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

How should a nurse speak to a patient with hearing loss?

  1. AShout loudly from behind the patient so they can hear every word
  2. BFace the patient and speak clearly at a normal pace
  3. CSpeak very fast to keep the message short
  4. DCover the mouth to stop background noise
2.护理学基础困难

A patient spills hot tea on their forearm. What is the best immediate first aid?

  1. APop any blisters to let the heat escape
  2. BCover it with butter or a greasy cream
  3. CCool the burn under cool running water for about 20 minutes
  4. DPut ice or an ice pack directly on the burn for about 10 minutes
3.感染控制与患者安全中等

使用中心静脉导管接头之前，护士应该做什么？

  1. A用消毒剂擦洗接头并待其干燥
  2. B轻轻吹接头以去除灰尘
  3. C什么都不用做，因为接头在无菌帽的保护下
  4. D用干的无菌纱布快速擦拭
4.感染控制与患者安全困难

A competent patient at high risk of falls insists on walking to the bathroom alone. What is the best nursing approach?

  1. AApply wrist restraints so the patient stays in bed
  2. BTell the patient that walking alone is against hospital law
  3. CExplain the risks, agree on ways to reduce them, respect the decision and document
  4. DRemove the patient’s shoes and walking aid so that they cannot walk alone
5.优先排序与委派中等

Which action helps prevent a catheter-associated urinary tract infection?

  1. ALeaving the catheter in place longer than needed
  2. BRaising the drainage bag above the bladder when walking
  3. CKeeping the drainage bag below the level of the bladder
  4. DDisconnecting the bag every shift to empty it
6.优先排序与委派困难

A toddler with tetralogy of Fallot becomes very blue and breathless while crying. What should the nurse do first?

  1. APlace the child in a knee-to-chest position
  2. BEncourage the child to keep crying to open the lungs
  3. CLay the child flat on their back
  4. DGive a large drink of water to calm the child
7.临床护理中等

What should a patient be told before using sublingual glyceryl trinitrate (GTN, nitroglycerin) spray for angina?

  1. ATake it with a large glass of milk to protect the stomach lining
  2. BSwallow the spray rather than leaving it under the tongue
  3. CUse it only after the pain has lasted over an hour, with the patient lying flat
  4. DSit down before using it, as it can cause dizziness and low blood pressure
8.临床护理困难

Why can sepsis be missed in older adults?

  1. AOlder adults cannot develop sepsis because their immune system is weaker
  2. BThey may have no fever and present with confusion, falls or reduced mobility
  3. COlder adults always have a very high fever
  4. DBlood tests are not useful in older people
9.实验室检查值与电解质中等

A patient starts high-dose prednisone. Which laboratory change should the nurse expect?

  1. AA fall in the white cell count
  2. BA rise in serum potassium
  3. CA fall in serum sodium
  4. DA rise in blood glucose
10.实验室检查值与电解质困难

A patient has macrocytic anemia with low vitamin B12 and antibodies to intrinsic factor. What does this suggest, and how is it usually treated?

  1. AFolate deficiency, treated with folic acid only
  2. BHemolytic anemia, treated with blood transfusion
  3. CPernicious anemia, treated with B12 injections
  4. DIron deficiency, treated with oral iron tablets
11.药理学中等

A patient uses a salbutamol (albuterol) inhaler and a corticosteroid inhaler at the same time of day. Which order is usually taught?

  1. AUse both in the same breath to save time
  2. BUse the steroid first, then the salbutamol right after without any gap
  3. CThe order does not matter and no waiting is needed
  4. DUse the salbutamol first, wait a few minutes, then use the steroid
12.药理学困难

A patient with myasthenia gravis took extra pyridostigmine doses. She now has increasing weakness, heavy salivation, sweating, small pupils and diarrhoea. What is the most likely cause?

