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 is the purpose of the Z-track technique for intramuscular injections?

  1. AIt numbs the skin before the needle goes in
  2. BIt makes the injection go into the fatty tissue instead of the muscle
  3. CIt seals the drug in the muscle and stops it leaking into the tissue above
  4. DIt lets the nurse give a larger volume into a small muscle
2.护理学基础困难

A urine culture reports a mixed growth of several organisms. What is the most likely explanation?

  1. AThe laboratory used the wrong test
  2. BThe sample was contaminated during collection
  3. CThe patient is resistant to all antibiotics
  4. DThe patient has several serious infections at once
3.感染控制与患者安全中等

在准备无菌区时，护士转身离开去回答问题。下列哪项正确？

  1. A只需更换离护士最近的物品
  2. B之后盖住即可继续使用
  3. C该无菌区视为已污染，必须重新铺设
  4. D无菌区仍然无菌，因为这段时间没有人碰过它
4.感染控制与患者安全困难

In US nursing practice, which task should the RN not assign to an LPN/LVN?

  1. AGiving scheduled oral antibiotics to a stable patient
  2. BReinforcing hand hygiene teaching that the RN has already given
  3. CA dressing change on a healing surgical wound that has no signs of infection
  4. DThe initial admission assessment of a new patient with suspected sepsis
5.优先排序与委派中等

一名患者突然流鼻血，意识清醒，呼吸正常。护士首先做什么？

  1. A让患者用力擤鼻子以清除血块
  2. B头向后仰，并在颈后敷冰
  3. C让患者平躺，膝下垫枕头
  4. D让患者坐起，身体前倾，并捏住鼻子的软骨部分
6.优先排序与委派困难

A patient admitted with suspected appendicitis says the pain suddenly got better, but now the abdomen is rigid and the heart rate is rising. What does this suggest?

  1. AThe appendicitis is getting better without surgery
  2. BThe pain has moved to a different, harmless place
  3. CThe appendix may have ruptured, causing peritonitis
  4. DThe patient’s analgesic has finally started to work
7.临床护理中等

A patient on insulin reports nightmares, night sweats and morning headaches. What should be suspected?

  1. ARaised intracranial pressure
  2. BHyperthyroidism
  3. CNight-time hypoglycaemia
  4. DA urinary tract infection
8.临床护理困难

Why is a patient kept under observation for several hours after successful treatment of anaphylaxis?

  1. ASymptoms can return later in a biphasic reaction
  2. BThe patient must stay until all allergy tests are complete
  3. CAdrenaline always causes a heart attack hours later
  4. DAntihistamines cause dangerous drowsiness for 24 hours
9.实验室检查值与电解质中等

Which technique is recommended for a capillary blood glucose test on an adult's finger?

  1. APrick the side of the fingertip
  2. BSqueeze the finger very hard
  3. CPrick the center of the fingertip
  4. DUse the same finger every time
10.实验室检查值与电解质困难

A patient without symptoms has a finger-stick glucose of 340 mg/dL (18.9 mmol/L). The previous values were normal, and the patient has just peeled an orange. What should the nurse do first?

  1. AHave the patient wash and dry their hands, then repeat the test
  2. BAsk the laboratory to measure HbA1c from the same drop of blood
  3. CGive a correction dose of insulin for a glucose of 340 mg/dL
  4. DReport the result as a new diagnosis of diabetes mellitus
11.药理学中等

A patient takes regular paracetamol (acetaminophen) at home. Which teaching point best prevents accidental overdose?

  1. AUse paracetamol only on an empty stomach
  2. BTake an extra dose if the first one does not work within 10 minutes
  3. CCheck cold and flu remedies, as many also contain paracetamol
  4. DTake paracetamol with alcohol to improve absorption
12.药理学困难

A patient who has taken lorazepam daily for many months stops it suddenly. Which serious complication may follow?

