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

How should oxygen cylinders be stored on a ward?

  1. AIn a warm cupboard next to the radiator
  2. BLying loose on the floor under the bed so they cannot fall over
  3. CSecured upright in a holder or trolley, away from heat
  4. DStacked on top of each other in a corridor
2.护理学基础困难

Why should only the patient press the button of a patient-controlled analgesia (PCA) pump?

  1. AVisitors might damage the pump or change its settings if they touch it
  2. BNurses are not allowed to give opioids
  3. CThe pump only works with the patient's fingerprint
  4. DA drowsy patient stops pressing, which helps prevent overdose
3.感染控制与患者安全中等

How should the urethral meatus be cared for in a patient with an indwelling urinary catheter?

  1. AWith daily bladder irrigation using an antibiotic solution through the catheter
  2. BWith routine hygiene, using soap and water during daily washing
  3. CWith antiseptic cream applied to the meatus every shift
  4. DBy sliding the catheter in and out a little to clean it
4.感染控制与患者安全困难

护士的哪项行为表明她遵守了手卫生五个时刻？

  1. A她在接触床栏之后清洁双手
  2. B她只在手看起来脏时才清洁双手
  3. C她只在班次开始和结束时清洁双手
  4. D她在两位患者之间戴着同一副手套
5.优先排序与委派中等

一名护士将测量血糖的任务委派给一名受过培训的助理，却从不询问结果。缺少了委派的哪项正确原则？

  1. A适合该任务的正确人员
  2. B正确的情境
  3. C正确的监督与评价
  4. D适合该环境的正确任务
6.优先排序与委派困难

A competent adult patient refuses a blood transfusion for religious reasons. What should the nurse do?

  1. ATell the patient that refusing treatment is not allowed in hospital
  2. BAsk the family to persuade the patient until they agree
  3. CGive the transfusion while the patient is asleep, because saving their life comes first
  4. DRespect the refusal, check the patient understands the risks and inform the provider
7.临床护理中等

Why are alternate sutures sometimes removed first when taking out stitches?

  1. ATo reduce the cost of dressings
  2. BTo check the wound stays closed before removing the rest
  3. CTo make the procedure faster
  4. DBecause the remaining sutures dissolve on their own within a day
8.临床护理困难

A patient has new facial weakness. Which feature suggests a stroke rather than Bell's palsy?

  1. AThe forehead can still be wrinkled on the affected side
  2. BThe whole of one side of the face, including the forehead, is weak
  3. CThe patient has had a recent cold
  4. DThe patient has pain behind the ear
9.实验室检查值与电解质中等

How should a blood sample for serum ammonia be handled?

  1. AKept warm and sent with the next routine batch
  2. BLeft at room temperature for several hours first
  3. CPlaced on ice and sent to the laboratory at once
  4. DShaken firmly to mix it before it is sent away
10.实验室检查值与电解质困难

A patient with jaundice and nausea has a positive IgM antibody to hepatitis A virus (IgM anti-HAV). What does this show?

  1. AChronic hepatitis A lasting many years
  2. BPast hepatitis B infection that has cleared
  3. CA current or recent hepatitis A infection
  4. DImmunity from hepatitis A vaccine long ago
11.药理学中等

An Rh-negative mother gives birth to an Rh-positive baby. When is anti-D immunoglobulin usually given?

  1. AIt is not needed if the baby is Rh-positive
  2. BOnly at the start of the next pregnancy
  3. CAt least two weeks after the birth
  4. DWithin 72 hours after the birth
12.药理学困难

A patient on long-term prednisolone has been vomiting for two days and could not take her tablets. She is now hypotensive and confused, with low sodium and high potassium. What is the most urgent treatment?

  1. AIV insulin with glucose only
  2. BOral prednisolone with a glass of water
  3. CIV furosemide
  4. DIV hydrocortisone and IV fluids
13.内外科护理：心血管与呼吸中等

Why is a raised serum lactate concerning in a patient with shock?