  1. AAn allergic reaction to pyridostigmine
  2. BCholinergic crisis from too much anticholinesterase drug
  3. CA stroke unrelated to the medication
  4. DMyasthenic crisis from too little anticholinesterase drug
13.内外科护理：心血管与呼吸中等

哪一组副作用是噻嗪类或吲达帕胺等类噻嗪利尿剂的典型副作用？

  1. A高钾、高钠、尿酸降低和血糖降低
  2. B低钾、低钠、尿酸升高和血糖升高
  3. C高钠、高镁，血糖降低
  4. D干咳、味觉障碍和嘴唇肿胀
14.内外科护理：心血管与呼吸困难

A nurse looked after a patient for a shift before smear-positive pulmonary TB was diagnosed, without wearing a respirator. What should happen?

  1. AStay off work for six months in case symptoms develop
  2. BStart a full six-month course of TB drugs at once without any tests
  3. CReport it so occupational health can arrange follow-up screening
  4. DTake no action, as healthcare workers are immune to TB
15.内外科护理：神经、内分泌与肾脏中等

A patient with Alzheimer's disease starts donepezil. Which side effects should the nurse look for?

  1. ANausea, diarrhoea and a slow heart rate
  2. BWeight gain, high glucose and swollen ankles
  3. CA persistent dry cough and a raised potassium
  4. DDry mouth, constipation and a fast heart rate
16.内外科护理：神经、内分泌与肾脏困难

A man who takes tamsulosin for BPH is listed for cataract surgery. Which statement is correct?

  1. ATamsulosin has no effects outside the urinary tract, so nothing changes
  2. BThe eye surgeon must be told, as it can cause floppy iris during surgery
  3. CIt should be swapped for oxybutynin the night before to protect the eye
  4. DThe dose should be doubled before surgery to prevent urinary retention
17.内外科护理：消化、围手术期与肿瘤中等

许多化疗药物给药后，对体液采取特殊预防措施通常要持续多长时间？

  1. A从不需要
  2. B仅在输注期间
  3. C整整一年
  4. D通常约 48 小时
18.内外科护理：消化、围手术期与肿瘤困难

一名乳腺癌患者出现意识混乱、口渴、便秘和多尿。应考虑哪种肿瘤急症？

  1. A肿瘤溶解综合征
  2. B上腔静脉阻塞
  3. C恶性肿瘤相关高钙血症
  4. D低血糖
19.产科护理中等

Why are afterpains often stronger in multiparous women?

  1. ATheir uterus is always infected
  2. BThey have a smaller uterus than first-time mothers
  3. CTheir uterus contracts and relaxes more irregularly
  4. DThey produce no oxytocin after birth
20.产科护理困难

一名妊娠期糖尿病女性在孕期使用胰岛素。产后即刻她的胰岛素需求预期会有何变化？

  1. A6 周内保持不变
  2. B因分娩的应激而增加一倍，所以要增加胰岛素剂量
  3. C迅速下降，因此需监测血糖，常停用胰岛素
  4. D她将需要终身使用胰岛素
21.儿科护理中等

A child with suspected measles is admitted. Which precaution is most important?

  1. ADroplet precautions in a shared bay
  2. BContact precautions only, with gloves
  3. CNo special precautions once the rash appears
  4. DAirborne precautions, ideally in a negative-pressure room
22.儿科护理困难

A 14-year-old took a large overdose of paracetamol (acetaminophen) 4 hours ago and says she feels fine. What should the nurse understand?

  1. AParacetamol is not toxic, so she only needs a psychiatric assessment
  2. BLiver damage develops over days, so urgent acetylcysteine may still be needed
  3. CSince she feels well, the overdose was too small to be harmful
  4. DTreatment is only useful if started within 30 minutes, so it is now too late to help
23.精神科护理中等

A patient who started a high-dose corticosteroid (prednisolone or prednisone) a week ago is now euphoric, sleeping little and talking very fast. What should the nurse suspect?

  1. AA normal reaction to feeling better from the treatment
  2. BAlcohol withdrawal
  3. CMood changes caused by the corticosteroid
  4. DLithium toxicity
24.精神科护理困难

A teenager says she cuts herself "to feel better, not to die." Which statement about this is correct?

