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 is hand hygiene still needed after removing gloves?

  1. AHand hygiene is only needed if the gloves were sterile
  2. BGloves can have tiny holes and hands can be contaminated during removal
  3. CIt is not needed, as the gloves protected the hands
  4. DGlove powder causes skin allergies and must always be washed off the hands
2.护理学基础困难

A man skips bowel cancer screening because he feels healthy and thinks cancer will not happen to him. Which Health Belief Model concept best explains this?

  1. AHigh self-efficacy
  2. BStrong cues to action
  3. CHigh perceived benefits
  4. DLow perceived susceptibility
3.感染控制与患者安全中等

对乳胶过敏的患者，下列哪项患者安全措施最恰当？

  1. A使用无乳胶设备并清楚记录过敏情况
  2. B使用乳胶手套，之后认真洗手
  3. C只使用有粉乳胶手套
  4. D护理患者时完全不戴手套
4.感染控制与患者安全困难

A patient in a vest restraint has slid down in bed, and the vest is pressing against the neck. What should the nurse do first?

  1. ATighten the vest so the patient cannot slide down again
  2. BWrite a note about the event in the chart
  3. CRelease the restraint at once and reposition the patient
  4. DCall the provider to ask about a different restraint
5.优先排序与委派中等

Two nursing assistants argue loudly at the station about their assignments. What is the charge nurse’s best first step?

  1. AMeet both of them privately to hear each side
  2. BIgnore it and hope they sort it out
  3. CReport them to human resources at once
  4. DChange both of their assignments without any discussion
6.优先排序与委派困难

At the end of a shift, the nurse’s relief has not arrived and the patients are acutely ill. What should the nurse do?

  1. AAsk a nursing assistant to watch the patients until someone comes
  2. BStay and tell the charge nurse, and hand over before leaving
  3. CLeave on time, because the shift has officially ended
  4. DLeave a written note at the station and go home
7.临床护理中等

A patient on the ward has shingles with open blisters. Which people are most at risk from contact?

  1. APregnant women and immunocompromised people who have not had chickenpox
  2. BNo one, because shingles cannot spread
  3. COnly people over 80 who have already had shingles themselves
  4. DPeople who have already had chickenpox in childhood and are now healthy
8.临床护理困难

交接班开始时，病房护士应首先评估哪位患者？

  1. A生命体征平稳、等待出院的患者
  2. B新出现意识混乱、呼吸频率 28 次/分的患者
  3. C慢性背痛评分 4/10 的患者
  4. D要求使用缓泻剂的患者
9.实验室检查值与电解质中等

A test has very high sensitivity for a disease. What does a negative result mean?

  1. AThe disease is certain, so treatment should begin
  2. BThe disease is unlikely, so it helps rule it out
  3. CThe result cannot be used, because sensitivity is high
  4. DThe patient must have a different disease instead
10.实验室检查值与电解质困难

一名患者在大量呕血 30 分钟后到达。心率 125 次/分，但首次血红蛋白为 13.0 g/dL（130 g/L）。为什么血红蛋白具有误导性？

  1. A该检测在紧急情况下从不准确
  2. B丢失的是全血，所以浓度数小时后才会下降
  3. C出血时血红蛋白升高，掩盖了失血
  4. D该数值证明没有明显出血
11.药理学中等

阿昔洛韦主要用于治疗由什么引起的感染？

  1. A单纯疱疹病毒和水痘-带状疱疹病毒等疱疹病毒
  2. B产 β-内酰胺酶的细菌
  3. CHIV
  4. D甲型流感病毒
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. ACholinergic crisis from too much anticholinesterase drug
  2. BMyasthenic crisis from too little anticholinesterase drug
  3. CA stroke unrelated to the medication
  4. DAn allergic reaction to pyridostigmine
13.内外科护理：心血管与呼吸中等

After a bronchoscopy with throat anaesthesia, when can the patient eat and drink?

  1. AOnly after a chest X-ray has been reported
  2. BImmediately after the scope is removed
  3. CWhen the gag and cough reflexes have returned
  4. DAfter a full 24 hours without food
14.内外科护理：心血管与呼吸困难

心肌梗死三周后，一名患者出现发热、胸膜性胸痛（前倾时减轻）和心包摩擦音。最可能的诊断是什么？

  1. A急性主动脉夹层
  2. B急性左心衰竭
  3. C另一条动脉的新发 STEMI
  4. D心肌梗死后（Dressler）综合征
15.内外科护理：神经、内分泌与肾脏中等

A man starts tamsulosin for BPH. Which teaching point is most important?

