NCLEX-PN 风格练习题（LPN/LVN）：速成包

公式表、每个专题的关键方法步骤和 34 道练习题，完整解答附在最后。

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1公式与方法

感染控制与患者安全

方法

  1. 对每位患者都从标准预防开始：手卫生、针对预期暴露的个人防护装备、安全使用锐器。
  2. 按传播途径追加预防措施：接触传播（隔离衣、手套）、飞沫传播（外科口罩）、空气传播（N95、负压病房）。
  3. 保持无菌物品的无菌状态：如有疑问就视为不无菌；更换，绝不擦拭。
  4. 预防环境中的伤害：防跌倒措施，约束仅作为最后手段，火灾时用 RACE 和 PASS。
  5. 核对给药的正确原则、两个身份识别信息，以及对高警示药物的额外保障；报告差错和险兆事件。

优先排序与委派

方法

  1. 问自己：如果什么都不做，什么会最快伤害患者。
  2. 应用 ABC（心脏骤停时为 C-A-B），然后是 Maslow 需求层次：生理需要先于安全，安全先于心理需要。
  3. 比较各选项：急性先于慢性，不稳定先于稳定，意外先于预期，全身性先于局部，并将每项发现与患者的基线对照。
  4. 除非是紧急情况，否则先评估再行动；然后选择其他步骤所依赖的那一步。
  5. 委派时核对五项正确：任务、情境、人员、指示和监督。评估、宣教和评价仍由注册护士负责。

实验室检查值与电解质

方法

  1. 把数值与本实验室自己的参考范围比较，再与患者的基线和趋势比较。
  2. 检查标本：溶血、延迟，或在静脉输液附近采血都可能得出错误结果。
  3. 把数值与其典型体征以及引起它的药物和疾病联系起来。
  4. 注意相互作用：低钾或低镁会增加地高辛中毒的风险；脱水会使锂浓度升高。
  5. 对患者采取行动：评估，血药浓度不安全时暂停用药，复述危急值并通知开医嘱的医生。

内外科护理：心血管与呼吸

方法

  1. 说出问题所在：泵衰竭、动脉阻塞、节律、血栓、气道狭窄、感染或设备问题。
  2. 先检查危险征象：低氧、低血压、胸痛、新出现的意识模糊、冰冷无脉搏的肢体。
  3. 让氧疗与患者相匹配：大多数人为 94–98%，有 CO₂ 潴留风险者为 88–92%。
  4. 把每种药物与其检测和风险联系起来：华法林与 INR，肝素与 aPTT 和血小板，利尿剂与血钾。
  5. 选择安全的第一步措施，然后升级处理并重新评估。

内外科护理：神经、内分泌与肾脏

方法

  1. 对每位新出现意识模糊、乏力或癫痫发作的患者都检查血糖。
  2. 把意识水平作为脑部问题最早的警示；瞳孔变化和库欣三联征出现得较晚。
  3. 对于糖尿病急症，要区分 DKA（酮体、酸中毒）和 HHS（渗透压很高、脱水）；先补液。
  4. 对于钠和水，要判断是 ADH 过多（SIADH）还是缺乏（尿崩症），并缓慢纠正慢性变化。
  5. 对于肾脏问题，把原因分为肾前性、肾性或肾后性，并监测血钾和液体。

内外科护理：消化、围手术期与肿瘤

方法

  1. 想一想可能隐藏着什么：内出血、无发热的感染、SpO₂ 正常背后的通气不足。
  2. 利用术后的时间来缩小并发症的范围：出血在数小时内，胸部问题在数天内，伤口和吻合口漏出现得更晚。
  3. 对于疼痛，要评估、用多模式镇痛治疗、重新评估，并且在每次使用阿片类药物时监测镇静程度。
  4. 对于癌症患者，把低谷期的任何疾病都当作中性粒细胞减少性脓毒症处理，并了解肿瘤急症。
  5. 对于烧伤，只计算浅二度/深二度和三度的面积，从烧伤的时刻开始计算 Parkland 时间，并根据尿量调整。

产科护理

方法

  1. 把产妇放在时间轴上定位：孕周、产程阶段或产后第几天，再判断此时什么是正常的。
  2. 找出处于危险中的对象：母亲、胎儿或新生儿，或者其中不止一个。
  3. 把发现与其原因联系起来：减速用 VEAL CHOP，出血用四个 T，产后用 BUBBLE-HE。
  4. 优先选择改善血流和氧合的措施（侧卧、停用缩宫素、宫底按摩），然后再升级处理。