  1. AShe should be told that cutting is only attention-seeking behaviour
  2. BNon-suicidal self-injury still increases the long-term risk of suicide, so risk is assessed each time
  3. CSelf-injury without suicidal intent shows that she has no mental health problems that need any treatment
  4. DSelf-injury without suicidal intent never needs any assessment
25.护理数学与单位换算中等
94969810010210410635363738394041°F°C? °F38 °C

练习题（虚构数值，不作为临床指导）。 一位患者的体温为 38 °C。用 °F = °C × 9/5 + 32 把它换算为华氏度T。取到一位小数。

38 °C
T = °F
26.护理数学与单位换算困难
12 mg/h? mcg/min1 mg = 1000 mcg1 h = 60 min

练习题（虚构数值，不作为临床指导）。 一次输注的给药速率为 12 mg/h。请把这个剂量速率D用 mcg/min 表示。取到一位小数。

12 mg/h1 mg = 1000 mcg1 h = 60 min
D = mcg/min
27.剂量计算中等
024681010 mL

一名体重 7 kg 的儿童按 4 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？

7 kg4 mg/kg10 mg/mL
V = mL
28.剂量计算困难
25k 件1000 mL? mL/h1200 件/h

一袋输液在 1000 mL 中含 25000 单位药物。医嘱为每小时 1200 单位。泵速 R 应设为多少 mL/h？

25000 件/1000 mL1200 件/h
R = mL/h
29.静脉输液速度中等
1000 mL15 gtt/mL10 h? gtt/min

用滴系数为 15 滴/mL 的输液器在 10 小时内输入 1000 mL。求滴速 R（滴/分）。

1000 mL10 h15 gtt/mL
R = gtt/min
30.静脉输液速度困难
560 mL剩余? mL/h4 h 剩余

医嘱要求在 8 小时内输入 1000 mL。4 小时后你发现袋中还剩 560 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？

1000 mL / 8 h经过 4 h: 560 mL
Δ = %
31.静脉输液与液体平衡中等
入量出量8 小时班次牛奶240 mL茶240 mL冰屑100 mL静脉输液80 mL/h × 8 h静脉抗生素1 × 100 mL尿液275 mL尿液425 mL尿液150 mL尿液300 mL呕吐物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 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）。 冰屑按其体积的一半计。

牛奶: 240 mL茶: 240 mL冰屑: 100 mL静脉输液: 80 mL/h × 8 h静脉抗生素: 1 × 100 mL尿液: 275 mL尿液: 425 mL尿液: 150 mL尿液: 300 mL呕吐物: 200 mL
B = mL
32.静脉输液与液体平衡困难
500 mL→ 100 mL/h开始 08:30t总数​ = ? h150 mL/h × 2 h

练习题（虚构数值，不作为临床指导）。 一份 500 mL 的输液于 08:30 开始以 150 mL/h 输注。2 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。

500 mL150 mL/h · 2 h100 mL/h
t = h
33.临床评估评分中等
3210123RR≤89–1112–2021–24≥25SpO₂≤9192–9394–95≥96空气 / O₂O₂空气SBP≤9091–100101–110111–219≥220HR≤4041–5051–9091–110111–130≥131ACVPUAC, V, P, UT °C≤35.035.1–36.036.1–38.038.1–39.0≥39.1

练习题（虚构数值，不作为临床指导）。 对这些观察结果使用 NEWS2 图表（SpO₂ 量表 1）：呼吸频率 12 次/分，SpO₂ 88%吸室内空气，血压 130/78 mmHg，脉搏 70 次/分，清醒，体温 36.4 °C。NEWS2 总分是多少？

RR 12SpO₂ 88%空气SBP 130HR 70AT 36.4 °C
NEWS2 =
34.临床评估评分困难
86?SBPDBPmmHgMAP = 70

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 70 mmHg。一位患者的收缩压为 86 mmHg。使用 MAP = (SBP + 2·DBP)/3，仍能使 MAP 达到 70 mmHg 的最低舒张压DBP是多少？

MAP 70 mmHgSBP 86 mmHg
DBP = mmHg

3溶液

1.护理学基础

答案: B · Face the patient and speak clearly at a normal pace

为什么是这个答案

Facing the patient in good light, reducing background noise and speaking clearly, without shouting, helps understanding. Hearing aids should be in and working.