  1. ATake it with grapefruit juice to make it work better
  2. BStand up slowly, because it can make you dizzy
  3. CExpect the drug to shrink the prostate within a day
  4. DStop it if the urine stream improves
16.内外科护理：神经、内分泌与肾脏困难

A nurse teaches a young adult with newly diagnosed epilepsy. Which statement shows a need for further teaching?

  1. A"As long as I take my tablets, I can swim alone."
  2. B"I will take a shower rather than a bath."
  3. C"I will tell my friends what to do if I have a seizure."
  4. D"I will keep a record of any seizures I have."
17.内外科护理：消化、围手术期与肿瘤中等

A patient is starting regular oral morphine. Which bowel advice is most appropriate?

  1. AWait until there has been no stool for a week
  2. BStop eating fibre completely
  3. CTake a bulk-forming laxative only with very little water
  4. DStart a regular laxative at the same time
18.内外科护理：消化、围手术期与肿瘤困难

A nurse teaches a patient about a fentanyl skin patch. Which statement shows a need for further teaching?

  1. A"I won't put a hot water bottle over the patch."
  2. B"I can cut the patch in half if I need less."
  3. C"I'll fold used patches sticky sides together before disposal."
  4. D"I'll put the new patch on a different area of skin."
19.产科护理中等

下列哪些表现是胎盘早剥的典型表现？

  1. A腹痛、子宫变硬或板状腹以及暗红色出血
  2. B手掌和足底瘙痒
  3. C无宫缩时漏出清亮液体
  4. D无痛性鲜红色出血，子宫柔软、松弛、无压痛
20.产科护理困难

A woman at 30 weeks reports a sudden gush of clear fluid from the vagina without contractions. What is the priority nursing action?

  1. AAssess the fetal heart rate and check the fluid, and avoid a digital examination
  2. BPerform a digital vaginal examination to check dilation
  3. CReassure her that it is urine and send her home
  4. DAdvise a warm bath to see whether the leaking stops
21.儿科护理中等

Which finding is expected in a healthy 4-month-old?

  1. AHolds the head steady when held upright, with little or no head lag
  2. BSits steadily without support for several minutes while playing with toys
  3. CPulls to stand while holding on to furniture
  4. DSays two or three clear words with meaning
22.儿科护理困难

Two weeks after a ventriculoperitoneal shunt was inserted, an infant has a fever, irritability and redness along the shunt tract. What should the nurse suspect?

  1. ATeething, which explains the fever and the irritability
  2. BShunt infection; report it urgently
  3. CAn allergy to the hospital soap
  4. DNormal healing; no action needed
23.精神科护理中等

A patient taking fluoxetine says she has started taking St John's wort to feel even better. What is the main risk?

  1. ASerotonin syndrome
  2. BHypertensive crisis from tyramine
  3. CAgranulocytosis
  4. DLithium toxicity
24.精神科护理困难

A caller says she is a patient's sister and asks how he is doing. The patient has not given consent to share information. What should the nurse do?

  1. ANeither confirm nor deny that he is there, and offer to pass on a message
  2. BAsk her to prove she is his sister and then share the details
  3. CTell her that he is on the ward but refuse to say anything else about his care or condition
  4. DGive a full update, because she is a close family member
25.护理数学与单位换算中等
4 lb 4 oz? kg1 lb = 16 oz1 kg = 2.2 lb

练习题（虚构数值，不作为临床指导）。 一名新生儿体重 4 lb 4 oz。按 1 lb = 16 oz 和 1 kg = 2.2 lb，求以千克表示的体重m。取到两位小数。

4 lb 4 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.护理数学与单位换算困难
4 mcg/min? mg/h1 h = 60 min1 mg = 1000 mcg