  1. AIt suggests tissues are short of oxygen and using anaerobic metabolism
  2. BIt means the kidneys are working harder than normal to clear fluid
  3. CIt confirms a bacterial infection is present
  4. DIt shows only that the patient has eaten a large meal in the past hour
14.内外科护理：心血管与呼吸困难

A 28-year-old woman taking the combined pill comes in breathless and anxious. RR is 30/min, heart rate 118/min and SpO₂ 90% on air. A colleague says it is a panic attack. What should the nurse conclude?

  1. ALow oxygen saturation is not explained by anxiety; PE must be excluded
  2. BBreathing into a paper bag is the best first treatment for her
  3. CThe saturation is normal for an anxious person who is breathing fast
  4. DShe should be sent home after a sedative
15.内外科护理：神经、内分泌与肾脏中等

An 85-year-old care home resident becomes newly confused and is falling more often. A UTI is one possibility. Why?

  1. AUrinary infections always cause a high fever in older adults
  2. BConfusion is the only symptom of a UTI at any age
  3. CA UTI cannot occur in people over 80
  4. DOlder adults often show infection as confusion
16.内外科护理：神经、内分泌与肾脏困难

The nurse has four endocrine patients. Which one needs to be seen first?

  1. AA patient with hypothyroidism who has been constipated for three days
  2. BA patient with hyperthyroidism who is confused, with a temperature of 39.5 °C (103.1 °F)
  3. CA patient after thyroidectomy with mild pain on swallowing
  4. DA patient with Graves' disease asking about radioactive iodine
17.内外科护理：消化、围手术期与肿瘤中等

一名急性上消化道出血患者到院时血红蛋白正常。为什么这可能有误导性？

  1. A血红蛋白只有在持续出血整整一周后才会下降
  2. B消化道出血不影响血红蛋白
  3. C只有在液体转移或静脉补液稀释血液后才会下降
  4. D任何失血后血红蛋白总是先升高
18.内外科护理：消化、围手术期与肿瘤困难

A patient with a leg ulcer has an ABPI of 0.5. The doctor's plan mentions starting strong compression bandages. What should the nurse do?

  1. AApply compression but only at night
  2. BApply the strongest compression to speed healing
  3. CApply compression and elevate the leg above the heart all day
  4. DWithhold strong compression and discuss urgent vascular referral
19.产科护理中等

When should an Rh-negative woman with no anti-D antibodies routinely receive antenatal anti-D immunoglobulin?

  1. AOnly if the baby is known to be Rh-negative
  2. BAfter she has formed anti-D antibodies
  3. CAt about 28 weeks of pregnancy
  4. DOnly at the first antenatal visit
20.产科护理困难

出生后 1 小时，糖尿病母亲所生的巨大儿烦躁不安、吃奶差。护士应首先做什么？

  1. A安慰父母烦躁不安是正常的
  2. B把婴儿紧紧包裹，4 小时后再检查
  3. C检测婴儿的血糖
  4. D给婴儿洗澡使其清醒
21.儿科护理中等

钳捏抓握（用拇指和食指捏起小物体）通常在大约多大时发育出来？

  1. A约 2 岁
  2. B约 3 个月
  3. C约 18 个月
  4. D约 9 至 10 个月
22.儿科护理困难

A 12-year-old with asthma has been prescribed a preventer inhaler (inhaled corticosteroid) to take every day. Which statement shows a need for further teaching?

  1. A"I rinse my mouth after using my preventer inhaler."
  2. B"I carry my reliever inhaler with me everywhere I go."
  3. C"I stop taking my preventer inhaler whenever I've had a few good days."
  4. D"I use my spacer with my inhaler, even at school."
23.精神科护理中等

Which question is the best way to ask a patient about suicidal thoughts?

  1. A"Things aren't that bad, are they?"
  2. B"You're not thinking of doing anything silly, are you?"
  3. C"You wouldn't hurt yourself, would you?"
  4. D"Are you having thoughts of killing yourself?"
24.精神科护理困难

A patient who has worked well with the nurse for three weeks becomes angry and refuses to attend their sessions after being told that discharge is planned for next week. What is the best interpretation?

