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

A goal states: "The patient will report pain of 3/10 or less within one hour of analgesia." After one hour the patient reports 6/10. What should the nurse do?

  1. AChange the goal to 6/10 or less so that it counts as met
  2. BRecord the goal as not met and review the plan
  3. CRecord the goal as met, as the pain has gone down
  4. DWait until the next day to evaluate again
2.护理学基础困难

ABO 血型不相容输血最常见的原因是什么？

  1. A患者或标本识别错误
  2. B对塑料血袋过敏
  3. C血液储存温度错误
  4. D输血速度太慢
3.感染控制与患者安全中等

A patient with a fentanyl skin patch wants to use a heating pad on the area. What should the nurse teach?

  1. AAvoid heat on or near the patch, because it increases how fast the drug is absorbed
  2. BHeat makes the patch last longer, so fewer patches are needed each month
  3. CHeat only matters if the patch is on the chest
  4. DHeat is fine to use, because it helps the patch stick better to the skin
4.感染控制与患者安全困难

A nurse calls a provider using SBAR about a patient with falling blood pressure. Which statement is the “Recommendation”?

  1. A“His blood pressure has fallen from 130/80 to 88/50 over the last two hours.”
  2. B“He is 72 and had a bowel resection yesterday.”
  3. C“I am calling about Mr. Jansen in room 12, who is hypotensive.”
  4. D“I think he needs to be assessed now. Can you come within the next 15 minutes?”
5.优先排序与委派中等

A patient with asthma uses a peak flow meter. A reading below 50% of personal best is in the red zone. Which statement shows correct understanding?

  1. A“I will stop all my inhalers until the reading is back up.”
  2. B“I will use my reliever inhaler and get emergency help straight away.”
  3. C“I will wait until tomorrow morning to see if the reading gets better on its own.”
  4. D“I will go for a short run to open up my lungs.”
6.优先排序与委派困难

Four stable patients need routine morning care. To reduce the spread of infection, which patient should the nurse visit first?

  1. AA patient with C. difficile diarrhea
  2. BA patient with influenza on droplet precautions
  3. CA patient with an MRSA wound infection
  4. DA patient with neutropenia after chemotherapy
7.临床护理中等

A patient is receiving enteral feeding through a nasogastric tube. How should they be positioned during feeding?

  1. ALying on the left side with the head down to help the feed drain
  2. BIn any position, as long as the feed runs slowly
  3. CLying completely flat
  4. DWith the head of the bed raised to at least 30 degrees
8.临床护理困难

A nurse is teaching a patient who is starting warfarin. Which statement shows a need for further teaching?

  1. A"I will report black stools or unusual bruising."
  2. B"I will tell my dentist that I take warfarin."
  3. C"I will keep my INR blood test appointments."
  4. D"I can take aspirin if I get a headache."
9.实验室检查值与电解质中等

A patient with hepatic encephalopathy is receiving lactulose. Which finding best shows that the treatment is effective?

  1. ATwo to three soft stools a day and clearer thinking
  2. BNo bowel movement for 2 days and calm sleep
  3. CSix to eight watery stools a day with dizziness
  4. DA rising serum ammonia with a slower flapping tremor
10.实验室检查值与电解质困难

一名心力衰竭患者入院时 BNP 很高，在利尿治疗后正在下降。这最可能说明什么？

  1. A心脏的牵拉减轻，与病情改善相符
  2. B必须立即停用利尿剂
  3. C心力衰竭加重，需要更多液体
  4. D利尿剂引起新的肾衰竭
11.药理学中等

Why are patients taking simvastatin often advised to avoid large amounts of grapefruit juice?

  1. AGrapefruit makes the tablet dissolve in the mouth
  2. BGrapefruit inhibits CYP3A4 in the gut, raising simvastatin levels and myopathy risk
  3. CGrapefruit speeds up simvastatin breakdown in the liver, so the drug stops working
  4. DGrapefruit blocks cholesterol absorption and causes low cholesterol
12.药理学困难

A ventilated ICU patient receives vecuronium, a neuromuscular blocker. Why must sedation and pain relief also be given?

  1. ANeuromuscular blockers paralyse muscles but do not cause sedation or analgesia
  2. BSedatives are needed to prevent vecuronium from causing seizures and agitation
  3. CVecuronium causes severe pain at the injection site
  4. DVecuronium stops working unless a sedative is also given
13.内外科护理：心血管与呼吸中等

During airway suctioning, when should suction be applied?