练习题（虚构数值，不作为临床指导）。 一次输注的给药速率为 4 mcg/min。请把这个剂量速率D用 mg/h 表示。

4 mcg/min1 h = 60 min1 mg = 1000 mcg
D = mg/h
27.剂量计算中等
1:10 000安瓿V = ? mL

一支肾上腺素预充式注射器标示为 1:10 000（0.1 mg/mL）。医嘱为心脏骤停时 1 mg 静脉注射（IV）。你应给多少体积 V？

1:10 0001 mg
V = mL
28.剂量计算困难
62 kg180 cmBSA = √(h·w/3600)75 mg/m²D = ? mg

一名患者身高 180 cm，体重 62 kg。医嘱为 75 mg/m²。用 Mosteller 公式 BSA = √(身高 (cm) × 体重 (kg)/3600) 求剂量 D，以 mg 表示。

180 cm62 kg75 mg/m²
D = mg
29.静脉输液速度中等
1500 mL15 gtt/mL8 h? gtt/min

用滴系数为 15 滴/mL 的输液器在 8 小时内输入 1500 mL。求滴速 R（滴/分）。 取整到最接近的整数。

1500 mL8 h15 gtt/mL
R = gtt/min
30.静脉输液速度困难
810 mL剩余? mL/h4 h 剩余

医嘱要求在 8 小时内输入 1500 mL。4 小时后你发现袋中还剩 810 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？

1500 mL / 8 h经过 4 h: 810 mL
Δ = %
31.静脉输液与液体平衡中等
入量出量12 小时班次果汁120 mL牛奶240 mL冰屑120 mL静脉输液60 mL/h × 12 h静脉抗生素1 × 100 mL尿液300 mL尿液350 mL尿液150 mL伤口引流140 mL呕吐物150 mL

练习题（虚构数值，不作为临床指导）。 记录显示了一名患者在一个 12 小时班次中的出入量。患者体重 48 kg。求平均尿量 U，以 mL/kg/h 计。 保留两位小数。

48 kg12 h尿液: 300 mL尿液: 350 mL尿液: 150 mL伤口引流: 140 mL呕吐物: 150 mL
U = mL/kg/h
32.静脉输液与液体平衡困难
500 mL50 mL/h开始 12:4519:45: ? mL

练习题（虚构数值，不作为临床指导）。 一袋 500 mL 的液体于 12:45 开始用输液泵以 50 mL/h 输注。到 19:45 时袋中还剩多少 mL V？

500 mL50 mL/h12:45 → 19:45
V = mL
33.临床评估评分中等
E2 / 4+V2 / 5+M? / 6GCS 5?

练习题（虚构数值，不作为临床指导）。 一张练习图表记录了 GCS 5，其中 E2 和 V2。记录的运动评分M是多少，它描述的是哪种反应？请给出数字。

GCS 5E2V2
M =
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 28 次/分，SpO₂ 97%正在补充吸氧，血压 124/74 mmHg，脉搏 88 次/分，清醒，体温 37.5 °C。患者属于哪个临床风险组？点击它。

RR 28SpO₂ 97%O₂SBP 124HR 88AT 37.5 °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: B · Gloves can have tiny holes and hands can be contaminated during removal

为什么是这个答案

Gloves reduce, but do not remove, the risk of hand contamination. Hand hygiene is performed after glove removal every time.

答案

B · Gloves can have tiny holes and hands can be contaminated during removal
2.护理学基础

答案: D · Low perceived susceptibility

为什么是这个答案

In the Health Belief Model, people act when they believe they are susceptible to a serious condition and that action will help. Low perceived susceptibility reduces the chance of screening.

答案

D · Low perceived susceptibility
3.感染控制与患者安全

答案: A · 使用无乳胶设备并清楚记录过敏情况

为什么是这个答案

应记录过敏情况，并让患者佩戴过敏腕带。使用无乳胶的手套、导尿管和其他设备，也可以清除房间内的乳胶制品。有粉乳胶手套尤其危险，因为粉末会把蛋白质带入空气中。

答案

A · 使用无乳胶设备并清楚记录过敏情况
4.感染控制与患者安全

答案: C · Release the restraint at once and reposition the patient

为什么是这个答案

Patients have died from strangulation when vest restraints moved up to the neck. The nurse frees the patient immediately, checks breathing and repositions them, then reassesses whether the restraint is needed at all.

答案

C · Release the restraint at once and reposition the patient
5.优先排序与委派

答案: A · Meet both of them privately to hear each side

为什么是这个答案

Talking with both staff members privately allows the charge nurse to understand the problem and look for a fair solution. Ignoring the conflict or acting without facts usually makes it worse.