儿科护理

方法

  1. 先记下患儿的年龄：它决定正常生命体征、发育里程碑和合适的疼痛量表。
  2. 评估气道、呼吸和循环，记住儿童代偿很久之后会迅速恶化。
  3. 让措施与发育阶段相匹配，并让家属参与。
  4. 检查答案对儿童是否安全：按体重计算，病毒感染不用阿司匹林，12 岁以下不用可待因。

精神科护理

方法

  1. 判断是否存在即时风险：自杀、暴力、药物急症或躯体疾病。
  2. 先保障安全：观察、移除危险物品、缓和局面、停用有害药物、寻求帮助。
  3. 选择治疗性回应：承认感受、陈述现实，避免虚假的安慰和“为什么”式提问。
  4. 尊重权利：采用限制最少的方案，知情同意，以及保密及其限度。

护理数学与单位换算

公制进位
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
体重和长度
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
家用计量
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
温度
°C = (°F − 32)·5/9, °F = °C·9/5 + 32
24 小时制
PM 1–11 点：加 12； 12 AM = 00:xx； 12 PM = 12:xx
给药速率
mcg/min × 60/1000 = mg/h
实验室换算系数
葡萄糖 1 mmol/L = 18 mg/dL； 肌酐 1 mg/dL = 88.4 µmol/L； Hb 1 g/dL = 10 g/L

方法

  1. 写出已知量及其单位，以及你想要的单位。
  2. 选定等量关系：kg、g、mg 和 mcg 之间，或 L 和 mL 之间为 1000；1 kg = 2.2 lb；1 tsp = 5 mL，1 tbsp = 15 mL，1 fl oz = 30 mL，1 cup = 240 mL。
  3. 写成分数，使不需要的单位相互约去；对于速率，每个变化的单位用一个分数。
  4. 检查方向：单位越小，数字越大。
  5. 只对最终答案取整，精度按题目所述。

剂量计算

由浓度计算剂量
体积 = 剂量 / 浓度
按体重给药
剂量 = mg/kg × 体重
片剂
片数 = 剂量 / 每片规格
单位
1 g = 1000 mg, 1 mg = 1000 mcg

方法

  1. 把医嘱剂量和药品规格换算为同一单位。
  2. 用“需要量除以现有量再乘以数量”：(D/H) × Q。
  3. 按体重给药时，先乘以以 kg 计的体重，再用日剂量除以给药次数。
  4. 先估算，再检查答案是否合理。

静脉输液速度

泵速
mL/h = volume (mL)/time (h)
滴速
drops/min = volume (mL) × drop factor / time (min)
输注时间
time (h) = volume (mL)/rate (mL/h)

方法

  1. 泵速 mL/h：体积除以以小时计的时间。
  2. 滴速 drops/min：体积 × 滴系数，再除以以分钟计的时间。
  3. 剩余时间：剩余体积除以速率。
  4. 按题目或设备的要求取整。

静脉输液与液体平衡

Holliday–Segar 每小时量
4 mL/kg（前 10 kg）+ 2 mL/kg（次 10 kg）+ 1 mL/kg（20 kg 以上每 kg）
Holliday–Segar 每日量
相同分段分别为 100 / 50 / 20 mL/kg
液体平衡
入量 − 出量
冰屑
按其体积的一半计算
尿量
mL/kg/h = mL / (kg × h)
输注时间
时间 (h) = 剩余体积 (mL) / 速率 (mL/h)
已输入体积
mL = 速率 × 时间

临床评估评分

格拉斯哥昏迷量表
GCS = E (1–4) + V (1–5) + M (1–6) = 3–15
Apgar
5 项体征 × 0–2 = 0–10； 7–10 令人放心， 4–6 中度异常， 0–3 低
Braden 量表
5 × (1–4) + 1 × (1–3) = 6–23； ≤ 18 有风险
Morse 跌倒评分
跌倒 25， 诊断 15， 辅助 15/30， 静脉输液 20， 步态 10/20， 精神状态 15
NEWS2 风险
0–4 低； 单项 3 分为中低； 5–6 中； ≥ 7 高
平均动脉压
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
脉压和休克指数
PP = SBP − DBP, SI = HR/SBP
体质指数
BMI = kg/m² = 703·lb/in²

方法

  1. 找出题目使用的评分表及其范围（GCS 3–15，Apgar 0–10，Braden 6–23，Morse 0–125）。
  2. 分别为每个条目评分，将描述与其对应的等级匹配。
  3. 把各条目得分相加，并检查总分是否在范围内。
  4. 应用分界值：对于 NEWS2，还要查看是否有单项参数得 3 分。
  5. 对于导出的数值，使用 MAP = (SBP + 2·DBP)/3，PP = SBP − DBP，SI = HR/SBP，BMI = kg/m²。

2练习题

1.护理学基础中等

What makes "Risk for falls" a risk nursing diagnosis rather than an actual one?