  1. AThe nurse has made an error and should cancel the discharge
  2. BThe patient is reacting to the coming end of the relationship
  3. CThe patient has developed a new psychotic illness
  4. DThe patient no longer needs the sessions and should be discharged at once
25.护理数学与单位换算中等
94969810010210410635363738394041°F°C105.3 °F? °C

练习题（虚构数值，不作为临床指导）。 一位患者的体温为 105.3 °F。用 °C = (°F − 32) × 5/9 把它换算为摄氏度T。取到一位小数。

105.3 °F
T = °C
26.护理数学与单位换算困难
2 mcg/min? mg/h1 h = 60 min1 mg = 1000 mcg

练习题（虚构数值，不作为临床指导）。 一次输注的给药速率为 2 mcg/min。请把这个剂量速率D用 mg/h 表示。

2 mcg/min1 h = 60 min1 mg = 1000 mcg
D = mg/h
27.剂量计算中等
25 kg20 mg/kg/天2× 每天D = ? mg

某患者体重 25 kg。医嘱剂量为每天 20 mg/kg，分 2 次等量给药。每次给多少毫克 D？

25 kg20 mg/kg/天2× 每天
D = mg
28.剂量计算困难
200 mg/5 mLV = ? mL

一名体重 12 kg 的儿童，医嘱为口服混悬液每次 20 mg/kg，该混悬液每 5 mL 含 200 mg。你应给多少体积 V？

12 kg20 mg/kg200 mg/5 mL
V = mL
29.静脉输液速度中等
1000 mL10 gtt/mL8 h? gtt/min

用滴系数为 10 滴/mL 的输液器在 8 小时内输入 1000 mL。求滴速 R（滴/分）。 取整到最接近的整数。

1000 mL8 h10 gtt/mL
R = gtt/min
30.静脉输液速度困难
480 mL剩余? mL/h2 h 剩余

医嘱要求在 8 小时内输入 1500 mL。6 小时后你发现袋中还剩 480 mL，而输液仍须按时完成。 原来的泵速必须提高百分之多少 Δ？

1500 mL / 8 h经过 6 h: 480 mL
Δ = %
31.静脉输液与液体平衡中等
入量出量12 小时班次汤180 mL果冻120 mL水240 mL静脉输液50 mL/h × 12 h静脉抗生素2 × 100 mL尿液200 mL尿液325 mL尿液150 mL伤口引流30 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）。

汤: 180 mL果冻: 120 mL水: 240 mL静脉输液: 50 mL/h × 12 h静脉抗生素: 2 × 100 mL尿液: 200 mL尿液: 325 mL尿液: 150 mL伤口引流: 30 mL
B = mL
32.静脉输液与液体平衡困难
500 mL250 mL 已输入60 mL/h20:00t = ? 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 60 mL/h 输注。到 20:00 时已输入 250 mL。还要多少小时 t 袋子才会输完？ 保留一位小数。

500 mL250 mL 已输入60 mL/h
t = h
33.临床评估评分中等
11563SBPDBPmmHgHR 102/min · SI = ?

练习题（虚构数值，不作为临床指导）。 一位患者的脉搏为 102 次/分，血压为 115/63 mmHg。求休克指数SI = HR/SBP。取到两位小数。

HR 102/minBP 115/63 mmHg
SI =
34.临床评估评分困难
令人放心中度异常低

练习题（虚构数值，不作为临床指导）。 一名练习用新生儿出生后 1 分钟时：全身皮肤青紫或苍白，心率 155 次/分，刺激时做鬼脸，四肢略有屈曲，无呼吸。 为 Apgar 评分并点击该评分的解读。

  1. 1令人放心
  2. 2中度异常
  3. 3低

3溶液

1.护理学基础

答案: C · Secured upright in a holder or trolley, away from heat

为什么是这个答案

Cylinders are heavy and contain gas under pressure. They are kept upright and secured, away from heat and flames, and are handled carefully.

答案

C · Secured upright in a holder or trolley, away from heat
2.护理学基础

答案: D · A drowsy patient stops pressing, which helps prevent overdose

为什么是这个答案

If the patient becomes too sleepy they cannot press the button, so no more opioid is given. When others press it this safety is lost and respiratory depression can follow.