  1. AProfound respiratory depression
  2. BSevere bradycardia
  3. CPinpoint pupils and coma
  4. DWithdrawal seizures
13.内外科护理：心血管与呼吸中等

一名患者血压为 200/125 mmHg，伴新发意识混乱和视物模糊。通常应如何降压？

  1. A尽可能快，几分钟内降到正常值
  2. B完全不降压，因为现在大脑依赖高压
  3. C用一种新的口服药片，一周后复查
  4. D用滴定的静脉药物，第一小时内降低最多约 25%
14.内外科护理：心血管与呼吸困难

A woman starting rifampicin (rifampin) for tuberculosis uses a combined oral contraceptive pill. What advice is correct?

  1. AUse another reliable method, as rifampicin reduces the pill's effect
  2. BContinue the pill as usual, because there is no interaction with TB drugs
  3. CTake two pills a day to make up for the drug
  4. DStop all contraception during TB treatment, as pregnancy cannot occur
15.内外科护理：神经、内分泌与肾脏中等

一次癫痫发作已持续五分钟且仍在继续。通常的一线药物治疗是什么？

  1. A大腿外侧肌肉注射肾上腺素
  2. B苯二氮䓬类药物，如静脉劳拉西泮或颊黏膜咪达唑仑
  3. C对每位患者先静脉注射 50% 葡萄糖，然后重新评估
  4. D首先静脉负荷剂量苯妥英
16.内外科护理：神经、内分泌与肾脏困难

Six weeks after a kidney transplant, a patient has a fever, tenderness over the graft, less urine and a rising creatinine. What is most likely?

  1. AAcute rejection, needing urgent transplant team review
  2. BA normal finding as the kidney settles in
  3. CA side effect of sun exposure
  4. DDehydration that needs only more oral fluids and rest
17.内外科护理：消化、围手术期与肿瘤中等

Which practice is correct when giving parenteral nutrition through a central line?

  1. AUse a dedicated lumen and strict aseptic technique
  2. BGive other IV drugs through the same lumen to save time
  3. CLet the bag hang at room temperature for several days
  4. DDisconnect and reconnect the line without cleaning the hub
18.内外科护理：消化、围手术期与肿瘤困难

An older patient on regular opioids has small amounts of liquid stool leaking all day, but has not had a formed bowel movement for 6 days. What is the most likely cause?

  1. AA flare of ulcerative colitis
  2. BAcute infective gastroenteritis
  3. CNormal stool pattern on opioids
  4. DFaecal impaction with overflow
19.产科护理中等

What should parents be taught about the water for a newborn's bath?

  1. ACheck that it is warm, not hot, before the baby goes in
  2. BAdd adult bubble bath to soften the baby's skin
  3. CLeave the baby briefly if the water is only shallow
  4. DUse very hot water so that germs on the skin are killed
20.产科护理困难

一名子痫前期的女性发生强直–阵挛性抽搐。护士应首先怎么做？

  1. A呼救，留在她身边，保护她免受伤害，并在可能时将她翻成侧卧位
  2. B约束她的四肢
  3. C测量宫高
  4. D在她的牙齿之间放入压舌板或带垫的口咽通气道，以免她咬断舌头
21.儿科护理中等

Which newborn problem may be the first sign of cystic fibrosis?

  1. APhysiological jaundice
  2. BUmbilical hernia
  3. CErythema toxicum
  4. DMeconium ileus
22.儿科护理困难

A child with extensive burns is receiving IV fluid resuscitation. Which finding best shows that fluid replacement is adequate?

  1. AThe blood pressure is in the high range
  2. BA urine output of about 1 mL/kg per hour
  3. CThe child is asking for a drink
  4. DThe burned skin looks less red and the blisters are smaller
23.精神科护理中等

What is the key difference between factitious disorder and malingering?

  1. AIn factitious disorder, the aim is to be seen as ill; in malingering, the aim is an external reward
  2. BThere is no real difference between them, and both terms mean exactly the same thing
  3. CIn factitious disorder, the symptoms are not produced on purpose at all
  4. DMalingering is a severe mental disorder, while factitious disorder is not classed as a mental disorder at all
24.精神科护理困难

A patient in a mental health unit asks to read his own health records. What is the correct general principle?