  1. AThe problem can never be prevented
  2. BThe doctor has confirmed the diagnosis with tests and a scan
  3. CThe fall has not happened yet, but risk factors are present
  4. DThe patient has already fallen several times
2.护理学基础困难

Which statement about the use of physical restraint is correct?

  1. AIt can be used whenever a patient is confused, without further assessment
  2. BIt is a last resort, uses the least restrictive option and needs regular checks
  3. CIt never needs to be documented if it is used only overnight
  4. DIt is the best way to stop older patients from falling
3.感染控制与患者安全中等

Which practice makes shift handoff safer?

  1. AGiving handoff from memory without any structure
  2. BUsing a standard format such as SBAR or I-PASS, with time for questions
  3. CGiving handoff in a busy corridor so that the outgoing nurse can leave on time
  4. DLeaving written notes only, without a chance for questions
4.感染控制与患者安全困难

A patient punches a nurse during care. The nurse is not seriously hurt. What should the nurse do?

  1. AGet medical assessment and report the assault according to policy
  2. BRefuse to care for any patient for the rest of the week until the patient is moved
  3. CSay nothing, because violence is part of the job
  4. DPunch the patient back in self-defense
5.优先排序与委派中等

值班护士长需要腾出一张床位。哪位患者最适合出院或转到较低级别的护理？

  1. A肺炎，氧需求在一夜之间从 2 L/min 升至 4 L/min
  2. B无并发症阑尾切除术后第 3 天，能进食，使用口服镇痛药
  3. C两小时前因胸痛入院；肌钙蛋白结果尚未回报
  4. D肠道手术后第 1 天，新出现体温 38.5 °C
6.优先排序与委派困难

An RN has five patients and a nursing assistant. One patient has just become short of breath. Which task should the RN delegate so that the RN can go to that patient?

  1. AAssessing the breathless patient’s lung sounds
  2. BExplaining the new diagnosis to the breathless patient’s family
  3. CGiving the breathless patient’s IV furosemide
  4. DMorning vital signs on the four stable patients
7.临床护理中等

一名意识不清的糖尿病患者血糖为 2.1 mmol/L，且没有静脉通路。可以给予什么？

  1. A口服果汁
  2. B肌内注射胰高血糖素
  3. C口服葡萄糖片
  4. D皮下注射胰岛素
8.临床护理困难

A patient with known cirrhosis suddenly vomits large amounts of bright red blood and becomes tachycardic. What is the most likely cause?

  1. AA Mallory-Weiss tear from a small amount of vomiting
  2. BSwallowed blood from a nosebleed
  3. CBleeding from ruptured oesophageal varices
  4. DA lower GI bleed from diverticular disease
9.实验室检查值与电解质中等

A patient scheduled for surgery this morning has a potassium of 3.0 mEq/L on pre-operative tests. What should the nurse do?

  1. AGive an oral potassium dose without a prescription
  2. BReport it to the surgical team before surgery
  3. CRepeat the test after the surgery is finished
  4. DSend the patient to surgery without comment
10.实验室检查值与电解质困难

Three days after starting haloperidol, a patient has a temperature of 40 °C, severe muscle rigidity and confusion. Which laboratory result would the nurse expect?

  1. AA very low white cell count
  2. BA very low serum sodium
  3. CA very high creatine kinase (CK)
  4. DA very high serum lithium
11.药理学中等

A patient takes cholestyramine. How should other oral medicines be timed?

  1. ATake them 1 hour before or several hours after cholestyramine
  2. BTake them all at the same time as cholestyramine
  3. CTiming does not matter, as cholestyramine is not absorbed
  4. DMix them into the cholestyramine drink so they are taken together
12.药理学困难

A pregnant woman develops a deep vein thrombosis. Which anticoagulant is usually preferred?

  1. AWarfarin
  2. BLow-molecular-weight heparin, such as enoxaparin
  3. CAspirin alone
  4. DRivaroxaban, a direct oral factor Xa inhibitor
13.内外科护理：心血管与呼吸中等

A patient's capillary refill time at the fingertip is 4 seconds. What does this suggest?