答案

A · Meet both of them privately to hear each side
6.优先排序与委派

答案: B · Stay and tell the charge nurse, and hand over before leaving

为什么是这个答案

The nurse must not leave patients without handing over to another qualified nurse. Telling the charge nurse allows staffing to be arranged safely.

答案

B · Stay and tell the charge nurse, and hand over before leaving
7.临床护理

答案: A · Pregnant women and immunocompromised people who have not had chickenpox

为什么是这个答案

Someone who has never had chickenpox can catch chickenpox from contact with shingles blisters. Non-immune pregnant and immunocompromised people are at particular risk, so lesions are covered and precautions followed.

答案

A · Pregnant women and immunocompromised people who have not had chickenpox
8.临床护理

答案: B · 新出现意识混乱、呼吸频率 28 次/分的患者

为什么是这个答案

新出现的意识混乱伴呼吸急促提示急性病情恶化，例如脓毒症或缺氧。病情稳定的慢性问题患者可以稍后处理。

答案

B · 新出现意识混乱、呼吸频率 28 次/分的患者
9.实验室检查值与电解质

答案: B · The disease is unlikely, so it helps rule it out

为什么是这个答案

Sensitivity is the proportion of people with the disease who test positive. A highly sensitive test has few false negatives, so a negative result helps rule the disease out (the D-dimer is an example). Specificity relates to ruling in.

答案

B · The disease is unlikely, so it helps rule it out
10.实验室检查值与电解质

答案: B · 丢失的是全血，所以浓度数小时后才会下降

为什么是这个答案

出血早期，红细胞和血浆一起丢失，因此浓度起初保持正常。在最初几小时，心率和血压是判断失血更好的指标。

答案

B · 丢失的是全血，所以浓度数小时后才会下降
11.药理学

答案: A · 单纯疱疹病毒和水痘-带状疱疹病毒等疱疹病毒

为什么是这个答案

阿昔洛韦在受感染细胞中被病毒胸苷激酶磷酸化，随后阻断病毒 DNA 聚合酶。它用于唇疱疹、生殖器疱疹、水痘和带状疱疹。

答案

A · 单纯疱疹病毒和水痘-带状疱疹病毒等疱疹病毒
12.药理学

答案: A · 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

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

答案: C · When the gag and cough reflexes have returned

为什么是这个答案

Local anaesthetic sprayed on the throat abolishes the gag and cough reflexes for a time, so food or fluid could be aspirated. The nurse checks that the reflexes have returned (often after about one to two hours) before giving sips of water and then food.

答案

C · When the gag and cough reflexes have returned
14.内外科护理：心血管与呼吸

答案: D · 心肌梗死后（Dressler）综合征

为什么是这个答案

Dressler 综合征是心肌梗死数周后发生的免疫介导性心包炎，表现为发热、坐起前倾时缓解的胸膜性疼痛和摩擦音。在再灌注时代现已少见。新的梗死引起的缺血性疼痛不随体位改变，夹层引起放射到背部的撕裂样疼痛。

答案

D · 心肌梗死后（Dressler）综合征
15.内外科护理：神经、内分泌与肾脏

答案: B · Stand up slowly, because it can make you dizzy

为什么是这个答案

Tamsulosin relaxes smooth muscle in the prostate and bladder neck, improving urine flow within days. It can cause postural hypotension and dizziness, especially after the first dose, so patients rise slowly.

答案

B · Stand up slowly, because it can make you dizzy
16.内外科护理：神经、内分泌与肾脏

答案: A · "As long as I take my tablets, I can swim alone."

为什么是这个答案

People with epilepsy should never swim alone, even if their seizures are well controlled. Showers are safer than baths. Telling friends about first aid and keeping a seizure diary are good practice.

答案

A · "As long as I take my tablets, I can swim alone."
17.内外科护理：消化、围手术期与肿瘤

答案: D · Start a regular laxative at the same time

为什么是这个答案

Opioids slow gut movement, and tolerance to constipation does not develop. A regular laxative, often a stimulant with a softener, is started with the opioid, alongside fluids and mobility where possible.

答案

D · Start a regular laxative at the same time
18.内外科护理：消化、围手术期与肿瘤

答案: B · "I can cut the patch in half if I need less."