  1. AOnly while withdrawing the catheter
  2. BBefore the catheter enters the airway
  3. CContinuously for at least 30 seconds
  4. DOnly while inserting the catheter
14.内外科护理：心血管与呼吸困难

A hypotensive patient has a temperature of 39.2 °C, warm flushed skin, a bounding pulse and a fast heart rate. Which type of shock is most likely?

  1. AObstructive shock from tamponade
  2. BEarly septic (distributive) shock
  3. CHypovolaemic shock from bleeding
  4. DCardiogenic shock
15.内外科护理：神经、内分泌与肾脏中等

During continuous bladder irrigation, 3200 mL drains out in a shift. 2500 mL of irrigation fluid was put in. What is the true urine output?

  1. A700 mL
  2. B2500 mL
  3. C5700 mL
  4. D3200 mL
16.内外科护理：神经、内分泌与肾脏困难

A nurse teaches a wheelchair user with a spinal cord injury about skin care. Which statement shows a need for further teaching?

  1. A"I will shift my weight in the chair regularly."
  2. B"I will use a mirror to check my bottom and heels every day."
  3. C"I only need to check my skin when something hurts."
  4. D"I will keep my skin clean and dry."
17.内外科护理：消化、围手术期与肿瘤中等

Which neutrophil count indicates severe neutropenia?

  1. AAbove 2.0 × 109/L
  2. BBelow 7.5 × 109/L
  3. CAbove 10 × 109/L
  4. DBelow 0.5 × 109/L
18.内外科护理：消化、围手术期与肿瘤困难

During a nerve block, a patient reports a metallic taste and ringing in the ears, then has a seizure. Besides calling for help and supporting the airway, which specific treatment is given?

  1. AIV naloxone
  2. BIV dantrolene
  3. CIV glucose 50%
  4. DIV lipid emulsion
19.产科护理中等

Why must the fetal heart rate be monitored before and after external cephalic version?

  1. AIt confirms the baby's sex
  2. BIt is needed only to record the baby's position for billing
  3. CThe procedure can cause cord compression or abruption
  4. DIt is used to diagnose gestational diabetes
20.产科护理困难

After treatment for a molar pregnancy, what is the most important teaching point?

  1. ANo further follow-up is needed once the uterus is empty
  2. BTry to conceive again as soon as possible to reduce recurrence
  3. CAvoid all physical activity for 6 months
  4. DAttend serial hCG checks and use reliable contraception during follow-up
21.儿科护理中等

In acute post-streptococcal glomerulonephritis, which assessment is especially important?

  1. ABlood pressure
  2. BPeak flow
  3. CSerum bilirubin
  4. DBlood glucose
22.儿科护理困难

一名疑似阑尾炎的 10 岁儿童一直有剧烈腹痛，但疼痛突然明显缓解。这可能意味着什么？

  1. A这是正常的变化，无需随访
  2. B止痛药治好了问题
  3. C阑尾炎已经缓解，孩子可以回家
  4. D阑尾可能已穿孔；应立即上报
23.精神科护理中等

一名患者说：“我要吃药丸、账单、山丘、蒸馏器。”（I'll take the pill, the bill, the hill, the still.）这称为什么？

  1. A新语症
  2. B音联联想（clang association）
  3. C持续言语
  4. D模仿言语
24.精神科护理困难

A patient with borderline personality disorder and frequent self-harm says, "I'm going to kill myself tonight," after an argument on the phone. A colleague says, "She always says that." What should the nurse do?

  1. AAgree with the colleague and take no action at all
  2. BTell the patient she is only seeking attention
  3. CWait until the next morning to see if she still feels the same once the argument has settled down
  4. DCarry out a full suicide risk assessment, as with any patient who expresses suicidal intent
25.护理数学与单位换算中等
1234567891011128:10 AM?08:1007:1009:1020:10

练习题（虚构数值，不作为临床指导）。 一个剂量记录在 8:10 AM。哪个条目是 24 小时制中的同一时间？点击它。

8:10 AM
  1. 108:10
  2. 207:10
  3. 309:10
  4. 420:10
26.护理数学与单位换算困难
173 g/L? g/dL1 L = 10 dL