  1. APatients generally have a right of access, with limited exceptions to prevent serious harm
  2. BOnly his family can request access to his records on his behalf
  3. CThe nurse should give him the records immediately without following any procedure
  4. DPsychiatric patients are never allowed to see their records
25.护理数学与单位换算中等
94969810010210410635363738394041°F°C104.3 °F? °C

练习题（虚构数值，不作为临床指导）。 一位患者的体温为 104.3 °F。用 °C = (°F − 32) × 5/9 把它换算为摄氏度T。取到一位小数。

104.3 °F
T = °C
26.护理数学与单位换算困难
0.5 mg/dL? µmol/L1 mg/dL = 88.4 µmol/L

练习题（虚构数值，不作为临床指导）。 血清肌酐结果为 0.5 mg/dL。按肌酐 1 mg/dL = 88.4 µmol/L，求以 µmol/L 表示的c，取到最接近的整数。

0.5 mg/dL1 mg/dL = 88.4 µmol/L
c = µmol/L
27.剂量计算中等
112 kgBSA = 2.06 m²250 mg/m²D = ? mg

一名体重 112 kg 的患者体表面积为 2.06 m²。医嘱为 250 mg/m²。求剂量 D，以 mg 表示。

112 kgBSA = 2.06 m²250 mg/m²
D = mg
28.剂量计算困难
21 kg100 cmBSA = √(h·w/3600)25 mg/m²D = ? mg

一名患者身高 100 cm，体重 21 kg。医嘱为 25 mg/m²。用 Mosteller 公式 BSA = √(身高 (cm) × 体重 (kg)/3600) 求剂量 D，以 mg 表示。

100 cm21 kg25 mg/m²
D = mg
29.静脉输液速度中等
V = ?15 gtt/mL25 gtt/min2 h

滴注以 25 gtt/min 的速度通过滴系数为 15 gtt/mL 的输液器。患者在 2 小时内接受多少毫升 V？

25 gtt/min15 gtt/mL2 h
V = mL
30.静脉输液速度困难
400 mg500 mL30 mL/h? mcg/min

400 mg 药物溶于 500 mL 的输液以 30 mL/h 运行。患者每分钟接受多少微克 D？

400 mg/500 mL30 mL/h
D = mcg/min
31.静脉输液与液体平衡中等
入量出量12 小时班次水150 mL茶150 mL静脉输液100 mL/h × 12 h静脉抗生素1 × 100 mL尿液275 mL尿液150 mL尿液200 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。患者体重 66 kg。求平均尿量 U，以 mL/kg/h 计。 保留两位小数。

66 kg12 h尿液: 275 mL尿液: 150 mL尿液: 200 mL
U = mL/kg/h
32.静脉输液与液体平衡困难
1000 mL→ 100 mL/h开始 18:30t总数​ = ? h150 mL/h × 3 h

练习题（虚构数值，不作为临床指导）。 一份 1000 mL 的输液于 18:30 开始以 150 mL/h 输注。3 小时后速率改为 100 mL/h，之后不再改变。从开始算起多少小时 t 后袋子会输完？ 保留一位小数。

1000 mL150 mL/h · 3 h100 mL/h
t = h
33.临床评估评分中等
S? / 4+M? / 4+A? / 4+Mob? / 4+N? / 4+F? / 3Σ?

练习题（虚构数值，不作为临床指导）。 用 Braden 量表评估一位练习患者：感觉知觉: 完全受限; 潮湿程度: 非常潮湿; 活动: 卧床不起; 活动能力: 非常受限; 营养: 非常差; 摩擦力和剪切力: 潜在问题。求 Braden 总分B。

6–23
B =
34.临床评估评分困难
低风险中度风险高风险

练习题（虚构数值，不作为临床指导）。 用 Morse 跌倒评分评估一位练习患者：过去 3 个月内的跌倒史: 否; 次要诊断: 是; 行走辅助: 无、卧床休息或由护士协助; 静脉输液或封管: 否; 步态: 虚弱; 精神状态: 高估或忘记自身局限。使用分界值 0–24 低，25–44 中度，45 或以上高，点击跌倒风险等级。

  1. 1低风险
  2. 2中度风险
  3. 3高风险

3溶液

1.护理学基础

答案: C · It seals the drug in the muscle and stops it leaking into the tissue above

为什么是这个答案

Pulling the skin sideways before injecting and releasing it afterwards makes a zigzag track that closes over the needle path, preventing leakage and skin staining.

