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

营养不良通用筛查工具（MUST）评估的是什么？

  1. A吞咽能力
  2. B跌倒的风险
  3. C营养不良的风险
  4. D疼痛程度
2.护理学基础困难

A patient's notes record a penicillin allergy with a rash. The new prescription is for amoxicillin. What should the nurse do?

  1. AGive an antihistamine first, then the amoxicillin
  2. BWithhold it and contact the prescriber, as amoxicillin is a penicillin
  3. CGive half the dose and watch for a rash
  4. DGive the dose, as amoxicillin is a different drug from penicillin itself
3.感染控制与患者安全中等

Why does a nurse wear chemotherapy-tested gloves and a gown when emptying the urinal of a patient who recently had chemotherapy?

  1. AThe body fluids can contain active drug for a time after treatment
  2. BChemotherapy makes the urine strongly acidic and corrosive
  3. CThe patient is on airborne precautions after treatment
  4. DThe urine always contains infectious bacteria after chemotherapy
4.感染控制与患者安全困难

A nurse teaches a patient about care of a surgical incision at home. Which statement shows a need for further teaching?

  1. A“I will keep the dressing clean and dry as I was shown.”
  2. B“If the wound gets red and drains pus, I will wait for my appointment next month.”
  3. C“I will wash my hands with soap before I touch or change the dressing.”
  4. D“I will call the clinic if I get a fever or more pain around the wound.”
5.优先排序与委派中等

A conscious patient with hypoglycemia drank juice 15 minutes ago. The glucose is now 62 mg/dL (3.4 mmol/L). What should the nurse do next?

  1. AWait another hour, because juice can take a long time to work
  2. BGive the next scheduled dose of rapid-acting insulin with the meal
  3. CGive another serving of fast-acting carbohydrate and recheck in 15 minutes
  4. DRecord the result and recheck the glucose at the usual time before the evening meal
6.优先排序与委派困难

A patient has a wrist restraint. The nurse finds the fingers on that hand pale, cool and tingling. What should the nurse do first?

  1. ARaise the arm on a pillow and check again in two hours
  2. BDocument the finding and continue with the medication round
  3. CTighten the restraint so the patient moves less
  4. DLoosen the restraint and assess the circulation
7.临床护理中等

Why should a urinary catheter drainage bag be kept below the level of the bladder?

  1. ATo make the bag easier for the nurse to empty
  2. BTo prevent urine flowing back into the bladder
  3. CTo stop the catheter from falling out
  4. DTo keep the urine warm
8.临床护理困难

A patient with myasthenia gravis develops increasing difficulty swallowing and weak, shallow breathing. What is the main danger?

  1. ASevere hypertension from anxiety
  2. BA urinary tract infection
  3. CRespiratory failure from a myasthenic crisis
  4. DA sudden rise in blood glucose from the stress
9.实验室检查值与电解质中等

A patient with HIV on antiretroviral therapy has an undetectable viral load. What does this mean?

  1. AThe virus has been completely cured and removed
  2. BThe CD4 count must now be dangerously low too
  3. CThe treatment can now be stopped without any risk
  4. DThe treatment is suppressing the virus very well
10.实验室检查值与电解质困难

Two weeks after a sore throat, a child develops dark (cola-colored) urine, puffy eyes and high blood pressure. Urinalysis shows red cell casts and protein. Which condition is most likely?

  1. APrerenal acute kidney injury
  2. BLower urinary tract infection (cystitis)
  3. CKidney stone in the ureter
  4. DPost-streptococcal glomerulonephritis
11.药理学中等

氯吡格雷如何减少血小板聚集？

  1. A激活抗凝血酶
  2. B阻断血小板上的 ADP 受体 P2Y12
  3. C直接阻断糖蛋白 IIb/IIIa 受体
  4. D抑制血小板 COX-1
12.药理学困难

A patient who uses insulin is taught sick-day rules. Which statement shows a need for further teaching?

  1. A"I will keep drinking fluids, even if I cannot eat much."
  2. B"I will check my blood glucose and ketones more often while I am ill."
  3. C"If I am ill and not eating, I will stop my insulin completely."
  4. D"I will seek help if I keep vomiting or have ketones."
13.内外科护理：心血管与呼吸中等

什么是射血分数？

  1. A心脏每分钟泵出的血量
  2. B每次心搏射出的心室血量所占的百分比
  3. C每次心跳泵出的血量
  4. D舒张期充盈末期左心室内的压力
14.内外科护理：心血管与呼吸困难

The stump of a recent below-knee amputation suddenly bleeds heavily through the dressing. What should the nurse do first?