练习题（虚构数值，不作为临床指导）。 血红蛋白结果为 173 g/L。请用 g/dL 表示Hb。

173 g/L1 L = 10 dL
Hb = g/dL
27.剂量计算中等
1:1000安瓿V = ? mL

一支肾上腺素安瓿标示为 1:1000（1 mg/mL）。医嘱为 0.3 mg 肌内注射（IM），用于严重过敏反应。你应抽取多少体积 V？

1:10000.3 mg
V = mL
28.剂量计算困难
250 mg/5 mLV = ? mL

一名体重 14 kg 的儿童，医嘱为口服混悬液每次 12.5 mg/kg，该混悬液每 5 mL 含 250 mg。你应给多少体积 V？

14 kg12.5 mg/kg250 mg/5 mL
V = mL
29.静脉输液速度中等
450 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 450 mL，而输液仍须按时完成。 必须把泵重新设定为多少 mL/h 的速率 R？

500 mL / 8 h经过 2 h: 450 mL
R = mL/h
30.静脉输液速度困难
210 mL剩余? mL/h2 h 剩余

医嘱要求在 6 小时内输入 500 mL。4 小时后你发现袋中还剩 210 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 / 6 h经过 4 h: 210 mL
Δ = %
31.静脉输液与液体平衡中等
入量出量8 小时班次汤180 mL果冻120 mL静脉输液80 mL/h × 8 h静脉抗生素1 × 50 mL尿液150 mL尿液325 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 8 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静脉输液: 80 mL/h × 8 h静脉抗生素: 1 × 50 mL尿液: 150 mL尿液: 325 mL
B = mL
32.静脉输液与液体平衡困难
500 mL→ 50 mL/h开始 20:00t总数​ = ? h100 mL/h × 4 h

练习题（虚构数值，不作为临床指导）。 一份 500 mL 的输液于 20:00 开始以 100 mL/h 输注。4 小时后速率改为 50 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。

500 mL100 mL/h · 4 h50 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: 非常受限; 潮湿程度: 很少潮湿; 活动: 卧床不起; 活动能力: 轻度受限; 营养: 极好; 摩擦力和剪切力: 无明显问题。求 Braden 总分B。

6–23
B =
34.临床评估评分困难
105?SBPDBPmmHgMAP = 65

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 65 mmHg。一位患者的收缩压为 105 mmHg。使用 MAP = (SBP + 2·DBP)/3，仍能使 MAP 达到 65 mmHg 的最低舒张压DBP是多少？

MAP 65 mmHgSBP 105 mmHg
DBP = mmHg

3溶液

1.护理学基础

答案: B · Record the goal as not met and review the plan

为什么是这个答案

Evaluation compares the outcome with the goal. The goal was not met, so the nurse reassesses, reports and revises the plan, for example with a different analgesic.

答案

B · Record the goal as not met and review the plan
2.护理学基础

答案: A · 患者或标本识别错误

为什么是这个答案

大多数输错血事件源于识别错误，例如标本标签贴错或省略了床旁身份核对。在每一步都确认患者身份可以预防这类事件。

答案

A · 患者或标本识别错误
3.感染控制与患者安全

答案: A · Avoid heat on or near the patch, because it increases how fast the drug is absorbed

为什么是这个答案

Heat from heating pads, electric blankets, hot tubs or fever increases fentanyl absorption and can cause an overdose. Patients are taught to avoid heat over the patch.

答案

A · Avoid heat on or near the patch, because it increases how fast the drug is absorbed
4.感染控制与患者安全

答案: D · “I think he needs to be assessed now. Can you come within the next 15 minutes?”

为什么是这个答案

In SBAR, the situation names the problem, the background gives the history, the assessment shares the nurse’s findings and judgement, and the recommendation states a clear request with a time frame.

答案

D · “I think he needs to be assessed now. Can you come within the next 15 minutes?”
5.优先排序与委派

答案: B · “I will use my reliever inhaler and get emergency help straight away.”

为什么是这个答案

A red-zone reading means a severe flare. The patient uses their quick-relief inhaler as in their action plan and seeks emergency care at once.

答案

B · “I will use my reliever inhaler and get emergency help straight away.”
6.优先排序与委派

答案: D · A patient with neutropenia after chemotherapy

为什么是这个答案

When urgency is equal, the nurse cares for the most vulnerable patient first and patients with transmissible infections last. This lowers the risk of carrying organisms to an immunocompromised patient.

答案

D · A patient with neutropenia after chemotherapy
7.临床护理

答案: D · With the head of the bed raised to at least 30 degrees

为什么是这个答案

Keeping the head raised to at least 30–45° during feeding and for a period afterwards lowers the risk of aspiration pneumonia.