答案

C · It seals the drug in the muscle and stops it leaking into the tissue above
2.护理学基础

答案: B · The sample was contaminated during collection

为什么是这个答案

A mixed growth usually means skin or perineal bacteria contaminated the sample. A clean-catch midstream sample, or a sample from the catheter sampling port, gives a more reliable result.

答案

B · The sample was contaminated during collection
3.感染控制与患者安全

答案: C · 该无菌区视为已污染，必须重新铺设

为什么是这个答案

无菌区必须始终处于视线范围内。如果无法确认无菌状态，就应视为已污染。原则是：有疑问时，视为非无菌。

答案

C · 该无菌区视为已污染，必须重新铺设
4.感染控制与患者安全

答案: D · The initial admission assessment of a new patient with suspected sepsis

为什么是这个答案

The initial assessment of a new, potentially unstable patient is an RN responsibility. LPNs/LVNs can give routine medications, perform routine procedures and reinforce teaching for stable patients.

答案

D · The initial admission assessment of a new patient with suspected sepsis
5.优先排序与委派

答案: D · 让患者坐起，身体前倾，并捏住鼻子的软骨部分

为什么是这个答案

身体前倾可使血液不进入气道和胃，用力捏住鼻子的软骨部分通常可止血。头后仰或平躺会使血液流入咽喉。

答案

D · 让患者坐起，身体前倾，并捏住鼻子的软骨部分
6.优先排序与委派

答案: C · The appendix may have ruptured, causing peritonitis

为什么是这个答案

A sudden ease in pain followed by a rigid abdomen and a rising pulse can mean rupture and peritonitis. This is a surgical emergency, so the nurse reports at once.

答案

C · The appendix may have ruptured, causing peritonitis
7.临床护理

答案: C · Night-time hypoglycaemia

为什么是这个答案

Nocturnal hypoglycaemia can cause sweating, restless sleep, nightmares and morning headache. Checking glucose overnight and reviewing insulin doses can confirm and correct it.

答案

C · Night-time hypoglycaemia
8.临床护理

答案: A · Symptoms can return later in a biphasic reaction

为什么是这个答案

Some patients have a second wave of symptoms hours after the first, called a biphasic reaction. Observation, an adrenaline auto-injector where indicated and allergy referral are part of safe discharge.

答案

A · Symptoms can return later in a biphasic reaction
9.实验室检查值与电解质

答案: A · Prick the side of the fingertip

为什么是这个答案

The sides of the fingertips are less sensitive than the pads, so they are used for capillary sampling. Rotating sites reduces soreness, and hard squeezing can add tissue fluid that gives inaccurate results.

答案

A · Prick the side of the fingertip
10.实验室检查值与电解质

答案: A · Have the patient wash and dry their hands, then repeat the test

为什么是这个答案

Sugar residue on the fingers can give a falsely high finger-stick result. The hands are washed with soap and water and dried, and the test repeated. If the value is still high, it is confirmed and reported. Treating a false result could cause hypoglycemia.

答案

A · Have the patient wash and dry their hands, then repeat the test
11.药理学

答案: C · Check cold and flu remedies, as many also contain paracetamol

为什么是这个答案

Many combination products contain paracetamol, so a patient can take too much without realising. Regular alcohol use and liver disease also increase the risk of liver damage.

答案

C · Check cold and flu remedies, as many also contain paracetamol
12.药理学

答案: D · Withdrawal seizures

为什么是这个答案

Abrupt withdrawal after long-term benzodiazepine use causes anxiety, insomnia, tremor and sometimes seizures. Long-term users should have the dose tapered gradually.

答案

D · Withdrawal seizures
13.内外科护理：心血管与呼吸

答案: D · 用滴定的静脉药物，第一小时内降低最多约 25%

为什么是这个答案

高血压急症（严重高血压伴急性器官损害）应在监护下用滴定的静脉药物治疗。降压过快可引起脑、冠状动脉或肾缺血，因此多数指南的目标是第一小时内降低不超过约 25%（主动脉夹层等某些情况目标不同）。

答案

D · 用滴定的静脉药物，第一小时内降低最多约 25%
14.内外科护理：心血管与呼吸

答案: A · Use another reliable method, as rifampicin reduces the pill's effect

为什么是这个答案

Rifampicin induces liver enzymes that break down oestrogen and progestogen, so hormonal contraception may fail. A non-hormonal or unaffected method, such as a copper IUD, is advised during and for a time after treatment. The interaction also affects warfarin and many other drugs.

