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

Why should a patient wash and dry their hands before a fingerprick glucose test?

  1. AWet hands give a falsely high reading
  2. BClean hands make the finger bleed more slowly
  3. CSugar on the skin can give a falsely high reading
  4. DIt is only needed if the hands look dirty
2.护理学基础困难

The wife of a man with terminal cancer cries often and says she is already grieving for him. What is this called?

  1. AComplicated grief
  2. BDisenfranchised grief
  3. CDelayed grief
  4. DAnticipatory grief
3.感染控制与患者安全中等

Where should the dispersive (grounding) pad for electrosurgery be placed?

  1. AOver a bony prominence such as the hip bone
  2. BOver an area with scar tissue or a tattoo, so that the pad does not slip
  3. COn skin that is wet with antiseptic prep
  4. DOn clean, dry skin over a well-perfused muscle, close to the surgical site
4.感染控制与患者安全困难

一名意识混乱的患者不断拉扯鼻胃管。应首先尝试哪种方法？

  1. A立即使用腕部约束以保护管道
  2. B限制性较小的措施，如重新定向和陪护
  3. C不咨询团队就拔掉管道
  4. D给予镇静剂，让患者整夜安静睡觉
5.优先排序与委派中等

交班后，护士应首先看哪位患者？

  1. A一名哮喘患者，使用辅助呼吸肌，SpO₂ 为 88%
  2. B一名肺炎患者，体温 38.2 °C，30 分钟前刚用过退热药
  3. C一名糖尿病患者，早餐前血糖 160 mg/dL（8.9 mmol/L）
  4. D一名髋关节置换术后两天、疼痛 5/10 的患者
6.优先排序与委派困难

Four laboratory results come back at once. Which one should the nurse report first?

  1. APotassium 3.4 mEq/L in a patient on a diuretic
  2. BCreatinine 1.3 mg/dL in an older adult, unchanged from last week
  3. CHemoglobin 6.5 g/dL (65 g/L) in a patient with a GI bleed
  4. DGlucose 180 mg/dL after a meal in a patient with diabetes
7.临床护理中等

A rising serum creatinine most often indicates:

  1. AIncreased muscle strength
  2. BDehydration of the skin only
  3. CImproved liver function
  4. DReduced kidney function
8.临床护理困难

A patient with a central venous catheter needs the line removed. Which position reduces the risk of air embolism during removal of a neck or chest line?

  1. ALying flat or slightly head-down, holding the breath or breathing out
  2. BLying on the right side with the legs raised
  3. CStanding up and walking
  4. DSitting fully upright and taking a deep breath in as the line comes out
9.实验室检查值与电解质中等

一名患者的血红蛋白为 7.8 g/dL（78 g/L）。护士预期会有哪些发现？

  1. A头痛、鼻出血和面色发红
  2. B心率慢、皮肤潮红和血压高
  3. C瘙痒、皮肤发黄和尿色深
  4. D疲劳、苍白、心率快和活动时呼吸急促
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. APast hepatitis B infection that has cleared
  2. BChronic hepatitis A lasting many years
  3. CImmunity from hepatitis A vaccine long ago
  4. DA current or recent hepatitis A infection
11.药理学中等

Which early signs suggest systemic toxicity from a local anaesthetic?

  1. AHeavy sweating, salivation and diarrhoea
  2. BPinpoint pupils and slow, shallow breathing
  3. CItchy rash and swelling only at the injection site
  4. DNumbness around the mouth, metallic taste and tinnitus
12.药理学困难

A patient taking azathioprine is prescribed allopurinol for gout. What is the main danger?

  1. AGout becomes worse because allopurinol is inactivated by azathioprine
  2. BSevere hypertension from the combination
  3. CLiver enzyme induction, making azathioprine ineffective
  4. DSevere bone marrow suppression, because azathioprine breakdown is reduced
13.内外科护理：心血管与呼吸中等

Why is a shock for cardioversion synchronised with the QRS complex?

  1. ATo keep the pads from burning the skin
  2. BTo avoid delivering the shock during the T wave
  3. CTo allow the use of a lower battery charge
  4. DTo make the shock less painful for the patient
14.内外科护理：心血管与呼吸困难

A patient receiving weeks of IV antibiotics through a PICC line in the left arm develops swelling and aching of that arm and neck veins that look fuller on the left. What should the nurse suspect?