答案

D · With the head of the bed raised to at least 30 degrees
8.临床护理

答案: D · "I can take aspirin if I get a headache."

为什么是这个答案

Aspirin and other NSAIDs increase the bleeding risk with warfarin, so patients should ask before taking any new medicine. Paracetamol (acetaminophen) is usually the safer choice for simple pain.

答案

D · "I can take aspirin if I get a headache."
9.实验室检查值与电解质

答案: A · Two to three soft stools a day and clearer thinking

为什么是这个答案

Lactulose acidifies the colon, traps ammonia and speeds its removal, so the goal is usually about 2–3 soft stools a day with improving mental status. Too much lactulose can cause severe diarrhea, dehydration and electrolyte loss.核对依据: Lactulose · MedlinePlus (NIH) (2024)

答案

A · Two to three soft stools a day and clearer thinking
10.实验室检查值与电解质

答案: A · 心脏的牵拉减轻，与病情改善相符

为什么是这个答案

BNP 下降意味着心室负荷减轻，这与液体状态改善相符。应结合症状、体重和检查来解读。核对依据: Natriuretic Peptide Tests (BNP, NT-proBNP) · MedlinePlus (NIH) (2023); Brain natriuretic peptide test · MedlinePlus (NIH) (2024)

答案

A · 心脏的牵拉减轻，与病情改善相符
11.药理学

答案: B · Grapefruit inhibits CYP3A4 in the gut, raising simvastatin levels and myopathy risk

为什么是这个答案

Grapefruit compounds inhibit intestinal CYP3A4, so more simvastatin is absorbed. Higher levels increase the risk of muscle damage; drugs such as some calcium channel blockers and ciclosporin are also affected.

答案

B · Grapefruit inhibits CYP3A4 in the gut, raising simvastatin levels and myopathy risk
12.药理学

答案: A · Neuromuscular blockers paralyse muscles but do not cause sedation or analgesia

为什么是这个答案

Neuromuscular blockers cause paralysis but leave awareness and pain sensation intact. Without sedation and analgesia, the patient could be awake and in pain while unable to move.

答案

A · Neuromuscular blockers paralyse muscles but do not cause sedation or analgesia
13.内外科护理：心血管与呼吸

答案: A · Only while withdrawing the catheter

为什么是这个答案

The catheter is inserted without suction and suction is applied as it is withdrawn, with each pass kept short. This limits mucosal trauma and hypoxaemia. The patient is monitored for desaturation and bradycardia.

答案

A · Only while withdrawing the catheter
14.内外科护理：心血管与呼吸

答案: B · Early septic (distributive) shock

为什么是这个答案

Early septic shock often causes warm peripheries and bounding pulses because of widespread vasodilation. Cardiogenic, hypovolaemic and obstructive shock usually cause cool, clammy skin from vasoconstriction. Septic shock can later become "cold" as it progresses.

答案

B · Early septic (distributive) shock
15.内外科护理：神经、内分泌与肾脏

答案: A · 700 mL

为什么是这个答案

True urine output equals total drainage minus irrigation volume: 3200 − 2500 = 700 mL. If drainage is less than the irrigant volume, the catheter may be blocked and fluid is being retained.

答案

A · 700 mL
16.内外科护理：神经、内分泌与肾脏

答案: C · "I only need to check my skin when something hurts."

为什么是这个答案

Patients usually cannot feel pain below the injury, so pain cannot warn them of pressure damage. They need daily skin checks, often with a mirror, regular pressure relief and good skin hygiene.

答案

C · "I only need to check my skin when something hurts."
17.内外科护理：消化、围手术期与肿瘤

答案: D · Below 0.5 × 109/L

为什么是这个答案

A neutrophil count below 0.5 × 109/L (500/mm³) is severe neutropenia, with a high risk of life-threatening infection. Fever in this setting is treated as neutropenic sepsis.

答案

D · Below 0.5 × 109/L
18.内外科护理：消化、围手术期与肿瘤

答案: D · IV lipid emulsion

为什么是这个答案

These are signs of local anaesthetic systemic toxicity. The injection is stopped, help is called, the airway is secured and seizures are treated. IV lipid emulsion is the specific treatment, especially if the circulation is affected.