答案

D · A drowsy patient stops pressing, which helps prevent overdose
3.感染控制与患者安全

答案: B · With routine hygiene, using soap and water during daily washing

为什么是这个答案

Routine perineal hygiene with soap and water is recommended. Antiseptic creams and routine irrigation do not reduce infection, and moving the catheter in and out carries organisms into the bladder.

答案

B · With routine hygiene, using soap and water during daily washing
4.感染控制与患者安全

答案: A · 她在接触床栏之后清洁双手

为什么是这个答案

接触床栏、桌子等患者周围环境会污染双手，所以之后需要手卫生。在患者之间应更换手套，无论手看起来是否脏都需要手卫生。

答案

A · 她在接触床栏之后清洁双手
5.优先排序与委派

答案: C · 正确的监督与评价

为什么是这个答案

护士必须跟进、检查结果并据此采取行动。委派后不检查结果违反了监督与评价的原则。

答案

C · 正确的监督与评价
6.优先排序与委派

答案: D · Respect the refusal, check the patient understands the risks and inform the provider

为什么是这个答案

Competent adults have the right to refuse treatment, even if it could save their life. The nurse makes sure the refusal is informed, informs the provider and documents it.

答案

D · Respect the refusal, check the patient understands the risks and inform the provider
7.临床护理

答案: B · To check the wound stays closed before removing the rest

为什么是这个答案

Removing alternate sutures allows the nurse to see whether the wound edges stay together. If they begin to separate, the remaining sutures can be left and the team informed.

答案

B · To check the wound stays closed before removing the rest
8.临床护理

答案: A · The forehead can still be wrinkled on the affected side

为什么是这个答案

In a stroke (upper motor neurone lesion), the forehead is usually spared because it has bilateral cortical supply. Bell's palsy (lower motor neurone) weakens the whole side, including the forehead.

答案

A · The forehead can still be wrinkled on the affected side
9.实验室检查值与电解质

答案: C · Placed on ice and sent to the laboratory at once

为什么是这个答案

Ammonia can rise in a standing sample as red cells and proteins break down. The sample is usually placed on ice and analyzed promptly to avoid a falsely high result.

答案

C · Placed on ice and sent to the laboratory at once
10.实验室检查值与电解质

答案: C · A current or recent hepatitis A infection

为什么是这个答案

IgM antibodies appear early, so IgM anti-HAV indicates acute hepatitis A. IgG anti-HAV alone shows past infection or vaccination and lifelong immunity. Hepatitis A does not become chronic and spreads by the fecal-oral route, so hand hygiene is essential.核对依据: Hepatitis A · MedlinePlus (NIH) (2025)

答案

C · A current or recent hepatitis A infection
11.药理学

答案: D · Within 72 hours after the birth

为什么是这个答案

Anti-D is given within 72 hours of birth to an Rh-negative mother of an Rh-positive baby. It is also given after events such as miscarriage or abdominal trauma, and often routinely during pregnancy.

答案

D · Within 72 hours after the birth
12.药理学

答案: D · IV hydrocortisone and IV fluids

为什么是这个答案

This suggests an adrenal crisis triggered by missed steroids and illness. Treatment is immediate IV or IM hydrocortisone, IV fluids with glucose as needed, and treating the cause.

答案

D · IV hydrocortisone and IV fluids
13.内外科护理：心血管与呼吸

答案: A · It suggests tissues are short of oxygen and using anaerobic metabolism

为什么是这个答案

When tissues are poorly perfused, cells switch to anaerobic metabolism and produce lactate. A raised lactate is a marker of tissue hypoperfusion and severity in sepsis and shock. Repeated measurements show whether treatment is working.

答案

A · It suggests tissues are short of oxygen and using anaerobic metabolism
14.内外科护理：心血管与呼吸

答案: A · Low oxygen saturation is not explained by anxiety; PE must be excluded

为什么是这个答案

Panic-related hyperventilation causes respiratory alkalosis but normal oxygen saturation. Hypoxaemia with tachycardia in a woman taking oestrogen suggests PE. She needs oxygen, urgent medical assessment and investigation. Paper-bag rebreathing is unsafe and can worsen hypoxaemia.