  1. AA high haemoglobin level
  2. BReduced peripheral perfusion
  3. CAn unusually strong cardiac output
  4. DNormal peripheral perfusion
14.内外科护理：心血管与呼吸困难

After a fall onto the chest, part of a patient's chest wall moves inward when they breathe in and outward when they breathe out. What does this indicate?

  1. AA large pleural effusion pressing on the chest wall
  2. BA single simple rib fracture with no lung injury
  3. CNormal chest movement caused by pain on breathing
  4. DA flail chest from ribs broken in more than one place
15.内外科护理：神经、内分泌与肾脏中等

一名 AKI 患者的导尿管没有任何尿液引出。哪项快速床旁检查有助于排除肾后性原因？

  1. A送尿样培养并等待实验室结果
  2. B检查导尿管有无扭曲或堵塞，并做膀胱扫描
  3. C立即大量静脉推注液体
  4. D鼓励患者喝两升水
16.内外科护理：神经、内分泌与肾脏困难

A nurse teaches a patient about peritoneal dialysis. Which statement shows a need for further teaching?

  1. A"If the fluid is cloudy, I'll see if it clears next time."
  2. B"I will weigh myself daily and record my fluid balance."
  3. C"I will wash my hands carefully before each exchange."
  4. D"I will check my exit site every day."
17.内外科护理：消化、围手术期与肿瘤中等

Which advice helps prevent dumping syndrome after gastrectomy?

  1. AThree large meals a day with plenty of sweet drinks with each meal
  2. BSit upright and walk briskly straight after every meal
  3. CA high-sugar diet with fruit juice to keep energy levels up
  4. DSmall, frequent meals low in simple sugars, with fluids between meals
18.内外科护理：消化、围手术期与肿瘤困难

A patient finds daily wound dressing changes very painful. What is the most effective nursing approach?

  1. AChange the dressing less often than the plan says
  2. BDo the dressing quickly and give analgesia afterwards
  3. CAvoid analgesia so the patient can report any problems during the change
  4. DGive analgesia timed so it works during the dressing change
19.产科护理中等

A woman with epilepsy is planning a pregnancy. Which advice is most appropriate?

  1. ABreastfeeding will never be possible
  2. BReview her medicines with her doctor before conception
  3. CAvoid folic acid because it lowers drug levels
  4. DStop all antiepileptic drugs before trying to conceive
20.产科护理困难

胎膜破裂后，护士看到脐带从阴道脱出。首先应采取什么措施？

  1. A让产妇在下一次宫缩时用力
  2. B用干毛巾盖住脐带，让她平躺等待医生
  3. C呼救，并用戴手套的手将先露部托离脐带
  4. D轻轻把脐带推回阴道
21.儿科护理中等

一名儿童在咽痛两周后出现可乐色尿、眼睑浮肿和高血压。可能的诊断是什么？

  1. A肾病综合征
  2. BWilms 瘤
  3. C尿路感染
  4. D急性链球菌感染后肾小球肾炎
22.儿科护理困难

A sexually active 17-year-old has no symptoms and asks why chlamydia testing is offered. What is the best answer?

  1. AChlamydia can only be caught from shared towels and toilet seats
  2. BTesting is required by law before any young person can see a nurse or doctor for any reason
  3. CChlamydia always causes severe pain, so testing is only a formality
  4. DChlamydia often causes no symptoms but can lead to pelvic inflammatory disease and infertility
23.精神科护理中等

Which group of signs suggests drug-induced pseudoparkinsonism in a patient taking haloperidol?

  1. AShuffling gait, mask-like face, rigidity and a resting tremor
  2. BRestless pacing and an inability to sit still
  3. CLip smacking, tongue thrusting and grimacing after years of treatment
  4. DSudden muscle spasm of the neck with the eyes rolled upwards
24.精神科护理困难

一名神经性贪食患者的血清钾为 2.8 mmol/L。主要担忧是什么？

  1. A有发生危及生命的心律失常的风险
  2. B有体重增加的风险
  3. C食欲增加
  4. D肌力改善
25.护理数学与单位换算中等
12345678910111210:10 AM?22:1010:1011:1009:10

练习题（虚构数值，不作为临床指导）。 一个剂量记录在 10:10 AM。哪个条目是 24 小时制中的同一时间？点击它。

10:10 AM
  1. 122:10
  2. 210:10
  3. 311:10
  4. 409:10
26.护理数学与单位换算困难
00:0020:3501:10t = ?

