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 catheterised patient has had no urine in the bag for two hours. What should the nurse check first?

  1. AThe tubing for kinks or blockage and where the bag is
  2. BWhether the patient has eaten or drunk anything recently
  3. CThe patient's blood glucose level and recent insulin doses
  4. DNothing, as two hours without urine is normal
2.护理学基础困难

A patient with COPD and a known risk of hypercapnia is acutely breathless with an SpO₂ of 82%. What is correct?

  1. AGive controlled oxygen, e.g. via a Venturi mask, aiming for 88–92%
  2. BWithhold oxygen completely, because oxygen is dangerous in COPD
  3. CWait for an arterial blood gas result before giving any oxygen at all
  4. DGive the highest oxygen flow possible and aim for 100%
3.感染控制与患者安全中等

During a surgical hand scrub, how are the hands held?

  1. ABelow the elbows, so water runs off the fingertips into the sink
  2. BPointing downward into the sink at all times
  3. CAbove the elbows, so water runs from the fingertips toward the elbows
  4. DAt the level of the waist, close to the body
4.感染控制与患者安全困难

A patient on long-term high-dose corticosteroids asks for the nasal spray influenza vaccine. What should the nurse explain?

  1. AThe nasal spray is the best choice for people on steroids, because it is not injected
  2. BEither type is fine, as long as it is given in the morning
  3. CPeople on steroids should never have any influenza vaccine
  4. DThe nasal spray is a live vaccine, so the injected inactivated vaccine is used instead
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让患者坐起，身体前倾，并捏住鼻子的软骨部分
  3. C让患者平躺，膝下垫枕头
  4. D头向后仰，并在颈后敷冰
6.优先排序与委派困难

A provider asks a nurse to perform a procedure that is outside the nurse’s scope of practice. What should the nurse do?

  1. ADo it, because the provider gave the instruction
  2. BDecline, explain why and suggest who can safely do it
  3. CAsk a nursing assistant to do it instead
  4. DDo it just this once and promise the provider not to do it again
7.临床护理中等

A nurse gives a patient analgesia for post-operative pain. What should be done next?

  1. AGive a second analgesic straight away just in case
  2. BWait until the next shift before asking the patient about the pain
  3. CReassess the pain and any side effects once the drug has had time to work
  4. DAssume the pain has gone if the patient is quiet and has their eyes closed
8.临床护理困难

一名患者恶心呕吐三天，并在服用呋塞米。最可能出现哪种电解质问题？

  1. A高钙血症
  2. B仅高钠血症
  3. C高钾血症
  4. D低钾血症
9.实验室检查值与电解质中等

Why must vitamin B12 deficiency be ruled out before treating macrocytic anemia with folic acid alone?

  1. AFolic acid can fix the anemia while B12-related nerve damage continues
  2. BFolic acid causes iron overload when B12 levels are low
  3. CFolic acid makes B12 deficiency anemia much worse within a few days
  4. DFolic acid blocks the absorption of all B12 from the diet
10.实验室检查值与电解质困难

A patient with severe sepsis is oozing blood from IV sites. Platelets 40 × 10³/µL, fibrinogen low, D-dimer very high, PT and aPTT both prolonged. Which condition fits best?

  1. AHemophilia A (factor VIII deficiency)
  2. BHeparin-induced thrombocytopenia (HIT)
  3. CDisseminated intravascular coagulation (DIC)
  4. DImmune thrombocytopenic purpura (ITP)
11.药理学中等

Which blood test is used to monitor warfarin therapy?

  1. ASerum albumin
  2. BActivated partial thromboplastin time (aPTT)
  3. CPlatelet count
  4. DINR (prothrombin time)
12.药理学困难

A man taking doxazosin for hypertension starts sildenafil for erectile dysfunction. What is the main risk?

  1. AHyperkalaemia
  2. BSymptomatic low blood pressure and fainting
  3. CSevere hypertension and a pounding headache
  4. DBronchospasm
13.内外科护理：心血管与呼吸中等

A patient's blood pressure is high in clinic but normal on home readings. Which step best confirms the diagnosis?

  1. AStarting two antihypertensive drugs at once at full dose
  2. BA single repeat reading in the same clinic visit
  3. CA chest X-ray
  4. DAmbulatory or structured home blood pressure monitoring
14.内外科护理：心血管与呼吸困难

An older patient's varicose vein bursts at the ankle and bleeds heavily. What is the most effective first aid?