答案

A · Low oxygen saturation is not explained by anxiety; PE must be excluded
15.内外科护理：神经、内分泌与肾脏

答案: D · Older adults often show infection as confusion

为什么是这个答案

In older adults, infections such as UTI may present with delirium, falls or reduced mobility rather than dysuria or fever. Other causes of delirium must also be considered, and urine tests alone can mislead.

答案

D · Older adults often show infection as confusion
16.内外科护理：神经、内分泌与肾脏

答案: B · A patient with hyperthyroidism who is confused, with a temperature of 39.5 °C (103.1 °F)

为什么是这个答案

Fever and confusion in a patient with hyperthyroidism suggest thyroid storm, which can be fatal without urgent treatment. The other problems are expected or non-urgent.

答案

B · A patient with hyperthyroidism who is confused, with a temperature of 39.5 °C (103.1 °F)
17.内外科护理：消化、围手术期与肿瘤

答案: C · 只有在液体转移或静脉补液稀释血液后才会下降

为什么是这个答案

在急性出血时，红细胞和血浆一起丢失，因此浓度起初不变。随着液体从组织进入循环以及静脉补液，浓度才会下降。生命体征和临床体征是更可靠的早期指标。

答案

C · 只有在液体转移或静脉补液稀释血液后才会下降
18.内外科护理：消化、围手术期与肿瘤

答案: D · Withhold strong compression and discuss urgent vascular referral

为什么是这个答案

An ABPI of 0.5 suggests severe arterial disease, and strong compression could cause limb ischaemia. The nurse raises the concern and the patient is referred to vascular specialists.

答案

D · Withhold strong compression and discuss urgent vascular referral
19.产科护理

答案: C · At about 28 weeks of pregnancy

为什么是这个答案

Routine antenatal anti-D around 28 weeks, in a single or split dose depending on the programme, protects against sensitisation from silent fetomaternal bleeds. It is given again after birth if the baby is Rh-positive.

答案

C · At about 28 weeks of pregnancy
20.产科护理

答案: C · 检测婴儿的血糖

为什么是这个答案

高危新生儿的烦躁不安和吃奶差提示低血糖。床旁血糖检测可指导处理，如按规程喂养或使用葡萄糖凝胶，血糖持续偏低则上报。

答案

C · 检测婴儿的血糖
21.儿科护理

答案: D · 约 9 至 10 个月

为什么是这个答案

钳捏抓握通常在约 9–10 个月时出现，到约 12 个月时变得灵巧精细。这也是这个年龄小物体成为窒息风险的原因。

答案

D · 约 9 至 10 个月
22.儿科护理

答案: C · "I stop taking my preventer inhaler whenever I've had a few good days."

为什么是这个答案

Preventer (inhaled corticosteroid) inhalers reduce airway inflammation and must be taken daily as prescribed, even when the child feels well. Carrying a reliever, rinsing the mouth and using a spacer are correct.

答案

C · "I stop taking my preventer inhaler whenever I've had a few good days."
23.精神科护理

答案: D · "Are you having thoughts of killing yourself?"

为什么是这个答案

Asking directly and calmly shows that it is safe to talk. Questions that suggest the "right" answer, or that minimise the problem, make it harder for the patient to be honest.

答案

D · "Are you having thoughts of killing yourself?"
24.精神科护理

答案: B · The patient is reacting to the coming end of the relationship

为什么是这个答案

Anger, withdrawal or return of symptoms are common responses to termination. The nurse acknowledges the feelings, reviews progress and helps the patient prepare for the ending.

答案

B · The patient is reacting to the coming end of the relationship
25.护理数学与单位换算

答案: T = 40.7 °C

温度：°C = (°F − 32) × 5/9，°F = °C × 9/5 + 32。从 °F 换算时先减 32 再乘，从 °C 换算时先乘再加 32。快速核对：37 °C 为 98.6 °F，每 1 °C 相当于 1.8 °F。

减去 32

105.3 − 32 = 73.3

乘以 5/9

T = 73.3·5/9 = 40.72 ≈ 40.7 °C

答案

T = 40.7 °C
26.护理数学与单位换算

答案: D = 0.12 mg/h

量纲分析：先写出已知量，再乘以写成分数形式的换算系数（例如 60 min/1 h 或 1 mg/1000 mcg），使每个不需要的单位在分子和分母各出现一次并相互约去。只剩下所求单位时再计算。使用题目给出的等量关系，只对最终答案取整。