练习题（虚构数值，不作为临床指导）。 一次输注从 20:35 开始，到次日早晨 01:10 结束（24 小时制）。它运行了多少分钟t？

20:3501:10
t = min
27.剂量计算中等
15 kg2 mg/kgD = ? mg

某患者体重 15 kg，医嘱为单次给药 2 mg/kg。求剂量 D（mg）。

15 kg2 mg/kg
D = mg
28.剂量计算困难
100 mg/1 mLV = ? mL

一名患者体重 187 lb。医嘱为单次剂量 15 mg/kg，储备液为 1 mL 中含 100 mg。按 1 kg = 2.2 lb 计算，你应给予多少容量 V？ 保留一位小数。

187 lb15 mg/kg100 mg/1 mL1 kg = 2.2 lb
V = mL
29.静脉输液速度中等
V = ?60 gtt/mL100 gtt/min12 h

滴注以 100 gtt/min 的速度通过滴系数为 60 gtt/mL 的输液器。患者在 12 小时内接受多少毫升 V？

100 gtt/min60 gtt/mL12 h
V = mL
30.静脉输液速度困难
4 g1000 mL? mL/h1.5 mg/min

一袋中含有 4 g 药物，溶于 1000 mL。医嘱为每分钟 1.5 mg。泵速 R 应设为多少 mL/h？

4 g/1000 mL1.5 mg/min
R = mL/h
31.静脉输液与液体平衡中等
入量出量12 小时班次果冻120 mL茶150 mL牛奶240 mL冰屑200 mL静脉输液75 mL/h × 12 h静脉抗生素2 × 50 mL尿液400 mL尿液375 mL尿液225 mL尿液225 mL伤口引流120 mL

练习题（虚构数值，不作为临床指导）。 记录显示了一名患者在一个 12 小时班次中的出入量。静脉输液在整个班次中按所示速率输注。求液体平衡 B = 入量 − 出量，以 mL 计（答案为负表示净丢失）。 冰屑按其体积的一半计。

果冻: 120 mL茶: 150 mL牛奶: 240 mL冰屑: 200 mL静脉输液: 75 mL/h × 12 h静脉抗生素: 2 × 50 mL尿液: 400 mL尿液: 375 mL尿液: 225 mL尿液: 225 mL伤口引流: 120 mL
B = mL
32.静脉输液与液体平衡困难
500 mL150 mL 已输入150 mL/h16:00t = ? h

练习题（虚构数值，不作为临床指导）。 一袋 500 mL 的液体用输液泵以 150 mL/h 输注。到 16:00 时已输入 150 mL。还要多少小时 t 袋子才会输完？ 保留一位小数。

500 mL150 mL 已输入150 mL/h
t = h
33.临床评估评分中等
3210123RR≤89–1112–2021–24≥25SpO₂≤9192–9394–95≥96空气 / O₂O₂空气SBP≤9091–100101–110111–219≥220HR≤4041–5051–9091–110111–130≥131ACVPUAC, V, P, UT °C≤35.035.1–36.036.1–38.038.1–39.0≥39.1

练习题（虚构数值，不作为临床指导）。 对这些观察结果使用 NEWS2 图表（SpO₂ 量表 1）：呼吸频率 16 次/分，SpO₂ 93%正在补充吸氧，血压 106/64 mmHg，脉搏 140 次/分，清醒，体温 36.5 °C。NEWS2 总分是多少？

RR 16SpO₂ 93%O₂SBP 106HR 140AT 36.5 °C
NEWS2 =
34.临床评估评分困难
体重过轻健康体重超重肥胖 I 级肥胖 II 级肥胖 III 级

练习题（虚构数值，不作为临床指导）。 一名成人体重 93 kg，身高 195 cm。计算 BMI 并点击 WHO 体重分类。

93 kg195 cm
  1. 1体重过轻
  2. 2健康体重
  3. 3超重
  4. 4肥胖 I 级
  5. 5肥胖 II 级
  6. 6肥胖 III 级

3溶液

1.护理学基础

答案: C · The fall has not happened yet, but risk factors are present

为什么是这个答案

A risk diagnosis describes a problem the patient is vulnerable to, based on risk factors, with no signs yet. Care aims to prevent the problem from occurring.

答案

C · The fall has not happened yet, but risk factors are present
2.护理学基础

答案: B · It is a last resort, uses the least restrictive option and needs regular checks

为什么是这个答案

Restraint carries risks such as injury, distress and pressure damage. It is used only when alternatives have failed, in the least restrictive form, for the shortest time, with monitoring and documentation.