  1. AApply a hot compress to the leg to help the vein close up
  2. BLie the patient down, raise the leg and press firmly on the site
  3. CKeep the leg hanging down over the bed
  4. DStand the patient up so the blood flows away and clots faster
15.内外科护理：神经、内分泌与肾脏中等

一名 C6 水平急性脊髓损伤患者，哪种表现提示神经源性休克？

  1. A低血压、脉搏快、皮肤冰冷湿冷
  2. B血压正常、脉搏快、高热
  3. C高血压、脉搏缓慢、剧烈头痛
  4. D低血压、脉搏缓慢、皮肤温暖干燥
16.内外科护理：神经、内分泌与肾脏困难

A nurse teaches a patient with Hashimoto's thyroiditis about levothyroxine. Which statement shows a need for further teaching?

  1. A"I can stop the tablets once I feel back to normal."
  2. B"I will take the tablets at the same time each day."
  3. C"I will have regular blood tests to check my dose."
  4. D"I will report palpitations or chest pain."
17.内外科护理：消化、围手术期与肿瘤中等

Why is pethidine (meperidine) generally avoided for regular pain relief?

  1. AIt can only be given by mouth
  2. BA metabolite can build up and cause seizures
  3. CIt always causes severe diarrhoea
  4. DIt has no pain-relieving effect at all in adults
18.内外科护理：消化、围手术期与肿瘤困难

为什么对术后阿片类药物引起呼吸抑制的患者，纳洛酮通常以小剂量重复给予？

  1. A因为高剂量纳洛酮会引起呼吸抑制
  2. B恢复呼吸，同时不引起剧烈疼痛和戒断反应
  3. C使阿片类药物起效更快、更强
  4. D因为大剂量纳洛酮没有额外的效果
19.产科护理中等

Why is it important to do newborn bloodspot screening at the recommended time rather than in the first hours?

  1. ASome results, such as PKU, need milk feeds first
  2. BThe heel cannot be pricked until the cord falls off
  3. CThe baby's blood cannot be sampled before day 3
  4. DEarlier testing always gives false negatives for all conditions
20.产科护理困难

A woman has a painful, red breast with a fluctuant swelling that has not improved after antibiotics. What should be suspected?

  1. AA blocked duct needing only massage
  2. BA breast abscess needing drainage
  3. CNormal engorgement
  4. DAn allergic reaction to the antibiotic
21.儿科护理中等

A child is in skin traction for a leg fracture. Which nursing action is correct?

  1. ALet the weights rest on the floor while the child sleeps, so the pull is gentler
  2. BLift the weights off when the child is uncomfortable
  3. CRemove the traction tapes every hour to check the skin
  4. DKeep the weights hanging freely, clear of the bed and floor
22.儿科护理困难

A 6-year-old boy has had a limp and mild hip pain for several weeks. Imaging shows avascular necrosis of the femoral head. What is the diagnosis?

  1. ASlipped capital femoral epiphysis
  2. BTransient synovitis
  3. CDevelopmental dysplasia of the hip
  4. DLegg–Calvé–Perthes disease
23.精神科护理中等

A patient taking an antipsychotic is going on a summer day trip. What should the nurse teach?

  1. AExercise as hard as possible in the heat to burn off the extra weight
  2. BAvoid all fluids so that there is less need to find a toilet
  3. CDrink enough fluids and avoid overheating, because the medicine can affect temperature control
  4. DStop the medicine for the day so that it does not interact with the sunlight and cause a dangerous reaction
24.精神科护理困难

A patient who had been abstinent from alcohol for 6 months has started drinking again. He says, "I've failed completely. There's no point in trying." What is the most helpful response?

  1. A"You'll have to start a completely new treatment from the beginning."
  2. B"Relapse is common in recovery. Let's look at what led to it and what you learned."
  3. C"Yes, I'm afraid you've wasted all of your hard work over the last six months."
  4. D"You obviously weren't serious about stopping."
25.护理数学与单位换算中等
94969810010210410635363738394041°F°C99.6 °F? °C

练习题（虚构数值，不作为临床指导）。 一位患者的体温为 99.6 °F。用 °C = (°F − 32) × 5/9 把它换算为摄氏度T。取到一位小数。

99.6 °F
T = °C
26.护理数学与单位换算困难
00:0022:5505:30t = ?