答案

B · Face the patient and speak clearly at a normal pace
2.护理学基础

答案: C · Cool the burn under cool running water for about 20 minutes

为什么是这个答案

Cool running water for about 20 minutes reduces pain and depth of injury. Ice can damage tissue further, grease holds heat in, and blisters are left intact to protect the skin.

答案

C · Cool the burn under cool running water for about 20 minutes
3.感染控制与患者安全

答案: A · 用消毒剂擦洗接头并待其干燥

为什么是这个答案

用酒精或氯己定等消毒剂“擦洗接头”，并充分摩擦、留足干燥时间，可减少中心静脉导管相关血流感染。干燥时间是消毒的一部分。

答案

A · 用消毒剂擦洗接头并待其干燥
4.感染控制与患者安全

答案: C · Explain the risks, agree on ways to reduce them, respect the decision and document

为什么是这个答案

A competent patient can accept a risk. The nurse explains the danger, offers measures such as a low bed, non-slip footwear, a clear path and a call light, respects the choice and documents the discussion.

答案

C · Explain the risks, agree on ways to reduce them, respect the decision and document
5.优先排序与委派

答案: C · Keeping the drainage bag below the level of the bladder

为什么是这个答案

Keeping the bag below the bladder prevents backflow, and the closed system is not broken. Catheters are removed as soon as they are no longer needed.

答案

C · Keeping the drainage bag below the level of the bladder
6.优先排序与委派

答案: A · Place the child in a knee-to-chest position

为什么是这个答案

In a hypercyanotic (“tet”) spell, the knee-chest position raises systemic vascular resistance and sends more blood to the lungs. Oxygen and prescribed medication follow.

答案

A · Place the child in a knee-to-chest position
7.临床护理

答案: D · Sit down before using it, as it can cause dizziness and low blood pressure

为什么是这个答案

GTN causes vasodilation, which can lead to headache, flushing, dizziness and hypotension. Patients should sit, and seek emergency help if the pain does not settle after the advised doses.

答案

D · Sit down before using it, as it can cause dizziness and low blood pressure
8.临床护理

答案: B · They may have no fever and present with confusion, falls or reduced mobility

为什么是这个答案

Older people may have a normal or low temperature and present with delirium, falls or general decline. Early warning scores and a high index of suspicion are important.

答案

B · They may have no fever and present with confusion, falls or reduced mobility
9.实验室检查值与电解质

答案: D · A rise in blood glucose

为什么是这个答案

Glucocorticoids raise blood glucose by increasing glucose production and reducing insulin sensitivity. They also tend to lower potassium, retain sodium and raise the white cell count by releasing neutrophils into the blood.

答案

D · A rise in blood glucose
10.实验室检查值与电解质

答案: C · Pernicious anemia, treated with B12 injections

为什么是这个答案

Pernicious anemia is an autoimmune condition in which antibodies block intrinsic factor or destroy the cells that make it, so B12 is not absorbed. Treatment is lifelong B12, usually by injection (very high oral doses are an alternative).

答案

C · Pernicious anemia, treated with B12 injections
11.药理学

答案: D · Use the salbutamol first, wait a few minutes, then use the steroid

为什么是这个答案

The bronchodilator opens the airways so that the inhaled steroid can reach further into the lungs. A short wait between the inhalers is usually advised.