答案

B · It is a last resort, uses the least restrictive option and needs regular checks
3.感染控制与患者安全

答案: B · Using a standard format such as SBAR or I-PASS, with time for questions

为什么是这个答案

Many errors happen at transitions of care. A structured handoff with an opportunity to ask questions, ideally at the bedside, reduces missed information.

答案

B · Using a standard format such as SBAR or I-PASS, with time for questions
4.感染控制与患者安全

答案: A · Get medical assessment and report the assault according to policy

为什么是这个答案

Workplace violence should always be reported. Reporting allows care for the injured staff member, review of risks and changes to the patient’s care plan to protect staff and other patients.

答案

A · Get medical assessment and report the assault according to policy
5.优先排序与委派

答案: B · 无并发症阑尾切除术后第 3 天，能进食，使用口服镇痛药

为什么是这个答案

阑尾切除术后的患者病情稳定，能进食，口服镇痛即可控制。肌钙蛋白结果未出、氧需求上升和新发热，都意味着患者的病程尚不明朗。

答案

B · 无并发症阑尾切除术后第 3 天，能进食，使用口服镇痛药
6.优先排序与委派

答案: D · Morning vital signs on the four stable patients

为什么是这个答案

Routine vital signs on stable patients can be delegated, freeing the RN to assess and treat the unstable patient. Assessment, IV medication and explaining a new diagnosis stay with the RN.

答案

D · Morning vital signs on the four stable patients
7.临床护理

答案: B · 肌内注射胰高血糖素

为什么是这个答案

对意识不清的低血糖患者，口服治疗有误吸风险。肌注胰高血糖素可释放肝糖原；如有静脉通路则静脉给予葡萄糖。

答案

B · 肌内注射胰高血糖素
8.临床护理

答案: C · Bleeding from ruptured oesophageal varices

为什么是这个答案

Portal hypertension in cirrhosis causes oesophageal varices, which can bleed massively. This needs resuscitation, urgent endoscopy and specific drug treatment.

答案

C · Bleeding from ruptured oesophageal varices
9.实验室检查值与电解质

答案: B · Report it to the surgical team before surgery

为什么是这个答案

Hypokalemia increases the risk of arrhythmias during anesthesia and can prolong muscle weakness. Abnormal pre-operative results are reported to the surgeon and anesthetist, who decide whether to correct it or delay surgery.核对依据: Hypokalemia · StatPearls (NCBI Bookshelf) (2025)

答案

B · Report it to the surgical team before surgery
10.实验室检查值与电解质

答案: C · A very high creatine kinase (CK)

为什么是这个答案

These signs suggest neuroleptic malignant syndrome, a medical emergency. Muscle rigidity releases CK, often to very high levels, and the white count is often raised. Myoglobin can damage the kidneys. The antipsychotic is stopped and supportive care is started.

答案

C · A very high creatine kinase (CK)
11.药理学

答案: A · Take them 1 hour before or several hours after cholestyramine

为什么是这个答案

Bile acid sequestrants bind many drugs, such as warfarin, digoxin and levothyroxine, as well as fat-soluble vitamins. Other drugs are taken about 1 hour before or 4–6 hours after it.

答案

A · Take them 1 hour before or several hours after cholestyramine
12.药理学

答案: B · Low-molecular-weight heparin, such as enoxaparin

为什么是这个答案

Heparins are large molecules that do not cross the placenta. Warfarin is teratogenic, and direct oral anticoagulants are not recommended in pregnancy.

答案

B · Low-molecular-weight heparin, such as enoxaparin
13.内外科护理：心血管与呼吸

答案: B · Reduced peripheral perfusion

为什么是这个答案

Capillary refill time above about 2 seconds suggests poor peripheral perfusion, for example from dehydration, shock or cold. It should be interpreted with other signs such as heart rate, blood pressure, skin temperature and urine output.

答案

B · Reduced peripheral perfusion
14.内外科护理：心血管与呼吸

答案: D · A flail chest from ribs broken in more than one place

为什么是这个答案

A flail segment occurs when adjacent ribs are fractured in two or more places, so the segment moves paradoxically. It is often associated with lung contusion and respiratory failure. Management includes oxygen, strong analgesia and sometimes ventilation or surgical fixation.