练习题（虚构数值，不作为临床指导）。 一次输注从 22:55 开始，到次日早晨 05:30 结束（24 小时制）。它运行了多少分钟t？

22:5505:30
t = min
27.剂量计算中等
024681010 mL

一名体重 15 kg 的儿童按 2 mg/kg 处方用药。原液浓度为 10 mg/mL。请抽取剂量：应给多少体积 V？

15 kg2 mg/kg10 mg/mL
V = mL
28.剂量计算困难
00.10.20.30.40.50.60.70.80.911 mL

处方为 270 单位的药物，药液规格为 1000 单位/mL。请用 1 mL 注射器抽取剂量：应给多少体积 V？

270 units1000 units/mL
V = 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
1000 mg50 mL5 mL/h? mg/h

一袋液体在 50 mL 中含药 1000 mg，以 5 mL/h 的速度输注。患者每小时获得多少毫克 D？

1000 mg/50 mL5 mL/h
D = mg/h
31.静脉输液与液体平衡中等
入量出量8 小时班次汤180 mL水120 mL冰屑100 mL静脉输液60 mL/h × 8 h静脉抗生素2 × 100 mL尿液225 mL尿液400 mL尿液275 mL尿液500 mL呕吐物100 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。求总入量 I，以 mL 计。 冰屑按其体积的一半计。

汤: 180 mL水: 120 mL冰屑: 100 mL静脉输液: 60 mL/h × 8 h静脉抗生素: 2 × 100 mL
I = mL
32.静脉输液与液体平衡困难
1000 mL100 mL/h开始 11:3014:00: ? mL

练习题（虚构数值，不作为临床指导）。 一袋 1000 mL 的液体于 11:30 开始用输液泵以 100 mL/h 输注。到 14:00 时袋中还剩多少 mL V？

1000 mL100 mL/h11:30 → 14:00
V = mL
33.临床评估评分中等
12474SBPDBPmmHgHR 129/min · SI = ?

练习题（虚构数值，不作为临床指导）。 一位患者的脉搏为 129 次/分，血压为 124/74 mmHg。求休克指数SI = HR/SBP。取到两位小数。

HR 129/minBP 124/74 mmHg
SI =
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: 否; 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: 正常、卧床休息或轮椅; 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: A · The tubing for kinks or blockage and where the bag is

为什么是这个答案

Kinked or trapped tubing, a bag above bladder level or a blocked catheter are common causes. If these are fine, the patient is assessed for low output and the doctor informed.

答案

A · The tubing for kinks or blockage and where the bag is
2.护理学基础

答案: A · Give controlled oxygen, e.g. via a Venturi mask, aiming for 88–92%

为什么是这个答案

Oxygen must not be withheld from a hypoxic patient. In those at risk of hypercapnia it is given in a controlled way to a target of 88–92%, with blood gases checked.

答案

A · Give controlled oxygen, e.g. via a Venturi mask, aiming for 88–92%
3.感染控制与患者安全

答案: C · Above the elbows, so water runs from the fingertips toward the elbows

为什么是这个答案

After a surgical scrub, the hands are the cleanest area, so they are held above the elbows to let water drain away from them toward the less clean elbows.

答案

C · Above the elbows, so water runs from the fingertips toward the elbows
4.感染控制与患者安全

答案: D · The nasal spray is a live vaccine, so the injected inactivated vaccine is used instead

为什么是这个答案

The nasal spray influenza vaccine contains live, weakened virus and is avoided in immunosuppressed people. The inactivated injectable vaccine is safe and recommended for them.

答案

D · The nasal spray is a live vaccine, so the injected inactivated vaccine is used instead
5.优先排序与委派

答案: B · 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

B · 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: B · Decline, explain why and suggest who can safely do it

为什么是这个答案

Nurses must work within their legal scope of practice, even when asked by a provider. The nurse declines, explains the reason and helps find a suitable professional.

答案

B · Decline, explain why and suggest who can safely do it
7.临床护理

答案: C · Reassess the pain and any side effects once the drug has had time to work

为什么是这个答案

The effect of analgesia should be reassessed when it is expected to work, with side effects such as sedation and breathing checked. The result is documented and the plan adjusted.