答案

A · Use another reliable method, as rifampicin reduces the pill's effect
15.内外科护理：神经、内分泌与肾脏

答案: B · 苯二氮䓬类药物，如静脉劳拉西泮或颊黏膜咪达唑仑

为什么是这个答案

持续五分钟或以上的发作（或反复发作且间歇期未恢复）按癫痫持续状态处理。首先给予苯二氮䓬类药物（有静脉通路时用静脉劳拉西泮；没有时用颊黏膜或鼻内咪达唑仑或直肠地西泮），发作持续时再用左乙拉西坦、苯妥英或丙戊酸等二线抗癫痫药。应检测血糖，仅在偏低时给予葡萄糖。

答案

B · 苯二氮䓬类药物，如静脉劳拉西泮或颊黏膜咪达唑仑
16.内外科护理：神经、内分泌与肾脏

答案: A · Acute rejection, needing urgent transplant team review

为什么是这个答案

Fever, graft tenderness, falling urine output and rising creatinine suggest acute rejection, although infection must also be ruled out. Early treatment, often with high-dose steroids, can save the graft, so the transplant team is contacted urgently.

答案

A · Acute rejection, needing urgent transplant team review
17.内外科护理：消化、围手术期与肿瘤

答案: A · Use a dedicated lumen and strict aseptic technique

为什么是这个答案

PN is rich in nutrients that bacteria can use. A dedicated lumen, aseptic non-touch technique and hanging limits reduce catheter-related bloodstream infection.

答案

A · Use a dedicated lumen and strict aseptic technique
18.内外科护理：消化、围手术期与肿瘤

答案: D · Faecal impaction with overflow

为什么是这个答案

Overflow diarrhoea occurs when liquid stool leaks around impacted faeces. Antidiarrhoeal drugs would worsen it; the nurse escalates for assessment, and treatment includes laxatives or enemas and review of the opioids.

答案

D · Faecal impaction with overflow
19.产科护理

答案: A · Check that it is warm, not hot, before the baby goes in

为什么是这个答案

Bath water should be comfortably warm, about 37 °C (98.6 °F), checked with a thermometer or the elbow, and the baby is never left alone, even in shallow water. Plain water or a mild baby cleanser is used. Some guidance, such as in the US, advises sponge baths until the cord stump has fallen off.

答案

A · Check that it is warm, not hot, before the baby goes in
20.产科护理

答案: A · 呼救，留在她身边，保护她免受伤害，并在可能时将她翻成侧卧位

为什么是这个答案

子痫发作时，应呼救、防止受伤，抽搐停止后将她翻成侧卧位以保持气道通畅并给氧。按医嘱给予硫酸镁，待母亲情况稳定后再评估胎儿。

答案

A · 呼救，留在她身边，保护她免受伤害，并在可能时将她翻成侧卧位
21.儿科护理

答案: D · Meconium ileus

为什么是这个答案

In about 10–20% of babies with CF, thick, sticky meconium blocks the small bowel (meconium ileus), causing distension and vomiting. Newborn screening also helps detect CF early.

答案

D · Meconium ileus
22.儿科护理

答案: B · A urine output of about 1 mL/kg per hour

为什么是这个答案

Urine output, usually measured by catheter, is the main guide to fluid resuscitation in burns. In children, an output of about 1 mL/kg/hour suggests adequate perfusion; fluids are adjusted to keep it in the target range.

答案

B · A urine output of about 1 mL/kg per hour
23.精神科护理

答案: A · In factitious disorder, the aim is to be seen as ill; in malingering, the aim is an external reward

为什么是这个答案

In both, symptoms are produced or exaggerated on purpose. In factitious disorder the motivation is internal, the sick role; in malingering it is external, such as money, drugs or avoiding duties.