答案

D · A flail chest from ribs broken in more than one place
15.内外科护理：神经、内分泌与肾脏

答案: B · 检查导尿管有无扭曲或堵塞，并做膀胱扫描

为什么是这个答案

导尿管堵塞或扭曲，或膀胱膨胀，可以引起或模拟无尿。检查管路、在允许时冲洗或更换导尿管，以及做膀胱扫描，可迅速发现梗阻。肾脏超声用于寻找肾积水等更上方的梗阻。

答案

B · 检查导尿管有无扭曲或堵塞，并做膀胱扫描
16.内外科护理：神经、内分泌与肾脏

答案: A · "If the fluid is cloudy, I'll see if it clears next time."

为什么是这个答案

Cloudy effluent may be the first sign of peritonitis and must be reported to the PD unit straight away, keeping the bag for testing. Waiting can allow a serious infection to develop.

答案

A · "If the fluid is cloudy, I'll see if it clears next time."
17.内外科护理：消化、围手术期与肿瘤

答案: D · Small, frequent meals low in simple sugars, with fluids between meals

为什么是这个答案

Small meals, fewer simple sugars, more protein and fibre, and taking fluids between rather than with meals slow emptying and reduce fluid shifts. Lying down briefly after meals can also help.

答案

D · Small, frequent meals low in simple sugars, with fluids between meals
18.内外科护理：消化、围手术期与肿瘤

答案: D · Give analgesia timed so it works during the dressing change

为什么是这个答案

Procedural pain is best managed by giving analgesia so its peak effect matches the procedure. Non-adherent dressings, soaking adherent dressings and allowing the patient to call pauses also help.

答案

D · Give analgesia timed so it works during the dressing change
19.产科护理

答案: B · Review her medicines with her doctor before conception

为什么是这个答案

Preconception review allows a switch to the lowest-risk effective drug, often at the lowest effective dose, and higher-dose folic acid. Most women can breastfeed while taking antiepileptics.

答案

B · Review her medicines with her doctor before conception
20.产科护理

答案: C · 呼救，并用戴手套的手将先露部托离脐带

为什么是这个答案

通过将先露部托离脐带来解除脐带所受的压力，紧急呼救，并采用膝胸卧位或头低位。不要试图把脐带送回去；如果脐带在体外，可用温热湿润的生理盐水纱布覆盖。通常需要尽快娩出胎儿。

答案

C · 呼救，并用戴手套的手将先露部托离脐带
21.儿科护理

答案: D · 急性链球菌感染后肾小球肾炎

为什么是这个答案

链球菌感染后肾小球肾炎出现在咽部感染后约 1–3 周（皮肤感染后则更晚），引起血尿、水肿和高血压。需监测血压、液体平衡和体重。

答案

D · 急性链球菌感染后肾小球肾炎
22.儿科护理

答案: D · Chlamydia often causes no symptoms but can lead to pelvic inflammatory disease and infertility

为什么是这个答案

Chlamydia is the most commonly diagnosed bacterial STI in young people and is often asymptomatic. Untreated, it can cause pelvic inflammatory disease, ectopic pregnancy and infertility. Testing is simple and treatment is effective.

答案

D · Chlamydia often causes no symptoms but can lead to pelvic inflammatory disease and infertility
23.精神科护理

答案: A · Shuffling gait, mask-like face, rigidity and a resting tremor

为什么是这个答案

Blocking dopamine in the nigrostriatal pathway can cause parkinsonian signs: bradykinesia, rigidity, tremor and a shuffling gait. The other options describe akathisia, acute dystonia and tardive dyskinesia.

答案

A · Shuffling gait, mask-like face, rigidity and a resting tremor
24.精神科护理

答案: A · 有发生危及生命的心律失常的风险

为什么是这个答案

反复呕吐会导致低钾血症和代谢性碱中毒。钾 2.8 mmol/L 低得危险，可引起心律失常。患者需要心电监护，并按处方补钾。

答案

A · 有发生危及生命的心律失常的风险
25.护理数学与单位换算

答案: 10:10

24 小时制：下午 1 点起，小时数加 12（下午 3:45 = 15:45）。午夜到凌晨 12:59 为 00:00–00:59，中午 12:00–12:59 仍为 12:00–12:59。反过来换算时，13–23 点减 12 并标为下午；00 点变为凌晨 12 点。跨午夜计算时间要分两段：先算到 24:00（00:00），再从 00:00 算起。

换算小时

10 AM → 10

答案

10:10

答案

10:10
26.护理数学与单位换算

答案: t = 275 min

24 小时制：下午 1 点起，小时数加 12（下午 3:45 = 15:45）。午夜到凌晨 12:59 为 00:00–00:59，中午 12:00–12:59 仍为 12:00–12:59。反过来换算时，13–23 点减 12 并标为下午；00 点变为凌晨 12 点。跨午夜计算时间要分两段：先算到 24:00（00:00），再从 00:00 算起。

