1.やさしい
Which resting heart rate is normal for a newborn?
- A210/min
- B140/min
- C80/min
- D60/min
2.やさしい
Which patient usually fits ESI level 5?
- AAn adult in cardiac arrest
- BAn adult with chest pain suggesting a heart attack
- CA stable adult who needs blood tests and an X-ray of the chest
- DA stable adult who only needs a repeat prescription
3.やさしい
看護師が最初に対応すべき成人の所見はどれですか?
- A血圧 138/88 mmHg で意識清明
- B体温 37.8 °C(100 °F)
- C呼吸数 8 回/分で傾眠
- D心拍数 98 回/分
4.ふつう
A patient’s urinary catheter has drained no urine for two hours, and the lower abdomen is swollen. What should the nurse do first?
- AGive a prescribed diuretic straight away
- BEncourage the patient to drink more water
- CRemove the catheter and wait for the patient to void
- DCheck the tubing for kinks or obstruction
5.ふつう
Which patient is most suitable for the nurse to assign to a nurse who has just finished orientation?
- AA patient with stable cellulitis on scheduled IV antibiotics
- BA patient with sepsis whose blood pressure is falling
- CA patient on a continuous heparin infusion with rising aPTT values
- DA patient with a new tracheostomy who needs frequent suctioning
6.ふつう
Which medication order should the nurse question?
- APotassium chloride by IV push
- BPotassium chloride diluted in an IV bag via a pump
- COral potassium chloride with food
- DPotassium chloride oral solution diluted in juice
7.むずかしい
A patient takes lithium. Which statement shows a need for further teaching?
- A“I will go for my blood tests as planned.”
- B“I will keep my daily salt intake about the same as usual.”
- C“I will take ibuprofen every day for my headaches.”
- D“I will drink enough fluid every day.”
8.むずかしい
A nursing assistant has twice not reported abnormal vital signs to the RN. What is the RN’s best action?
- ATalk to the assistant privately, restate what must be reported and follow up closely
- BSay nothing to the assistant and quietly recheck all of the assistant’s vital signs in secret
- CComplain about the assistant to the patients during care
- DStop delegating any tasks to the assistant for the rest of the year
解答
- 1. B · 140/min
- 2. D · A stable adult who only needs a repeat prescription
- 3. C · 呼吸数 8 回/分で傾眠
- 4. D · Check the tubing for kinks or obstruction
- 5. A · A patient with stable cellulitis on scheduled IV antibiotics
- 6. A · Potassium chloride by IV push
- 7. C · “I will take ibuprofen every day for my headaches.”
- 8. A · Talk to the assistant privately, restate what must be reported and follow up closely
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