答案

D · Use the salbutamol first, wait a few minutes, then use the steroid
12.药理学

答案: B · Cholinergic crisis from too much anticholinesterase drug

为什么是这个答案

Excess acetylcholine causes muscarinic signs (salivation, sweating, miosis, diarrhoea) and depolarising weakness. In myasthenic crisis, weakness occurs without these cholinergic signs; both can cause respiratory failure.

答案

B · Cholinergic crisis from too much anticholinesterase drug
13.内外科护理：心血管与呼吸

答案: B · 低钾、低钠、尿酸升高和血糖升高

为什么是这个答案

噻嗪类可引起低钾血症、低钠血症、低镁血症、高尿酸血症（痛风）、高血糖和高钙血症（它们减少钙的排泄）。干咳和血管性水肿是 ACE 抑制剂的作用。

答案

B · 低钾、低钠、尿酸升高和血糖升高
14.内外科护理：心血管与呼吸

答案: C · Report it so occupational health can arrange follow-up screening

为什么是这个答案

Contact tracing includes staff exposed without respiratory protection. Occupational health assesses the risk, checks for symptoms and arranges testing (for example IGRA) at suitable intervals. Treatment is offered for latent infection if found. Exposed people do not usually need to stop work unless they become unwell.

答案

C · Report it so occupational health can arrange follow-up screening
15.内外科护理：神经、内分泌与肾脏

答案: A · Nausea, diarrhoea and a slow heart rate

为什么是这个答案

Donepezil is a cholinesterase inhibitor. Raised acetylcholine can cause nausea, vomiting, diarrhoea, vivid dreams and bradycardia, which can lead to dizziness or fainting.

答案

A · Nausea, diarrhoea and a slow heart rate
16.内外科护理：神经、内分泌与肾脏

答案: B · The eye surgeon must be told, as it can cause floppy iris during surgery

为什么是这个答案

Tamsulosin blocks alpha-1A receptors in the iris dilator muscle as well as in the prostate, which can cause intraoperative floppy iris syndrome during cataract surgery. The effect can persist after the drug is stopped, so the surgeon must know in advance to plan the operation. Whether to pause it is a decision for the team.

答案

B · The eye surgeon must be told, as it can cause floppy iris during surgery
17.内外科护理：消化、围手术期与肿瘤

答案: D · 通常约 48 小时

为什么是这个答案

许多细胞毒性药物在给药后的一段时间内会经尿、粪、呕吐物和其他体液排出。当地规定通常要求处理体液时戴手套和穿隔离衣约 48 小时，某些药物需要更长时间。

答案

D · 通常约 48 小时
18.内外科护理：消化、围手术期与肿瘤

答案: C · 恶性肿瘤相关高钙血症

为什么是这个答案

恶性肿瘤相关高钙血症引起口渴、多尿、脱水、便秘、恶心、意识混乱和心律失常。治疗是先静脉补液，然后使用双膦酸盐，并监测钙和肾功能。肿瘤溶解引起的是低钙。

答案

C · 恶性肿瘤相关高钙血症
19.产科护理

答案: C · Their uterus contracts and relaxes more irregularly

为什么是这个答案

In multiparas, and after overdistension such as twins, the uterus relaxes and contracts intermittently, causing stronger afterpains. Breastfeeding increases them through oxytocin.

答案

C · Their uterus contracts and relaxes more irregularly
20.产科护理

答案: C · 迅速下降，因此需监测血糖，常停用胰岛素

为什么是这个答案

胎盘产生引起胰岛素抵抗的激素。分娩后血糖通常恢复正常，因此常停用胰岛素并检测血糖。产后数周她需要做血糖检测，并长期筛查 2 型糖尿病。

答案

C · 迅速下降，因此需监测血糖，常停用胰岛素
21.儿科护理

答案: D · Airborne precautions, ideally in a negative-pressure room

为什么是这个答案

Measles spreads through the air and can remain in a room for up to about 2 hours. Airborne precautions, a negative-pressure room where available and immune staff are required.

