An older adult with type 2 diabetes is confused and very dehydrated. The glucose is 900 mg/dL (50 mmol/L), and blood and urine show no significant ketones. What is the most likely problem?
AStress-induced mild hyperglycemia
BHypoglycemia with rebound
CHyperosmolar hyperglycemic state
DDiabetic ketoacidosis
7.การพยาบาลทางคลินิกปานกลาง
Why is an urgent brain scan needed before thrombolysis for a suspected stroke?
Why is simvastatin traditionally taken in the evening?
AIt is short-acting, and cholesterol synthesis peaks at night
BIt is inactivated by sunlight during the day
CIt must be taken with the largest meal of the day
DIt causes too much drowsiness to be taken in the morning
12.เภสัชวิทยายาก
A patient taking a GLP-1 receptor agonist such as semaglutide has severe, constant upper abdominal pain spreading to the back, with vomiting. What should the nurse suspect?
AHypoglycaemia; the patient should eat sweets and continue as usual
BExpected nausea; the patient should take the next dose with food
CAcute pancreatitis; the drug is stopped and urgent assessment arranged
Which finding in a term newborn's first hours is normal?
AA respiratory rate of 80 at rest with retractions
BCentral cyanosis of the lips and tongue
CPauses in breathing of 30 seconds with bradycardia
DShort breathing pauses with no colour change
20.การพยาบาลมารดาและสูติศาสตร์ยาก
A woman at 20 weeks presents with painless cervical dilation and bulging membranes, without contractions. She lost a previous pregnancy in the same way. What is the likely diagnosis?
APlacental abruption
BPlacenta praevia
CPreterm labour caused by infection
DCervical insufficiency
21.การพยาบาลเด็กปานกลาง
Which factor can make a pulse oximeter reading inaccurate in a child?
ACold hands, movement or a poorly fitting probe
BLying on the back instead of sitting up
CHolding a parent's hand during the reading
DHaving eaten a meal in the last hour
22.การพยาบาลเด็กยาก
The nurse has taught the parents of a child with sickle cell disease. Which statement shows a need for further teaching?
A"We'll dress her warmly before she goes out in cold weather."
B"In summer she can drink less so she doesn't need the toilet at school."
C"We'll learn how to feel her tummy for an enlarged spleen."
D"We'll call the hospital straight away if she has a fever."
คำตอบ: B · Gentle cleansing after each episode and a barrier product
เหตุผลที่เป็นคำตอบนี้
Moisture and urine break down the skin barrier. Prompt, gentle cleansing with a pH-balanced cleanser and a barrier cream or film protects against incontinence-associated dermatitis.
คำตอบ
B · Gentle cleansing after each episode and a barrier product
2.พื้นฐานการพยาบาล
คำตอบ: D · Explain that losing appetite is a natural part of dying
เหตุผลที่เป็นคำตอบนี้
As death approaches, the need for food and fluid falls. Forcing food causes distress and aspiration. Mouth care and small amounts on request keep the patient comfortable.
คำตอบ
D · Explain that losing appetite is a natural part of dying
3.การควบคุมการติดเชื้อและความปลอดภัยของผู้ป่วย
คำตอบ: A · A large toy with no small parts that can come off
เหตุผลที่เป็นคำตอบนี้
Small parts, marbles, magnets and uninflated or broken balloons are choking hazards for young children. Toys should be large, sturdy and suited to the child’s age.
คำตอบ
A · A large toy with no small parts that can come off
4.การควบคุมการติดเชื้อและความปลอดภัยของผู้ป่วย
คำตอบ: D · ไม่ผูกยึดเพื่อความสะดวกของบุคลากร ควรใช้การเดินตรวจเป็นรอบหรือผู้เฝ้า (sitter)
Hyperosmolar hyperglycemic state occurs mainly in type 2 diabetes, with extreme glucose, severe dehydration and little or no ketosis. Treatment starts with IV fluids, as in DKA.
คำตอบ
C · Hyperosmolar hyperglycemic state
7.การพยาบาลทางคลินิก
คำตอบ: C · To rule out bleeding in the brain
เหตุผลที่เป็นคำตอบนี้
A CT scan distinguishes haemorrhagic from ischaemic stroke. Clot-busting drugs are only given when bleeding has been excluded and other criteria are met.
D · ภาวะแข็งตัวของเลือดในหลอดเลือดกระจายทั่วร่างกาย (DIC)
11.เภสัชวิทยา
คำตอบ: A · It is short-acting, and cholesterol synthesis peaks at night
เหตุผลที่เป็นคำตอบนี้
The liver makes most cholesterol overnight, and short-acting statins such as simvastatin work best when taken in the evening. Atorvastatin and rosuvastatin can be taken at any time of day.
คำตอบ
A · It is short-acting, and cholesterol synthesis peaks at night
12.เภสัชวิทยา
คำตอบ: C · Acute pancreatitis; the drug is stopped and urgent assessment arranged
เหตุผลที่เป็นคำตอบนี้
Mild nausea is common with GLP-1 agonists, but severe persistent abdominal pain radiating to the back suggests pancreatitis. The drug is stopped and the patient needs urgent assessment, including serum lipase or amylase.
คำตอบ
C · Acute pancreatitis; the drug is stopped and urgent assessment arranged
อาการท้องเสียที่ไม่ทราบสาเหตุในผู้ป่วยที่ได้รับยาปฏิชีวนะต้องถือว่าอาจเป็น C. difficile ผู้ป่วยถูกแยกทันที ส่งตัวอย่างอุจจาระ และทบทวนยาปฏิชีวนะร่วมกับทีมแพทย์
คำตอบ
C · แยกผู้ป่วยและส่งตัวอย่างอุจจาระตรวจ
19.การพยาบาลมารดาและสูติศาสตร์
คำตอบ: D · Short breathing pauses with no colour change
เหตุผลที่เป็นคำตอบนี้
Newborns breathe irregularly, with short pauses of a few seconds and no change in colour or heart rate. Apnoea of 20 seconds or more, or any pause with cyanosis or bradycardia, is abnormal.
คำตอบ
D · Short breathing pauses with no colour change
20.การพยาบาลมารดาและสูติศาสตร์
คำตอบ: D · Cervical insufficiency
เหตุผลที่เป็นคำตอบนี้
Painless second-trimester cervical dilation without contractions suggests cervical insufficiency. A cervical cerclage may be offered in a later pregnancy.
คำตอบ
D · Cervical insufficiency
21.การพยาบาลเด็ก
คำตอบ: A · Cold hands, movement or a poorly fitting probe
เหตุผลที่เป็นคำตอบนี้
Pulse oximetry depends on a good pulsatile signal. Poor perfusion, cold extremities, movement, bright light and a wrong-sized probe can give false readings, so the reading is checked against the child's appearance and pulse.
คำตอบ
A · Cold hands, movement or a poorly fitting probe
22.การพยาบาลเด็ก
คำตอบ: B · "In summer she can drink less so she doesn't need the toilet at school."
เหตุผลที่เป็นคำตอบนี้
Dehydration promotes sickling, so children with sickle cell disease need plenty of fluids, especially in hot weather and during exercise. Seeking help for fever, avoiding cold and checking the spleen are correct.
คำตอบ
B · "In summer she can drink less so she doesn't need the toilet at school."
23.การพยาบาลสุขภาพจิต
คำตอบ: A · โรคเครียดเฉียบพลัน (acute stress disorder)