  1. AApply a warm compress to the stump
  2. BRemove all the dressings and wait for the bleeding to stop by itself
  3. CEncourage the patient to walk on crutches to ease the pressure
  4. DApply firm direct pressure and call for urgent surgical help
15.内外科护理：神经、内分泌与肾脏中等

甲状腺切除术后，为什么常在床边备有拆线或拆夹器？

  1. A用于从颈静脉抽血
  2. B用于在引流管不通时调整引流管
  3. C颈部血肿可压迫气道，可能需要松解
  4. D必须在术后第一天晚上拆线
16.内外科护理：神经、内分泌与肾脏困难

The day after a lumbar puncture, a patient has a headache that is severe when standing and almost gone when lying flat. Temperature and neck movement are normal. What is the most likely cause?

  1. AA subarachnoid haemorrhage
  2. BA migraine triggered by stress
  3. CPost-dural puncture headache
  4. DBacterial meningitis from the procedure
17.内外科护理：消化、围手术期与肿瘤中等

Which burn should usually be discussed with a specialist burns service even if it is small?

  1. AA partial-thickness burn on the hand
  2. BA tiny burn on the forearm with redness only
  3. CA small superficial sunburn on the back
  4. DA healed burn scar from many years ago
18.内外科护理：消化、围手术期与肿瘤困难

Four patients are on a gastroenterology ward. Which should the nurse see first?

  1. AA patient with stable ulcerative colitis asking about diet
  2. BA patient with cirrhosis who is newly confused and drowsy
  3. CA patient with an ileostomy waiting to change the pouch
  4. DA patient with GORD who wants an antacid
19.产科护理中等

A woman who is not breastfeeding has painful engorged breasts on day 3. Which advice is best?

  1. AWear a supportive bra and use cold packs
  2. BMassage the breasts to stimulate milk flow
  3. CExpress milk often to relieve fullness
  4. DApply warm showers to the breasts several times a day
20.产科护理困难

A labouring woman has a temperature of 38.5 °C (101.3 °F), and the fetal baseline has risen from 140 to 170 bpm over the last hour. What is the most likely explanation?

  1. AReassuring fetal response to contractions
  2. BFetal head compression
  3. CFetal tachycardia due to maternal fever or infection
  4. DFetal tachycardia due to a maternal opioid
21.儿科护理中等

How should anti-sickness medicine be given to a child receiving chemotherapy that often causes vomiting?

  1. AOnly after the child has already vomited at least twice
  2. BBefore the chemotherapy starts and then regularly
  3. COnly at night, when the child is asleep
  4. DOnly if the child asks for it
22.儿科护理困难

A toddler weighed 10 kg before 2 days of diarrhoea and now weighs 9.5 kg. How much has he lost?

  1. A500 g, about 50% of his body weight
  2. B500 g, about 5% of his body weight, mostly fluid
  3. C50 g, about 0.5% of his body weight
  4. D1 kg, about 10% of his body weight
23.精神科护理中等

Which psychological treatment is most effective for obsessive-compulsive disorder?

  1. AExposure and response prevention, a form of CBT
  2. BEncouraging the patient to perform the rituals more often
  3. CPsychoanalysis focused on early childhood memories
  4. DHypnosis to remove the obsessive thoughts permanently in a single session
24.精神科护理困难

An older patient receiving haloperidol for agitation has an episode of fainting and palpitations. Which test does the nurse expect to be ordered first?

  1. AA liver function test
  2. BAn ECG to look for a prolonged QT interval
  3. CA serum lithium level
  4. DA white blood cell count with differential
25.护理数学与单位换算中等
121.4011 kg? kg取整到 0.1 kg

练习题（虚构数值，不作为临床指导）。 一次体重换算得到 121.4011 kg。 本练习的规则是：体重取到最接近的十分之一千克。你记录的数值x是多少？

121.4011 kg
x = kg
26.护理数学与单位换算困难
00:0019:0504:25t = ?