答案

C · Reassess the pain and any side effects once the drug has had time to work
8.临床护理

答案: D · 低钾血症

为什么是这个答案

呕吐和袢利尿剂都会导致失钾。低钾血症会引起乏力、肌肉痉挛和心律失常，需要监测和补充。

答案

D · 低钾血症
9.实验室检查值与电解质

答案: A · Folic acid can fix the anemia while B12-related nerve damage continues

为什么是这个答案

Folic acid can improve the blood picture in B12 deficiency but does not prevent nerve damage. Giving folate alone can therefore mask the deficiency while neurological damage progresses. Both levels are checked before treatment.

答案

A · Folic acid can fix the anemia while B12-related nerve damage continues
10.实验室检查值与电解质

答案: C · Disseminated intravascular coagulation (DIC)

为什么是这个答案

In DIC, widespread clotting consumes platelets and clotting factors, so PT and aPTT are prolonged and fibrinogen falls, while clot breakdown raises the D-dimer. ITP lowers platelets only, and hemophilia A prolongs only the aPTT.

答案

C · Disseminated intravascular coagulation (DIC)
11.药理学

答案: D · INR (prothrombin time)

为什么是这个答案

Warfarin is monitored with the INR, a standardised prothrombin time. For most indications, such as atrial fibrillation or venous thrombosis, the target is usually 2–3.

答案

D · INR (prothrombin time)
12.药理学

答案: B · Symptomatic low blood pressure and fainting

为什么是这个答案

Alpha blockers and PDE5 inhibitors both cause vasodilation, so together they can cause marked hypotension. Patients should be stable on the alpha blocker, and the PDE5 inhibitor is started at a low dose.

答案

B · Symptomatic low blood pressure and fainting
13.内外科护理：心血管与呼吸

答案: D · Ambulatory or structured home blood pressure monitoring

为什么是这个答案

"White-coat" hypertension means raised readings only in clinical settings. Ambulatory monitoring over 24 hours or a structured series of home readings gives a truer picture and is widely recommended before diagnosing hypertension.

答案

D · Ambulatory or structured home blood pressure monitoring
14.内外科护理：心血管与呼吸

答案: B · Lie the patient down, raise the leg and press firmly on the site

为什么是这个答案

Bleeding from a varicose vein can be dramatic. Lying the patient flat and raising the leg above heart level lowers venous pressure, and firm direct pressure stops most bleeds. Medical review is needed afterwards, as it can recur.

答案

B · Lie the patient down, raise the leg and press firmly on the site
15.内外科护理：神经、内分泌与肾脏

答案: D · 低血压、脉搏缓慢、皮肤温暖干燥

为什么是这个答案

神经源性休克见于 T6 或以上水平的损伤。交感张力丧失引起血管扩张（皮肤温暖干燥）和迷走神经活动失去对抗（心动过缓）。低血容量性休克引起心动过速和皮肤湿冷；创伤患者可能两者都有，因此仍需寻找出血。

答案

D · 低血压、脉搏缓慢、皮肤温暖干燥
16.内外科护理：神经、内分泌与肾脏

答案: A · "I can stop the tablets once I feel back to normal."

为什么是这个答案

In Hashimoto's thyroiditis the gland is permanently damaged, so levothyroxine is usually lifelong. Feeling well shows that the dose is right, not that the disease is cured. Stopping causes symptoms to return.

答案

A · "I can stop the tablets once I feel back to normal."
17.内外科护理：消化、围手术期与肿瘤

答案: B · A metabolite can build up and cause seizures

为什么是这个答案

Pethidine's metabolite norpethidine accumulates with repeated doses or kidney impairment and can cause agitation, tremor and seizures. Other opioids are preferred.

答案

B · A metabolite can build up and cause seizures
18.内外科护理：消化、围手术期与肿瘤

答案: B · 恢复呼吸，同时不引起剧烈疼痛和戒断反应

为什么是这个答案

大剂量推注可突然逆转镇痛，引起剧烈疼痛、躁动、高血压、肺水肿和心律失常。滴定小剂量可恢复足够的呼吸。因为纳洛酮的作用可能比阿片类药物短，可能需要监测并重复给药或持续输注。

答案

B · 恢复呼吸，同时不引起剧烈疼痛和戒断反应
19.产科护理

答案: A · Some results, such as PKU, need milk feeds first

为什么是这个答案

Phenylalanine builds up only after the baby has had milk feeds, so very early samples can miss PKU. Programmes specify timing, and early samples may need repeating.