  1. ALymphoedema from lying in bed
  2. BA catheter-related deep vein thrombosis
  3. CA local skin allergy to the dressing
  4. DAn expected effect of the antibiotic
15.内外科护理：神经、内分泌与肾脏中等

A patient with gout has recurrent uric acid kidney stones. Which treatment helps prevent them?

  1. AVitamin C supplements and a high-meat diet
  2. BCalcium tablets and a low-fluid diet
  3. CRestricting fluids in the evening only
  4. DAllopurinol and making the urine less acidic
16.内外科护理：神经、内分泌与肾脏困难

A 74-year-old falls forward and hits their chin. Their arms are much weaker than their legs, and they have burning pain in the hands. Which injury is most likely?

  1. AA complete lumbar cord injury
  2. BCentral cord syndrome
  3. CCauda equina syndrome
  4. DBrown-Séquard syndrome
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 tiny burn on the forearm with redness only
  2. BA partial-thickness burn on the hand
  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

On day 5 after hip surgery, a patient suddenly becomes breathless, with sharp chest pain on breathing in, a pulse of 120/min and SpO₂ 89%. What should the nurse suspect and do first?

  1. AAnxiety; give reassurance and repeat the observations in an hour's time
  2. BWound infection; take a wound swab and wait for results
  3. CSimple atelectasis; encourage walking around the ward
  4. DPulmonary embolism; sit up, give oxygen and call for urgent help
19.产科护理中等

A woman is about to get out of bed for the first time after birth. What should the nurse do?

  1. AHelp her sit, then stand slowly with support
  2. BWait until day 3 before letting her stand
  3. CAsk her to stand quickly to reduce dizziness
  4. DLet her walk alone so she feels independent
20.产科护理困难

Which statement by a pregnant woman with gestational diabetes shows she understands her care?

  1. A"I can skip meals if my glucose is high in the morning."
  2. B"My baby's growth will not need monitoring."
  3. C"I will check my glucose as shown and record it."
  4. D"Insulin will harm my baby, so I will refuse it."
21.儿科护理中等

Which advice is best for a baby with mild nappy rash?

  1. AWipe with perfumed baby wipes at every change to kill the bacteria on the skin
  2. BApply talcum powder thickly at every nappy change
  3. CUse tighter nappies so that less urine reaches the skin
  4. DChange nappies often, clean gently, use a barrier cream and allow nappy-free time
22.儿科护理困难

A large baby born to a mother with diabetes becomes jittery at 1 hour of age. What should the nurse check first?

  1. AThe baby's blood group
  2. BThe baby's blood glucose
  3. CThe baby's serum bilirubin
  4. DThe baby's haemoglobin
23.精神科护理中等

A patient taking sertraline wants to take ibuprofen regularly for arthritis. What should the nurse teach?

  1. AIbuprofen will make the sertraline work faster
  2. BThe combination is completely safe because they act on different systems
  3. CIbuprofen should be taken instead of sertraline on the days when the arthritis pain is bad, to avoid any interaction
  4. DThe combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
24.精神科护理困难

In the working phase of the relationship, a patient who has been talking openly starts missing sessions and changes the subject whenever her childhood is mentioned. What is the best interpretation?

  1. AShe is being rude to the nurse on purpose and should be warned
  2. BShe may be showing resistance as painful topics come closer, which the nurse can gently explore
  3. CShe no longer needs any help, so the sessions should end at once
  4. DThe nurse has made a serious mistake and should hand her care to a colleague immediately
25.护理数学与单位换算中等
12345678910111222:45?12:45 PM10:45 AM10:45 PM9:45 PM

练习题（虚构数值，不作为临床指导）。 一个剂量记录在 22:45（24 小时制）。哪个条目是 12 小时制中的同一时间？点击它。

22:45
  1. 112:45 PM
  2. 210:45 AM
  3. 310:45 PM
  4. 49:45 PM
26.护理数学与单位换算困难
00:0017:3005:20t = ?