答案

A · In factitious disorder, the aim is to be seen as ill; in malingering, the aim is an external reward
24.精神科护理

答案: A · Patients generally have a right of access, with limited exceptions to prevent serious harm

为什么是这个答案

Data protection and health records laws in many countries give patients a right to access their records. Requests follow a formal procedure, and information may be withheld only in limited cases, for example if it could cause serious harm.

答案

A · Patients generally have a right of access, with limited exceptions to prevent serious harm
25.护理数学与单位换算

答案: T = 40.2 °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

104.3 − 32 = 72.3

乘以 5/9

T = 72.3·5/9 = 40.17 ≈ 40.2 °C

答案

T = 40.2 °C
26.护理数学与单位换算

答案: c = 44 µmol/L

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。

转换

c = 0.5·88.4 = 44.2 ≈ 44 µmol/L

答案

c = 44 µmol/L
27.剂量计算

答案: D = 515 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

剂量

D = 250·2.06 = 515 mg

答案

D = 515 mg
28.剂量计算

答案: D = 19.09 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

体表面积

BSA = √(100·21/3600) = √0.5833 = 0.7638 m²

剂量

D = 25·0.7638 = 19.09 mg

答案

D = 19.09 mg
29.静脉输液速度

答案: V = 200 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）

25·60/15 = 100 mL/h

体积

V = 100·2 = 200 mL

答案

V = 200 mL
30.静脉输液速度

答案: D = 400 mcg/min

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

400000 mcg/500 mL = 800 mcg/mL

每小时剂量

30·800 = 24000 mcg/h

每分钟剂量

D = 24000/60 = 400 mcg/min

答案

D = 400 mcg/min
31.静脉输液与液体平衡

答案: U = 0.79 mL/kg/h

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。

总尿量

275 + 150 + 200 = 625 mL

每千克每小时

U = 625/(66·12) = 0.7891 ≈ 0.79 mL/kg/h

答案

U = 0.79 mL/kg/h
32.静脉输液与液体平衡

答案: t = 8.5 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。

第一部分

150·3 = 450 mL
1000 − 450 = 550 mL 剩余

第二部分

550/100 = 5.5 h

总时间

t = 3 + 5.5 = 8.5 h

答案

t = 8.5 h

约为 8 h 30 min，所以袋子大约在 03:00 输完。

33.临床评估评分

答案: B = 9

Braden 量表：评估压力性损伤风险的六个分项。感觉知觉、潮湿程度、活动、活动能力和营养各评 1 至 4 分，从最差水平（1）到无问题（4）；摩擦力和剪切力评 1 至 3 分。总分为 6 至 23，总分越低风险越高。常用分级：19–23 无风险，15–18 轻度风险，13–14 中度风险，10–12 高风险，9 分及以下为极高风险。

为每个分项评分

感觉知觉: 完全受限 → 1
潮湿程度: 非常潮湿 → 2
活动: 卧床不起 → 1
活动能力: 非常受限 → 2
营养: 非常差 → 1
摩擦力和剪切力: 潜在问题 → 2

相加

Braden 总分 = 1 + 2 + 1 + 2 + 1 + 2 = 9

答案

B = 9
34.临床评估评分

答案: 中度风险

Morse 跌倒评分：六个条目。跌倒史：否 0 分，是 25 分。次要诊断：否 0 分，是 15 分。行走辅助：无、卧床休息或护士协助 0 分；拐杖、手杖或助行器 15 分；扶着家具 30 分。静脉输液或封管：否 0 分，是 20 分。步态：正常、卧床休息或轮椅 0 分；虚弱 10 分；受损 20 分。精神状态：了解自身局限 0 分；高估或忘记自身局限 15 分。总分为 0 至 125。各医院的风险分界值不同；常用的一套是 0–24 低风险，25–44 中度风险，45 及以上为高风险。

为每个条目评分

过去 3 个月内的跌倒史: 否 → 0
次要诊断: 是 → 15
行走辅助: 无、卧床休息或由护士协助 → 0
静脉输液或封管: 否 → 0
步态: 虚弱 → 10
精神状态: 高估或忘记自身局限 → 15

相加

Morse 总分 = 0 + 15 + 0 + 0 + 10 + 15 = 40

风险等级

40 → 中度风险

答案

中度风险

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