解答つき内科外科看護：循環器と呼吸器ワークシート

心不全の患者の体重は、毎日いつ測るのが最もよいですか？

1. A週に1回、その日に空いている病棟の体重計で
2. B毎晩、主な食事の後、同じ日中の服装で
3. C息苦しさが増したと患者が訴えたときはいつでも
4. D毎朝、排尿後、朝食前に、同じ体重計で

高流量鼻カニュラ酸素療法とは何ですか？

1. A標準的な鼻カニューラから1～4 L/分で送る、乾燥した酸素
2. Bリザーバーバッグ付きマスクによる15 L/分の酸素
3. C人工呼吸器につないだ、密着型のフルフェイスマスクによる酸素
4. D鼻カニューラから最大約60 L/分で送る、加温加湿した酸素

Which structure is the heart's natural pacemaker?

1. AThe atrioventricular (AV) node
2. BThe Purkinje fibres
3. CThe bundle of His
4. DThe sinoatrial (SA) node

Analysis of a pleural effusion shows it is an exudate (high protein and LDH compared with blood). Which cause is most likely?

1. ANephrotic syndrome with protein lost in urine
2. BPneumonia or cancer affecting the pleura
3. CHeart failure with raised venous pressure
4. DLiver cirrhosis with a low albumin

A patient who had a stroke has a weak swallow. Which measure most reduces the risk of aspiration pneumonia?

1. AGiving thin fluids quickly through a straw between meals
2. BLying flat for 30 minutes after eating to aid digestion
3. CA swallowing assessment and sitting upright for meals
4. DGiving meals while the patient is drowsy

The telemetry monitor suddenly shows a chaotic waveform resembling ventricular fibrillation, but the patient is talking and brushing their teeth. What should the nurse do first?

1. ADeliver an immediate defibrillation shock before checking anything
2. BGive IV amiodarone as a bolus
3. CStart chest compressions straight away and call the arrest team
4. DCheck the patient and the electrodes, as this is likely artefact

A patient on three blood pressure drugs still has high readings at every visit. What should the nurse check first?

1. AWhether the patient needs surgery on the renal arteries
2. BWhether the readings should be ignored
3. CWhether a fourth drug can be added at today's appointment
4. DWhether the patient is taking the medicines as prescribed

A hypotensive patient has a temperature of 39.2 °C, warm flushed skin, a bounding pulse and a fast heart rate. Which type of shock is most likely?

1. AHypovolaemic shock from bleeding
2. BObstructive shock from tamponade
3. CCardiogenic shock
4. DEarly septic (distributive) shock