答案

A · Some results, such as PKU, need milk feeds first
20.产科护理

答案: B · A breast abscess needing drainage

为什么是这个答案

A fluctuant, persistent painful mass despite antibiotics suggests a breast abscess. It needs ultrasound and drainage. Breastfeeding from the other breast can usually continue.

答案

B · A breast abscess needing drainage
21.儿科护理

答案: D · Keep the weights hanging freely, clear of the bed and floor

为什么是这个答案

The weights must hang freely to keep a steady pull, and the ropes must run smoothly over the pulleys. The nurse checks the skin, circulation and sensation regularly without removing the traction unless allowed.

答案

D · Keep the weights hanging freely, clear of the bed and floor
22.儿科护理

答案: D · Legg–Calvé–Perthes disease

为什么是这个答案

Perthes disease is avascular necrosis of the femoral head in children, most often boys aged about 4–8 years. It presents with a limp and hip, thigh or knee pain; treatment aims to keep the femoral head well positioned in the socket while it heals.

答案

D · Legg–Calvé–Perthes disease
23.精神科护理

答案: C · Drink enough fluids and avoid overheating, because the medicine can affect temperature control

为什么是这个答案

Antipsychotics, especially those with anticholinergic effects, can impair sweating and thermoregulation, increasing the risk of heat stroke. Hydration, shade and avoiding strenuous activity in the heat are advised.

答案

C · Drink enough fluids and avoid overheating, because the medicine can affect temperature control
24.精神科护理

答案: B · "Relapse is common in recovery. Let's look at what led to it and what you learned."

为什么是这个答案

Relapse is common and does not mean failure. Treating it as a learning opportunity, reviewing triggers and coping strategies and returning to the plan supports the person's motivation.

答案

B · "Relapse is common in recovery. Let's look at what led to it and what you learned."
25.护理数学与单位换算

答案: T = 37.6 °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

99.6 − 32 = 67.6

乘以 5/9

T = 67.6·5/9 = 37.56 ≈ 37.6 °C

答案

T = 37.6 °C
26.护理数学与单位换算

答案: t = 395 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

22:55 → 24:00 = 65 min

午夜之后

00:00 → 05:30 = 330 min

合计

t = 65 + 330 = 395 min

答案

t = 395 min
27.剂量计算

答案: V = 3 mL

抽取剂量：体积 = (处方剂量/药物浓度) × 药物体积。先换算成相同的单位，再检查该体积是否适合注射器，并落在它的某一个刻度上。

按体重计算剂量

D = 2·15 = 30 mg

体积

V = 30/10 = 3 mL

在注射器上

在这支 10 mL 的注射器上，每条小刻度线代表 0.2 mL。

答案

V = 3 mL
28.剂量计算

答案: V = 0.27 mL

抽取剂量：体积 = (处方剂量/药物浓度) × 药物体积。先换算成相同的单位，再检查该体积是否适合注射器，并落在它的某一个刻度上。

体积

V = 270/1000 = 0.27 mL

在注射器上

在这支 1 mL 的注射器上，每条小刻度线代表 0.01 mL。

答案

V = 0.27 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: D = 100 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

1000/50 = 20 mg/mL

给药速率

D = 20·5 = 100 mg/h

答案

D = 100 mg/h
31.静脉输液与液体平衡

答案: I = 1030 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。

计算入量

口服: 180 + 120 = 300 mL
冰屑: 100/2 = 50 mL
静脉输液: 60·8 = 480 mL
静脉抗生素: 2·100 = 200 mL
I = 1030 mL

答案

I = 1030 mL
32.静脉输液与液体平衡

答案: V = 750 mL

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。

经过的时间

11:30 → 14:00 = 2.5 h

已输入体积

100·2.5 = 250 mL

剩余体积

V = 1000 − 250 = 750 mL

答案

V = 750 mL
33.临床评估评分

答案: SI = 1.04

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 = 129/124 = 1.04

答案

SI = 1.04

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: 低风险

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: 否 → 0
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: 正常、卧床休息或轮椅 → 0
精神状态: 高估或忘记自身局限 → 15

相加

Morse 总分 = 0 + 0 + 0 + 0 + 0 + 15 = 15

风险等级

15 → 低风险

答案

低风险

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