds and drains and escalates for urgent review.
答え: B · No more than half the internal diameter of the tube
A catheter no larger than half the internal diameter of the tube lets air enter around it, reducing negative pressure in the lungs, atelectasis and hypoxaemia. Catheter size is often calculated from the tube size.
答え: B · "I will use a salt substitute instead of ordinary salt."
Many salt substitutes contain potassium chloride. With an ACE inhibitor and spironolactone, both of which raise potassium, they can cause dangerous hyperkalaemia. Daily weights, reporting rapid weight gain and avoiding NSAIDs (which cause fluid retention) are correct.
答え: B · An oral anticoagulant
In AF the main cause of stroke is a clot from the left atrium. Oral anticoagulants such as a DOAC or warfarin prevent this far better than antiplatelets. The start date after a stroke depends on its size and bleeding risk.
答え: B · It is usually paused in the days before surgery
Fasting, surgery and dehydration increase the risk of euglycaemic DKA with SGLT2 inhibitors. Guidance usually advises stopping them in the days before major surgery and restarting when the patient is eating and drinking normally.
答え: A · That swallowing and the gag reflex have returned
Throat spray numbs the pharynx, so drinking too early risks aspiration. Fluids are given once the gag reflex and swallowing have returned, usually after about an hour, starting with sips of water.
答え: C · Acute mesenteric ischaemia
An embolus from AF can block the mesenteric artery, causing bowel ischaemia. Early signs are severe pain with few findings; raised lactate and peritonitis appear as the bowel dies. It needs urgent CT and surgery.
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