解答つき優先順位の決定と委任ワークシート

救急の緊急度分類 ESI（Emergency Severity Index）で、レベル 1 は何を意味しますか？

1. A2 つ以上の資源が必要
2. B直ちに救命のための介入が必要
3. C最も緊急度が低い患者
4. Dファストトラックのエリアで診られるほど安定している

What is the normal range for arterial bicarbonate (HCO₃⁻)?

1. A3.5–5.0 mEq/L
2. B35–45 mEq/L
3. C22–26 mEq/L
4. D80–100 mEq/L

Which medication is the first-line treatment for anaphylaxis?

1. AAn oral antihistamine
2. BAn inhaled corticosteroid
3. CIntramuscular epinephrine
4. DOral paracetamol (acetaminophen)

A parent of a child with influenza talks with the nurse. Which statement shows a need for further teaching?

1. A“I will keep my child home from school and away from others while unwell.”
2. B“I will call if my child has trouble breathing.”
3. C“I will give my child aspirin to bring the fever down.”
4. D“I will give my child plenty of fluids.”

Which finding is an early sign of compartment syndrome in a patient with a lower leg fracture?

1. APain out of proportion to the injury that worsens when the toes are stretched
2. BA strong pedal pulse with warm, pink toes and pain that settles with analgesia
3. CItching under the cast during the first week after it was applied
4. DMild bruising around the fracture site on the second day

A patient uses patient-controlled analgesia (PCA) after surgery. Which statement by a family member shows a need for further teaching?

1. A“I will press the button for her while she is asleep so she stays comfortable.”
2. B“Only she should press the button when she needs pain relief.”
3. C“The pump has limits set by the nurse so she cannot get too much at once.”
4. D“I will tell the nurse if she becomes very sleepy or hard to wake.”

Four stable patients need routine morning care. To reduce the spread of infection, which patient should the nurse visit first?

1. AA patient with influenza on droplet precautions
2. BA patient with C. difficile diarrhea
3. CA patient with an MRSA wound infection
4. DA patient with neutropenia after chemotherapy

After surgery, a patient who has taken long-term steroids becomes hypotensive and weak, and the blood pressure does not rise with IV fluids. Which problem should the nurse suspect?

1. AFluid overload from too much IV fluid
2. BNormal tiredness after anesthesia
3. CAn allergic reaction to the anesthetic
4. DAdrenal crisis from steroid withdrawal