练习题（虚构数值，不作为临床指导）。 一次输注从 17:30 开始，到次日早晨 05:20 结束（24 小时制）。它运行了多少分钟t？

17:3005:20
t = min
27.剂量计算中等
79 kgBSA = 1.7 m²75 mg/m²D = ? mg

一名体重 79 kg 的患者体表面积为 1.7 m²。医嘱为 75 mg/m²。求剂量 D，以 mg 表示。

79 kgBSA = 1.7 m²75 mg/m²
D = mg
28.剂量计算困难
50k 件1000 mL? mL/h800 件/h

一袋输液在 1000 mL 中含 50000 单位药物。医嘱为每小时 800 单位。泵速 R 应设为多少 mL/h？

50000 件/1000 mL800 件/h
R = mL/h
29.静脉输液速度中等
250 mL60 gtt/mL12 h? gtt/min

用滴系数为 60 滴/mL 的输液器在 12 小时内输入 250 mL。求滴速 R（滴/分）。 取整到最接近的整数。

250 mL12 h60 gtt/mL
R = gtt/min
30.静脉输液速度困难
200 mg250 mL12 mL/h? mg/h

一袋液体在 250 mL 中含药 200 mg，以 12 mL/h 的速度输注。患者每小时获得多少毫克 D？

200 mg/250 mL12 mL/h
D = mg/h
31.静脉输液与液体平衡中等
入量出量12 小时班次茶240 mL果汁100 mL牛奶100 mL冰屑200 mL静脉输液100 mL/h × 12 h静脉抗生素1 × 50 mL尿液475 mL尿液175 mL伤口引流60 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。

茶: 240 mL果汁: 100 mL牛奶: 100 mL冰屑: 200 mL静脉输液: 100 mL/h × 12 h静脉抗生素: 1 × 50 mL尿液: 475 mL尿液: 175 mL伤口引流: 60 mL
B = mL
32.静脉输液与液体平衡困难
500 mL200 mL 已输入75 mL/h12:30t = ? 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 75 mL/h 输注。到 12:30 时已输入 200 mL。还要多少小时 t 袋子才会输完？ 保留一位小数。

500 mL200 mL 已输入75 mL/h
t = h
33.临床评估评分中等
12481SBPDBPmmHgHR 146/min · SI = ?

练习题（虚构数值，不作为临床指导）。 一位患者的脉搏为 146 次/分，血压为 124/81 mmHg。求休克指数SI = HR/SBP。取到两位小数。

HR 146/minBP 124/81 mmHg
SI =
34.临床评估评分困难
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低中低中高

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 23 次/分，SpO₂ 99%吸室内空气，血压 136/82 mmHg，脉搏 132 次/分，仅对声音有反应，体温 37.7 °C。患者属于哪个临床风险组？点击它。

RR 23SpO₂ 99%空气SBP 136HR 132VT 37.7 °C
  1. 1低
  2. 2中低
  3. 3中
  4. 4高

3溶液

1.护理学基础

答案: C · Sugar on the skin can give a falsely high reading

为什么是这个答案

Traces of food or drink on the finger can raise the reading. Washing with water and drying fully gives an accurate result; alcohol wipes can also affect some meters.

答案

C · Sugar on the skin can give a falsely high reading
2.护理学基础

答案: D · Anticipatory grief

为什么是这个答案

Anticipatory grief happens before an expected death. It is a normal reaction, and nurses can support it by listening and involving the family in care.

答案

D · Anticipatory grief
3.感染控制与患者安全

答案: D · On clean, dry skin over a well-perfused muscle, close to the surgical site

为什么是这个答案

The pad returns the current safely. Good contact over a well-perfused muscle prevents burns, while bony areas, scars, hair and moisture reduce contact and can cause burns at the pad site.

答案

D · On clean, dry skin over a well-perfused muscle, close to the surgical site
4.感染控制与患者安全

答案: B · 限制性较小的措施，如重新定向和陪护

为什么是这个答案

应先尝试限制性较小的措施：重新定向、查找疼痛等原因、把管道固定在看不到的位置，以及安排人员陪伴患者。只有这些措施无效且患者有风险时，才在有医嘱的情况下使用约束或镇静剂。

答案

B · 限制性较小的措施，如重新定向和陪护
5.优先排序与委派

答案: A · 一名哮喘患者，使用辅助呼吸肌，SpO₂ 为 88%

为什么是这个答案

哮喘患者使用辅助呼吸肌且 SpO₂ 低，显示急性呼吸窘迫，这是呼吸问题。血糖升高、中度疼痛以及已在处理的发热都是真实存在的，但紧急程度较低。

答案

A · 一名哮喘患者，使用辅助呼吸肌，SpO₂ 为 88%
6.优先排序与委派

答案: C · Hemoglobin 6.5 g/dL (65 g/L) in a patient with a GI bleed

为什么是这个答案

A hemoglobin of 6.5 g/dL (65 g/L) in a bleeding patient shows severe anemia and may need urgent transfusion. The other results are mildly abnormal or stable.