答案

D · IV lipid emulsion
19.产科护理

答案: C · The procedure can cause cord compression or abruption

为什么是这个答案

External cephalic version turns a breech fetus to cephalic. It can cause fetal bradycardia, cord problems, abruption and fetomaternal bleeding, so the fetus is monitored and anti-D given to Rh-negative women.

答案

C · The procedure can cause cord compression or abruption
20.产科护理

答案: D · Attend serial hCG checks and use reliable contraception during follow-up

为什么是这个答案

hCG is followed until it is undetectable because persistent trophoblastic disease or choriocarcinoma can develop. A new pregnancy would raise hCG and hide this, so reliable contraception is advised during follow-up.

答案

D · Attend serial hCG checks and use reliable contraception during follow-up
21.儿科护理

答案: A · Blood pressure

为什么是这个答案

Fluid and salt retention in glomerulonephritis often causes hypertension, which can lead to headache, visual disturbance and seizures (hypertensive encephalopathy). Blood pressure, weight, fluid balance and urine output are monitored closely.

答案

A · Blood pressure
22.儿科护理

答案: D · 阑尾可能已穿孔；应立即上报

为什么是这个答案

阑尾炎患者疼痛突然缓解可能提示穿孔，随后出现腹膜炎，疼痛加重、发热和腹肌强直。需要紧急上报。

答案

D · 阑尾可能已穿孔；应立即上报
23.精神科护理

答案: B · 音联联想（clang association）

为什么是这个答案

音联联想以押韵或声音联系词语，见于躁狂和精神病。模仿言语是重复他人的话；新语症是新创造的词。

答案

B · 音联联想（clang association）
24.精神科护理

答案: D · Carry out a full suicide risk assessment, as with any patient who expresses suicidal intent

为什么是这个答案

People with borderline personality disorder have a significantly raised risk of suicide. Every statement of suicidal intent must be assessed; labelling it as attention-seeking can lead to missed risk.

答案

D · Carry out a full suicide risk assessment, as with any patient who expresses suicidal intent
25.护理数学与单位换算

答案: 08:10

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

8 AM → 08

答案

08:10

答案

08:10
26.护理数学与单位换算

答案: Hb = 17.3 g/dL

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

Hb = 173 g/L × (1 L/10 dL) = 17.3 g/dL

答案

Hb = 17.3 g/dL
27.剂量计算

答案: V = 0.3 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

1:1000 = 1 g/1000 mL = 1 mg/mL

体积

V = 0.3/1 = 0.3 mL

答案

V = 0.3 mL

美国的标签现在标示 mg/mL（1 mg/mL = 1:1000；0.1 mg/mL = 1:10 000）。切勿静脉推注 1 mg/mL 的肾上腺素。

28.剂量计算

答案: V = 3.5 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

12.5·14 = 175 mg

体积

V = (175/250)·5 = 3.5 mL

答案

V = 3.5 mL
29.静脉输液速度

答案: R = 75 mL/h

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 = 450/6 = 75 mL/h

答案

R = 75 mL/h

许多医院允许在不重开医嘱的情况下进行不超过 25% 的此类调整；请查阅本院规定。

30.静脉输液速度

答案: Δ = 26 %

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

500/6 = 83.33 mL/h

新速率

R = 210/2 = 105 mL/h

变化百分比

Δ = (105 − 83.33)/83.33·100% = 26%

答案

Δ = 26%

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 = 515 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 = 300 mL
静脉输液: 80·8 = 640 mL
静脉抗生素: 1·50 = 50 mL
总入量 = 990 mL

总出量

150 + 325 = 475 mL

平衡

B = 990 − 475 = 515 mL

答案

B = 515 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 = 6 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

100·4 = 400 mL
500 − 400 = 100 mL 剩余

第二部分

100/50 = 2 h

总时间

t = 4 + 2 = 6 h

答案

t = 6 h

约为 6 h 00 min，所以袋子大约在 02:00 输完。

33.临床评估评分

答案: B = 17

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: 非常受限 → 2
潮湿程度: 很少潮湿 → 4
活动: 卧床不起 → 1
活动能力: 轻度受限 → 3
营养: 极好 → 4
摩擦力和剪切力: 无明显问题 → 3

相加

Braden 总分 = 2 + 4 + 1 + 3 + 4 + 3 = 17

答案

B = 17
34.临床评估评分

答案: DBP = 45 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 = (3·65 − 105)/2 = 90/2 = 45 mmHg

答案

DBP = 45 mmHg

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