1.やさしい
How many levels does the Emergency Severity Index have?
- AFour
- BSix
- CThree
- DFive
2.やさしい
3 段階のトリアージ分類で、足首を捻挫し、バイタルサインが正常で軽い痛みのある患者は、通常どのように分類されますか?
- A準緊急(急ぐ)
- B救命困難
- C緊急性なし(非緊急)
- D緊急(救急)
3.やさしい
What should the nurse try before using physical restraints on a confused patient?
- ALess restrictive measures, such as more frequent checks or a bed alarm
- BAsking the family to bring restraints from home
- CRestraining all four limbs to be fully safe
- DUsing restraints at once and removing them later if they turn out not to be needed
4.ふつう
A patient with schizophrenia says voices are telling him to hurt his roommate. What is the priority?
- AIgnore the comment, because voices are part of his illness
- BKeep everyone safe and tell the team, as the risk of harm is high
- CAsk the roommate to stay in the room with him and help calm him down
- DTell him the voices are not real and leave him alone
5.ふつう
甲状腺の手術の 4 時間後、看護師が最初に対応すべき患者の所見はどれですか?
- A飲むために座りたいという要望
- B頸部のドレッシングに少量の漿液性の排液がみられる
- C声がしだいにかすれ、新たにぜいぜいした呼吸がある
- D切開部の痛みが 4/10
6.ふつう
One day after surgery, a patient walked safely with the RN this morning. The RN now asks a nursing assistant to walk her again. Which instruction is most important?
- A“Stop and call me at once if she feels dizzy or short of breath.”
- B“Try to finish the walk before the lunch trays arrive.”
- C“Walk her to the end of the corridor and back twice before lunch.”
- D“Make sure she wears her own slippers if she has them.”
7.むずかしい
After a cervical spinal cord injury, a patient has a blood pressure of 80/50 mmHg, a heart rate of 48/min and warm, dry skin. What is most likely?
- AHypovolemic shock
- BNeurogenic shock
- CCardiac tamponade
- DSeptic shock
8.むずかしい
救急部で、すぐに処置室へ行くべき患者はどれですか?
- A2 日間のどが痛く、体温が 38.0 °C の 30 歳の患者
- B20 分前から、胸の圧迫感、発汗、悪心がある 60 歳の患者
- C手首を捻挫し、バイタルサインが正常な 25 歳の患者
- D処方の再発行を求めている 45 歳の患者
解答
- 1. D · Five
- 2. C · 緊急性なし(非緊急)
- 3. A · Less restrictive measures, such as more frequent checks or a bed alarm
- 4. B · Keep everyone safe and tell the team, as the risk of harm is high
- 5. C · 声がしだいにかすれ、新たにぜいぜいした呼吸がある
- 6. A · “Stop and call me at once if she feels dizzy or short of breath.”
- 7. B · Neurogenic shock
- 8. B · 20 分前から、胸の圧迫感、発汗、悪心がある 60 歳の患者
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