练习题（虚构数值，不作为临床指导）。 一次输注从 19:05 开始，到次日早晨 04:25 结束（24 小时制）。它运行了多少小时t？答案以小数表示小时数，取到两位小数。

19:0504:25
t = h
27.剂量计算中等
2%w/vV = ? mL

需要从 2%（w/v）溶液中取 80 mg 的剂量。多少容量 V 含有这一剂量？

80 mg2% w/v
V = mL
28.剂量计算困难
25%储备液V₁ = ? mL

你需要用 25%（w/v）储备液配制 200 mL 1%（w/v）溶液。 你需要多少容量的储备液 V₁？

C₁ = 25%C₂ = 1%V₂ = 200 mL
V₁ = mL
29.静脉输液速度中等
500 mL60 gtt/mL5 h? gtt/min

用滴系数为 60 滴/mL 的输液器在 5 小时内输入 500 mL。求滴速 R（滴/分）。

500 mL5 h60 gtt/mL
R = gtt/min
30.静脉输液速度困难
480 mL剩余? mL/h6 h 剩余

医嘱要求在 8 小时内输入 500 mL。2 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？

500 mL / 8 h经过 2 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200 mL牛奶200 mL冰屑100 mL静脉输液80 mL/h × 12 h静脉抗生素1 × 100 mL尿液300 mL尿液375 mL尿液400 mL尿液225 mL伤口引流60 mL呕吐物250 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。

汤: 200 mL牛奶: 200 mL冰屑: 100 mL静脉输液: 80 mL/h × 12 h静脉抗生素: 1 × 100 mL尿液: 300 mL尿液: 375 mL尿液: 400 mL尿液: 225 mL伤口引流: 60 mL呕吐物: 250 mL
B = mL
32.静脉输液与液体平衡困难
1000 mL350 mL 已输入75 mL/h18:30t = ? h

练习题（虚构数值，不作为临床指导）。 一袋 1000 mL 的液体用输液泵以 75 mL/h 输注。到 18:30 时已输入 350 mL。还要多少小时 t 袋子才会输完？ 保留一位小数。

1000 mL350 mL 已输入75 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 20 次/分，SpO₂ 89%吸室内空气，血压 118/70 mmHg，脉搏 88 次/分，清醒，体温 37.6 °C。NEWS2 总分是多少？

RR 20SpO₂ 89%空气SBP 118HR 88AT 37.6 °C
NEWS2 =
34.临床评估评分困难
104?SBPDBPmmHgMAP = 60

练习题（虚构数值，不作为临床指导）。 团队的目标是平均动脉压至少为 60 mmHg。一位患者的收缩压为 104 mmHg。使用 MAP = (SBP + 2·DBP)/3，仍能使 MAP 达到 60 mmHg 的最低舒张压DBP是多少？

MAP 60 mmHgSBP 104 mmHg
DBP = mmHg

3溶液

1.护理学基础

答案: C · 营养不良的风险

为什么是这个答案

MUST 把体重指数、非计划性体重下降和急性疾病影响合成一个评分，显示营养不良的风险并指导营养护理。

答案

C · 营养不良的风险
2.护理学基础

答案: B · Withhold it and contact the prescriber, as amoxicillin is a penicillin

为什么是这个答案

Amoxicillin is a penicillin and can cause the same allergic reaction, including anaphylaxis. The nurse withholds it and asks for an alternative.

答案

B · Withhold it and contact the prescriber, as amoxicillin is a penicillin
3.感染控制与患者安全

答案: A · The body fluids can contain active drug for a time after treatment

为什么是这个答案

Many hazardous drugs are excreted in urine, stool and vomit for a period after treatment. Staff wear protective gloves and gowns when handling these fluids, according to policy.

答案

A · The body fluids can contain active drug for a time after treatment
4.感染控制与患者安全

答案: B · “If the wound gets red and drains pus, I will wait for my appointment next month.”

为什么是这个答案

Increasing redness, purulent drainage, fever and worsening pain are signs of surgical site infection and should be reported promptly. Waiting a month could allow the infection to spread.

答案

B · “If the wound gets red and drains pus, I will wait for my appointment next month.”
5.优先排序与委派

答案: C · Give another serving of fast-acting carbohydrate and recheck in 15 minutes

为什么是这个答案

If the glucose is still below the hypoglycemia threshold after treatment (70 mg/dL in US guidance, 4.0 mmol/L in UK guidance), the fast-acting carbohydrate is repeated and the glucose rechecked. Once it is normal, a snack or meal helps keep it stable.

答案

C · Give another serving of fast-acting carbohydrate and recheck in 15 minutes
6.优先排序与委派

答案: D · Loosen the restraint and assess the circulation

为什么是这个答案

Pale, cool fingers with tingling suggest that the restraint is too tight and blood flow is reduced. The nurse releases it at once, assesses the hand and reviews whether the restraint is still needed.

答案

D · Loosen the restraint and assess the circulation
7.临床护理

答案: B · To prevent urine flowing back into the bladder

为什么是这个答案

Keeping the bag below the bladder allows drainage and prevents backflow, which reduces infection risk. The bag should also not touch the floor.