午夜之前

20:35 → 24:00 = 205 min

午夜之后

00:00 → 01:10 = 70 min

合计

t = 205 + 70 = 275 min

答案

t = 275 min
27.剂量计算

答案: D = 30 mg

剂量计算：给药量等于医嘱剂量除以现有药物的规格，再乘以该规格对应的量：给药量 = (医嘱剂量/储备规格) × 储备体积。始终统一单位（先把 g 换成 mg，mg 换成 mcg），并检查答案是否合理。

剂量

2·15 = 30 mg

答案

D = 30 mg
28.剂量计算

答案: V = 12.8 mL

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

体重 (kg)

187/2.2 = 85 kg

剂量

15·85 = 1275 mg

体积

V = (1275/100)·1 = 12.75 ≈ 12.8 mL

答案

V = 12.8 mL
29.静脉输液速度

答案: V = 1200 mL

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

速度（mL/h）

100·60/60 = 100 mL/h

体积

V = 100·12 = 1200 mL

答案

V = 1200 mL
30.静脉输液速度

答案: R = 22.5 mL/h

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

浓度

4000 mg/1000 mL = 4 mg/mL

每小时剂量

1.5·60 = 90 mg/h

泵速

R = 90/4 = 22.5 mL/h

答案

R = 22.5 mL/h
31.静脉输液与液体平衡

答案: B = 265 mL

出入量：入量计入所有进入体内的液体（口服液体、静脉输液、静脉用药及冲管液、管饲）；冰屑按其体积的一半计。出量计入尿液、引流液、呕吐物和其他丢失。平衡 = 总入量 − 总出量；平衡为负表示净丢失。 这些数字仅供练习；在临床工作中务必遵循当地规程，高危剂量须经双人核对。

总入量

口服: 120 + 150 + 240 = 510 mL
冰屑: 200/2 = 100 mL
静脉输液: 75·12 = 900 mL
静脉抗生素: 2·50 = 100 mL
总入量 = 1610 mL

总出量

400 + 375 + 225 + 225 + 120 = 1345 mL

平衡

B = 1610 − 1345 = 265 mL

答案

B = 265 mL

为正：摄入的液体多于排出的液体。

32.静脉输液与液体平衡

答案: t = 2.3 h

输液时间：时间 (h) = 待输体积 (mL)/速率 (mL/h)；使用袋中剩余的体积，而不是袋的容量。已输入体积 = 速率 × 时间。把小数小时换算为小时和分钟时，用小数部分 × 60（0.5 h = 30 min，而不是 50 min）。 这些数字仅供练习；在临床工作中务必遵循当地规程，高危剂量须经双人核对。

剩余体积

500 − 150 = 350 mL

时间

t = 350/150 = 2.333 ≈ 2.3 h

答案

t = 2.3 h

约为 2 h 20 min，所以袋子大约在 18:20 输完。

33.临床评估评分

答案: NEWS2 = 8

NEWS2（国家早期预警评分 2，英国皇家内科医师学会 2017）：按图表为七个参数分别评分（呼吸频率、量表 1 的 SpO₂、吸空气还是吸氧、收缩压、脉搏、按 ACVPU 量表评定的意识状态和体温），然后把分数相加。临床风险：0–4 为低；任何单项参数得 3 分为中低；5–6 为中；7 或以上为高。总分 5 或以上需要紧急响应。

为每个参数评分

RR 16/min → 0
SpO₂ 93% → 2
吸氧 → 2
SBP 106 mmHg → 1
HR 140/min → 3
清醒 (A) → 0
T 36.5 °C → 0

相加

NEWS2 = 0 + 2 + 2 + 1 + 3 + 0 + 0 = 8

答案

NEWS2 = 8
34.临床评估评分

答案: 健康体重

体质指数：BMI = 体重（kg）/身高（m）²，身高要先换算为米。使用磅和英寸时，BMI = 703 × 体重（lb）/身高（in）²。WHO 成人分类：低于 18.5 为体重过轻，18.5–24.9 为健康体重，25.0–29.9 为超重，30.0–34.9 为肥胖 I 级，35.0–39.9 为肥胖 II 级，40 及以上为肥胖 III 级。

BMI

BMI = 93/1.95² = 24.46

分类

健康体重

答案

健康体重

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