列出换算链

D = 2 mcg/min × (60 min/1 h) × (1 mg/1000 mcg)

计算

D = 2·60/1000 = 0.12 mg/h

答案

D = 0.12 mg/h
27.剂量计算

答案: D = 250 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。

每日总量

20·25 = 500 mg

每次剂量

D = 500/2 = 250 mg

答案

D = 250 mg
28.剂量计算

答案: V = 6 mL

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。

按体重计算剂量

20·12 = 240 mg

体积

V = (240/200)·5 = 6 mL

答案

V = 6 mL
29.静脉输液速度

答案: R = 21 gtt/min

输注速率：输液泵按 mL/h = 体积/时间（小时）设定。重力滴注按每分钟滴数计：gtt/min = 体积 (mL) × 滴系数 (gtt/mL)/时间 (min)。 滴系数印在输液器包装上：普通输液器为 10、15 或 20 gtt/mL（输血器在美国常为 10 gtt/mL，在英国为 15），微量输液器为 60 gtt/mL。务必使用题目或包装给出的滴系数。

以分钟计的时间

8·60 = 480 min

滴速

R = 1000·10/480 = 20.83 ≈ 21 gtt/min

答案

R = 21 gtt/min

床旁取最接近的整滴：21 滴/分。

30.静脉输液速度

答案: Δ = 28 %

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.

原速率

1500/8 = 187.5 mL/h

新速率

R = 480/2 = 240 mL/h

变化百分比

Δ = (240 − 187.5)/187.5·100% = 28%

答案

Δ = 28%

这超过了 25% 的增幅：大多数医院要求你联系开医嘱者，而不是加快补输，并评估患者是否存在液体过多。

31.静脉输液与液体平衡

答案: B = 635 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: 180 + 120 + 240 = 540 mL
静脉输液: 50·12 = 600 mL
静脉抗生素: 2·100 = 200 mL
总入量 = 1340 mL

总出量

200 + 325 + 150 + 30 = 705 mL

平衡

B = 1340 − 705 = 635 mL

答案

B = 635 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 = 4.2 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 − 250 = 250 mL

时间

t = 250/60 = 4.167 ≈ 4.2 h

答案

t = 4.2 h

约为 4 h 10 min，所以袋子大约在 00:10 输完。

33.临床评估评分

答案: SI = 0.89

血压数值：脉压 PP = SBP − DBP。平均动脉压 MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3，这是基于正常心率下心脏每搏约有三分之二时间处于舒张期的估算（心率快时准确性下降）；MAP 至少约 65 mmHg 是常用的器官灌注目标。休克指数 SI = 心率/SBP，正常约为 0.5–0.7；高于约 1 是休克的警示信号。

休克指数

SI = 102/115 = 0.887 ≈ 0.89

答案

SI = 0.89

高于通常的 0.5–0.7。

34.临床评估评分

答案: 中度异常

Apgar 评分：五项体征，每项评 0、1 或 2 分，在出生后 1 分钟和 5 分钟检查。外观（肤色）：青紫或苍白 0 分，躯干粉红、四肢青紫 1 分，全身粉红 2 分。脉搏：无 0 分，低于 100 次/分 1 分，100 次/分或以上 2 分。反射（反射应激性）：无 0 分，做鬼脸 1 分，哭叫、咳嗽或打喷嚏 2 分。肌张力（活动）：松软 0 分，略有屈曲 1 分，活动活跃 2 分。呼吸：无 0 分，缓慢或不规则、哭声微弱 1 分，良好、哭声响亮 2 分。总分 7–10 为令人放心，4–6 为中度异常，0–3 为低。

为每项体征评分

外观: 全身皮肤青紫或苍白 → 0
脉搏: 155/min → 2
反射: 刺激时做鬼脸 → 1
活动: 四肢略有屈曲 → 1
呼吸: 无呼吸 → 0

相加

APGAR = 0 + 2 + 1 + 1 + 0 = 4

解读

4 → 中度异常

答案

中度异常

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