答案

C · Hemoglobin 6.5 g/dL (65 g/L) in a patient with a GI bleed
7.临床护理

答案: D · Reduced kidney function

为什么是这个答案

Creatinine is a muscle waste product filtered by the kidneys. A rise shows the glomerular filtration rate is falling, as in acute kidney injury.

答案

D · Reduced kidney function
8.临床护理

答案: A · Lying flat or slightly head-down, holding the breath or breathing out

为什么是这个答案

A flat or head-down position and a Valsalva manoeuvre or breath-hold raise central venous pressure, reducing the risk of air being drawn in. An occlusive dressing is then applied.

答案

A · Lying flat or slightly head-down, holding the breath or breathing out
9.实验室检查值与电解质

答案: D · 疲劳、苍白、心率快和活动时呼吸急促

为什么是这个答案

贫血减少氧输送。心脏加快跳动以代偿，患者感到疲倦，活动时呼吸急促，面色苍白。严重贫血可使有心脏病的人出现胸痛。核对依据: Anemia · MedlinePlus (NIH) (2026)

答案

D · 疲劳、苍白、心率快和活动时呼吸急促
10.实验室检查值与电解质

答案: D · 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

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

答案: D · Numbness around the mouth, metallic taste and tinnitus

为什么是这个答案

Local anaesthetic toxicity starts with central nervous system signs such as perioral numbness, metallic taste, tinnitus and agitation. It can progress to seizures, arrhythmias and cardiac arrest.

答案

D · Numbness around the mouth, metallic taste and tinnitus
12.药理学

答案: D · Severe bone marrow suppression, because azathioprine breakdown is reduced

为什么是这个答案

Azathioprine is converted to mercaptopurine, which is partly inactivated by xanthine oxidase. Allopurinol blocks this enzyme, so levels rise and dangerous myelosuppression can occur unless the dose is greatly reduced or the combination avoided.

答案

D · Severe bone marrow suppression, because azathioprine breakdown is reduced
13.内外科护理：心血管与呼吸

答案: B · To avoid delivering the shock during the T wave

为什么是这个答案

A shock delivered on the T wave (the vulnerable period) can trigger ventricular fibrillation. Synchronisation times the shock to the R wave. In ventricular fibrillation there is no organised QRS, so defibrillation is unsynchronised.

答案

B · To avoid delivering the shock during the T wave
14.内外科护理：心血管与呼吸

答案: B · A catheter-related deep vein thrombosis

为什么是这个答案

Upper-limb DVT is a recognised complication of PICCs and other central lines. Arm swelling, pain and distended veins should be reported, and an ultrasound arranged. The line is not flushed forcefully, and treatment usually involves anticoagulation.

答案

B · A catheter-related deep vein thrombosis
15.内外科护理：神经、内分泌与肾脏

答案: D · Allopurinol and making the urine less acidic

为什么是这个答案

Uric acid stones form when urine is acidic and rich in uric acid. High fluid intake, alkalinising the urine (for example with potassium citrate) and allopurinol reduce the risk. Purine-rich foods are limited.

答案

D · Allopurinol and making the urine less acidic
16.内外科护理：神经、内分泌与肾脏

答案: B · Central cord syndrome

为什么是这个答案

Central cord syndrome often follows hyperextension of an arthritic neck. The central fibres, which serve the arms, are affected most, so the arms are weaker than the legs. It is the most common incomplete cord syndrome.

答案

B · Central cord syndrome
17.内外科护理：消化、围手术期与肿瘤

答案: B · 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

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

答案: D · Pulmonary embolism; sit up, give oxygen and call for urgent help

为什么是这个答案

Sudden pleuritic chest pain, breathlessness, tachycardia and hypoxia after surgery strongly suggest PE. The nurse supports breathing with oxygen, escalates urgently and prepares for investigations and anticoagulation.