答案

B · To prevent urine flowing back into the bladder
8.临床护理

答案: C · Respiratory failure from a myasthenic crisis

为什么是这个答案

In a myasthenic crisis, weakness of respiratory and bulbar muscles can cause aspiration and respiratory failure. Breathing function is monitored closely and ventilation may be needed.

答案

C · Respiratory failure from a myasthenic crisis
9.实验室检查值与电解质

答案: D · The treatment is suppressing the virus very well

为什么是这个答案

An undetectable viral load shows that antiretroviral therapy is suppressing viral replication. The virus remains in the body, so treatment must continue. People with a sustained undetectable viral load do not transmit HIV sexually.

答案

D · The treatment is suppressing the virus very well
10.实验室检查值与电解质

答案: D · Post-streptococcal glomerulonephritis

为什么是这个答案

Red cell casts show bleeding from the glomeruli, which is typical of glomerulonephritis. After a streptococcal infection, immune complexes inflame the glomeruli, causing hematuria, proteinuria, edema and hypertension. Cystitis and stones do not cause red cell casts.核对依据: Strep A Test · MedlinePlus (NIH) (2024)

答案

D · Post-streptococcal glomerulonephritis
11.药理学

答案: B · 阻断血小板上的 ADP 受体 P2Y12

为什么是这个答案

氯吡格雷在肝脏中被激活，不可逆地阻断血小板上的 P2Y12 ADP 受体。心肌梗死或支架植入后，它常与阿司匹林联用。

答案

B · 阻断血小板上的 ADP 受体 P2Y12
12.药理学

答案: C · "If I am ill and not eating, I will stop my insulin completely."

为什么是这个答案

Stress hormones during illness often raise glucose, so basal insulin is usually continued and doses may need adjusting. Stopping insulin in type 1 diabetes can lead to ketoacidosis.

答案

C · "If I am ill and not eating, I will stop my insulin completely."
13.内外科护理：心血管与呼吸

答案: B · 每次心搏射出的心室血量所占的百分比

为什么是这个答案

射血分数 = 每搏量 ÷ 舒张末期容积，正常约为 50–70%。射血分数降低的心力衰竭通常定义为 40% 或更低。心输出量是每分钟的容量，每搏量是每次心搏的容量。

答案

B · 每次心搏射出的心室血量所占的百分比
14.内外科护理：心血管与呼吸

答案: D · Apply firm direct pressure and call for urgent surgical help

为什么是这个答案

Haemorrhage from a stump needs immediate direct pressure, elevation if appropriate, and urgent surgical help. A tourniquet should be available as policy directs. Vital signs are monitored for shock.

答案

D · Apply firm direct pressure and call for urgent surgical help
15.内外科护理：神经、内分泌与肾脏

答案: C · 颈部血肿可压迫气道，可能需要松解

为什么是这个答案

甲状腺手术后颈部血肿可迅速压迫气道。许多病房在床边备有拆夹器或拆线器及气道设备，以便在紧急情况下打开伤口。护士应观察有无肿胀、喘鸣和呼吸困难。

答案

C · 颈部血肿可压迫气道，可能需要松解
16.内外科护理：神经、内分泌与肾脏

答案: C · Post-dural puncture headache

为什么是这个答案

A positional headache after a lumbar puncture, without fever or neck stiffness, fits a CSF leak. It is managed with rest, fluids, analgesia and caffeine, and an epidural blood patch if it persists. Fever or neck stiffness would suggest infection instead.

答案

C · Post-dural puncture headache
17.内外科护理：消化、围手术期与肿瘤

答案: A · A partial-thickness burn on the hand

为什么是这个答案

Burns of the face, hands, feet, genitalia, perineum and major joints, as well as circumferential, chemical, electrical and inhalation injuries, usually need specialist advice because of their risks and functional impact.

答案

A · A partial-thickness burn on the hand
18.内外科护理：消化、围手术期与肿瘤

答案: B · A patient with cirrhosis who is newly confused and drowsy

为什么是这个答案

New confusion and drowsiness in cirrhosis may be hepatic encephalopathy with a precipitant such as bleeding or infection, and the airway may be at risk. The others are stable.

答案

B · A patient with cirrhosis who is newly confused and drowsy
19.产科护理

答案: A · Wear a supportive bra and use cold packs

为什么是这个答案

In non-breastfeeding women, stimulation increases milk production. A firm supportive bra, cold packs and mild analgesics help until the engorgement settles in a few days.

答案

A · Wear a supportive bra and use cold packs
20.产科护理

答案: C · Fetal tachycardia due to maternal fever or infection

为什么是这个答案

Maternal fever, often from intra-amniotic infection, is a common cause of fetal tachycardia. The provider is informed, and treatment of fever and infection is expected. Opioids reduce variability rather than raise the rate.