答案

D · Airborne precautions, ideally in a negative-pressure room
22.儿科护理

答案: B · Liver damage develops over days, so urgent acetylcysteine may still be needed

为什么是这个答案

Paracetamol overdose may cause few early symptoms, but the toxic metabolite damages the liver over the following days. A timed blood level guides treatment with acetylcysteine, which works best when started early. A mental health assessment is also needed.

答案

B · Liver damage develops over days, so urgent acetylcysteine may still be needed
23.精神科护理

答案: C · Mood changes caused by the corticosteroid

为什么是这个答案

High-dose corticosteroids can cause mood changes, including mania, depression and psychosis. The nurse reports the change so the prescriber can review the dose and treatment.

答案

C · Mood changes caused by the corticosteroid
24.精神科护理

答案: B · Non-suicidal self-injury still increases the long-term risk of suicide, so risk is assessed each time

为什么是这个答案

Self-harm is a strong predictor of later suicide, even when the person does not intend to die. Each episode needs a compassionate assessment of risk, triggers and the function of the behaviour.

答案

B · Non-suicidal self-injury still increases the long-term risk of suicide, so risk is assessed each time
25.护理数学与单位换算

答案: T = 100.4 °F

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。

乘以 9/5

38·9/5 = 68.4

加 32

T = 68.4 + 32 = 100.4 °F

答案

T = 100.4 °F
26.护理数学与单位换算

答案: D = 200 mcg/min

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。

列出换算链

D = 12 mg/h × (1000 mcg/1 mg) × (1 h/60 min)

计算

D = 12000/60 = 200 mcg/min

答案

D = 200 mcg/min
27.剂量计算

答案: V = 2.8 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 = 4·7 = 28 mg

体积

V = 28/10 = 2.8 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 = 2.8 mL
28.剂量计算

答案: R = 48 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

25000/1000 = 25 件/mL

泵速

R = 1200/25 = 48 mL/h

答案

R = 48 mL/h
29.静脉输液速度

答案: R = 25 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

10·60 = 600 min

滴速

R = 1000·15/600 = 25 gtt/min

答案

R = 25 gtt/min
30.静脉输液速度

答案: Δ = 12 %

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

1000/8 = 125 mL/h

新速率

R = 560/4 = 140 mL/h

变化百分比

Δ = (140 − 125)/125·100% = 12%

答案

Δ = 12%

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。

31.静脉输液与液体平衡

答案: B = −80 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 + 240 = 480 mL
冰屑: 100/2 = 50 mL
静脉输液: 80·8 = 640 mL
静脉抗生素: 1·100 = 100 mL
总入量 = 1270 mL

总出量

275 + 425 + 150 + 300 + 200 = 1350 mL

平衡

B = 1270 − 1350 = −80 mL

答案

B = −80 mL

为负：患者丢失的液体多于摄入的液体。

32.静脉输液与液体平衡

答案: t = 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。

第一部分

150·2 = 300 mL
500 − 300 = 200 mL 剩余

第二部分

200/100 = 2 h

总时间

t = 2 + 2 = 4 h

答案

t = 4 h

约为 4 h 00 min，所以袋子大约在 12:30 输完。

33.临床评估评分

答案: NEWS2 = 3

NEWS2（国家早期预警评分 2，英国皇家内科医师学会 2017）：按图表为七个参数分别评分（呼吸频率、量表 1 的 SpO₂、吸空气还是吸氧、收缩压、脉搏、按 ACVPU 量表评定的意识状态和体温），然后把分数相加。临床风险：0–4 为低；任何单项参数得 3 分为中低；5–6 为中；7 或以上为高。总分 5 或以上需要紧急响应。

为每个参数评分

RR 12/min → 0
SpO₂ 88% → 3
吸空气 → 0
SBP 130 mmHg → 0
HR 70/min → 0
清醒 (A) → 0
T 36.4 °C → 0

相加

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

答案

NEWS2 = 3
34.临床评估评分

答案: DBP = 62 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 = (3·70 − 86)/2 = 124/2 = 62 mmHg

答案

DBP = 62 mmHg

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