答案

D · Pulmonary embolism; sit up, give oxygen and call for urgent help
19.产科护理

答案: A · Help her sit, then stand slowly with support

为什么是这个答案

Orthostatic hypotension is common after birth. The nurse helps her sit at the edge of the bed, dangle her legs, then stand slowly with assistance and stays close in case she feels faint.

答案

A · Help her sit, then stand slowly with support
20.产科护理

答案: C · "I will check my glucose as shown and record it."

为什么是这个答案

Regular glucose monitoring with records guides treatment changes. Skipping meals can cause hypoglycaemia and ketosis, insulin does not cross the placenta in a meaningful amount, and fetal growth is monitored.

答案

C · "I will check my glucose as shown and record it."
21.儿科护理

答案: D · Change nappies often, clean gently, use a barrier cream and allow nappy-free time

为什么是这个答案

Keeping the skin clean and dry with frequent changes, gentle cleaning with water, a barrier cream and nappy-free time helps nappy rash heal. Perfumed products and talc can irritate the skin; a rash that persists may be a candidal infection.

答案

D · Change nappies often, clean gently, use a barrier cream and allow nappy-free time
22.儿科护理

答案: B · The baby's blood glucose

为什么是这个答案

Babies of mothers with diabetes produce extra insulin before birth, so after the cord is cut they are at high risk of hypoglycaemia. Jitteriness is a common sign, so blood glucose is checked straight away and the baby is fed or treated as per protocol.

答案

B · The baby's blood glucose
23.精神科护理

答案: D · The combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber

为什么是这个答案

SSRIs reduce serotonin uptake into platelets, which impairs clotting. Combined with NSAIDs, aspirin or anticoagulants, the risk of gastrointestinal bleeding rises.

答案

D · The combination increases the risk of bleeding, especially in the stomach, so discuss it with the prescriber
24.精神科护理

答案: B · She may be showing resistance as painful topics come closer, which the nurse can gently explore

为什么是这个答案

Resistance, such as avoiding topics or missing sessions, is common in the working phase when anxiety-provoking issues arise. The nurse notes the pattern without blame and explores it with the patient at her pace.

答案

B · She may be showing resistance as painful topics come closer, which the nurse can gently explore
25.护理数学与单位换算

答案: 10:45 PM

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

22 − 12 = 10 → PM

答案

10:45 PM

答案

10:45 PM
26.护理数学与单位换算

答案: t = 710 min

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

午夜之前

17:30 → 24:00 = 390 min

午夜之后

00:00 → 05:20 = 320 min

合计

t = 390 + 320 = 710 min

答案

t = 710 min
27.剂量计算

答案: D = 127.5 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 = 75·1.7 = 127.5 mg

答案

D = 127.5 mg
28.剂量计算

答案: R = 16 mL/h

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。

浓度

50000/1000 = 50 件/mL

泵速

R = 800/50 = 16 mL/h

答案

R = 16 mL/h
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

12·60 = 720 min

滴速

R = 250·60/720 = 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: D = 9.6 mg/h

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。

浓度

200/250 = 0.8 mg/mL

给药速率

D = 0.8·12 = 9.6 mg/h

答案

D = 9.6 mg/h
31.静脉输液与液体平衡

答案: B = 1080 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: 240 + 100 + 100 = 440 mL
冰屑: 200/2 = 100 mL
静脉输液: 100·12 = 1200 mL
静脉抗生素: 1·50 = 50 mL
总入量 = 1790 mL

总出量

475 + 175 + 60 = 710 mL

平衡

B = 1790 − 710 = 1080 mL

答案

B = 1080 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 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 − 200 = 300 mL

时间

t = 300/75 = 4 h

答案

t = 4 h

约为 4 h 00 min，所以袋子大约在 16:30 输完。

33.临床评估评分

答案: SI = 1.18

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 = 146/124 = 1.177 ≈ 1.18

答案

SI = 1.18

1 或更高：在这个练习病例中是休克的警示信号。

34.临床评估评分

答案: 高

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 23/min → 2
SpO₂ 99% → 0
吸空气 → 0
SBP 136 mmHg → 0
HR 132/min → 3
仅对声音有反应 (V) → 3
T 37.7 °C → 0

总分和红色分值

NEWS2 = 2 + 0 + 0 + 0 + 3 + 3 + 0 = 8
至少有一个参数得 3 分。

风险组

高

答案

高

总分 5 或以上需要紧急的临床响应。

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