答案

C · Fetal tachycardia due to maternal fever or infection
21.儿科护理

答案: B · Before the chemotherapy starts and then regularly

为什么是这个答案

Antiemetics work best when given before chemotherapy and on a regular schedule, not only after vomiting begins. Uncontrolled vomiting can also cause anticipatory nausea with later treatments.

答案

B · Before the chemotherapy starts and then regularly
22.儿科护理

答案: B · 500 g, about 5% of his body weight, mostly fluid

为什么是这个答案

10 kg − 9.5 kg = 0.5 kg; 0.5 ÷ 10 = 5%. Rapid weight loss during acute illness is mostly fluid, so it is a useful measure of the degree of dehydration, alongside clinical signs.

答案

B · 500 g, about 5% of his body weight, mostly fluid
23.精神科护理

答案: A · Exposure and response prevention, a form of CBT

为什么是这个答案

In exposure and response prevention, the patient is gradually exposed to the anxiety-provoking trigger and resists the compulsion. Anxiety falls over time without the ritual, weakening the cycle. SSRIs are the main medicines used.

答案

A · Exposure and response prevention, a form of CBT
24.精神科护理

答案: B · An ECG to look for a prolonged QT interval

为什么是这个答案

Haloperidol and several other antipsychotics can prolong the QT interval, which increases the risk of dangerous ventricular arrhythmias. Fainting and palpitations need an ECG and a check of potassium and magnesium.

答案

B · An ECG to look for a prolonged QT interval
25.护理数学与单位换算

答案: x = 121.4 kg

取整：看舍入位后面的那个数字：5 或更大则进位，4 或更小则保持原数字不变。只对最终答案取整，绝不对中间步骤取整。典型的考试规则：1 mL 或以上的体积取到十分位，低于 1 mL 的体积取到百分位，滴速取整到整滴，体重取到一位小数；务必遵循题目所规定的规则。

十分位位上的数字

121.4011 → 4

只看下一位数字

121.4011 → 0
0 小于或等于 4，所以 4 不变。
后面的数字（11）不考虑：只取整一次，不要逐位取整。

取整

x = 121.4 kg

答案

x = 121.4 kg
26.护理数学与单位换算

答案: t = 9.33 h

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

19:05 → 24:00 = 295 min

午夜之后

00:00 → 04:25 = 265 min

合计

295 + 265 = 560 min
t = 560/60 = 9.333 ≈ 9.33 h

答案

t = 9.33 h
27.剂量计算

答案: V = 4 mL

Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.

浓度

2% = 20 mg/mL

体积

V = 80/20 = 4 mL

答案

V = 4 mL
28.剂量计算

答案: V₁ = 8 mL

Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.

储备液的容量

V₁ = 1·200/25 = 8 mL

答案

V₁ = 8 mL
29.静脉输液速度

答案: R = 100 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

5·60 = 300 min

滴速

R = 500·60/300 = 100 gtt/min

答案

R = 100 gtt/min
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

500/8 = 62.5 mL/h

新速率

R = 480/6 = 80 mL/h

变化百分比

Δ = (80 − 62.5)/62.5·100% = 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 = −100 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: 200 + 200 = 400 mL
冰屑: 100/2 = 50 mL
静脉输液: 80·12 = 960 mL
静脉抗生素: 1·100 = 100 mL
总入量 = 1510 mL

总出量

300 + 375 + 400 + 225 + 60 + 250 = 1610 mL

平衡

B = 1510 − 1610 = −100 mL

答案

B = −100 mL

为负：患者丢失的液体多于摄入的液体。

32.静脉输液与液体平衡

答案: t = 8.7 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

1000 − 350 = 650 mL

时间

t = 650/75 = 8.667 ≈ 8.7 h

答案

t = 8.7 h

约为 8 h 40 min，所以袋子大约在 03:10 输完。

33.临床评估评分

答案: NEWS2 = 3

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 20/min → 0
SpO₂ 89% → 3
吸空气 → 0
SBP 118 mmHg → 0
HR 88/min → 0
清醒 (A) → 0
T 37.6 °C → 0

相加

NEWS2 = 0 + 3 + 0 + 0 + 0 + 0 + 0 = 3

答案

NEWS2 = 3
34.临床评估评分

答案: DBP = 38 mmHg

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。

变形

DBP = (3·MAP − SBP)/2

代入

DBP = (3·60 − 104)/2 = 76/2 = 38 mmHg

答案

DBP = 38 mmHg

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