为什么是这个答案

Cutting a fentanyl patch can release the drug unpredictably and cause overdose. Heat increases absorption, used patches still contain drug and must be folded and disposed of safely, and sites are rotated.

答案

B · "I can cut the patch in half if I need less."
19.产科护理

答案: A · 腹痛、子宫变硬或板状腹以及暗红色出血

为什么是这个答案

胎盘早剥引起疼痛、子宫压痛和强直以及暗色出血。出血可隐藏在胎盘后方，因此失血量可能远大于可见出血量。

答案

A · 腹痛、子宫变硬或板状腹以及暗红色出血
20.产科护理

答案: A · Assess the fetal heart rate and check the fluid, and avoid a digital examination

为什么是这个答案

Preterm prelabour rupture of membranes is suspected. The nurse assesses the fetal heart rate and the fluid's colour, amount and odour, and avoids digital examinations, which raise the risk of infection.

答案

A · Assess the fetal heart rate and check the fluid, and avoid a digital examination
21.儿科护理

答案: A · Holds the head steady when held upright, with little or no head lag

为什么是这个答案

By about 4 months most infants have good head control with little head lag when pulled to sit. Sitting without support comes at about 6–8 months, pulling to stand at about 9 months and first words at about 12 months.

答案

A · Holds the head steady when held upright, with little or no head lag
22.儿科护理

答案: B · Shunt infection; report it urgently

为什么是这个答案

Shunt infections usually occur within the first months after surgery and may show fever, redness or swelling along the tract, poor feeding and irritability, sometimes with signs of shunt blockage. Urgent assessment, cultures and antibiotics are needed.

答案

B · Shunt infection; report it urgently
23.精神科护理

答案: A · Serotonin syndrome

为什么是这个答案

St John's wort has serotonergic effects, so combining it with an SSRI can cause serotonin syndrome. It also induces liver enzymes and interacts with many other drugs, so patients should tell the prescriber about herbal products.

答案

A · Serotonin syndrome
24.精神科护理

答案: A · Neither confirm nor deny that he is there, and offer to pass on a message

为什么是这个答案

Without the patient's consent, the nurse should not disclose that a person is receiving mental health care. Offering to pass on a message respects confidentiality while allowing the patient to decide.

答案

A · Neither confirm nor deny that he is there, and offer to pass on a message
25.护理数学与单位换算

答案: m = 1.93 kg

家用计量和体重：护理考试使用取整的等量关系：1 茶匙（tsp）= 5 mL，1 汤匙（tbsp）= 15 mL = 3 tsp，1 液量盎司（fl oz）= 30 mL = 2 tbsp，1 杯 = 8 fl oz = 240 mL。体重方面，1 kg = 2.2 lb，1 lb = 16 oz；长度方面，1 英寸 = 2.54 cm。设置换算时，要让你不需要的单位相互约去。

盎司换算为磅

4 oz/16 = 0.25 lb
4 + 0.25 = 4.25 lb

磅换算为千克

m = 4.25/2.2 = 1.932 ≈ 1.93 kg

答案

m = 1.93 kg
26.护理数学与单位换算

答案: D = 0.24 mg/h

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 = 4 mcg/min × (60 min/1 h) × (1 mg/1000 mcg)

计算

D = 4·60/1000 = 0.24 mg/h

答案

D = 0.24 mg/h
27.剂量计算

答案: V = 10 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

1:10 000 = 1 g/10000 mL = 0.1 mg/mL

体积

V = 1/0.1 = 10 mL

答案

V = 10 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: D = 132.1 mg

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

体表面积

BSA = √(180·62/3600) = √3.1 = 1.761 m²

剂量

D = 75·1.761 = 132.1 mg

答案

D = 132.1 mg
29.静脉输液速度

答案: R = 47 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

8·60 = 480 min

滴速

R = 1500·15/480 = 46.88 ≈ 47 gtt/min

答案

R = 47 gtt/min

床旁取最接近的整滴：47 滴/分。

30.静脉输液速度

答案: Δ = 8 %

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

1500/8 = 187.5 mL/h

新速率

R = 810/4 = 202.5 mL/h

变化百分比

Δ = (202.5 − 187.5)/187.5·100% = 8%

答案

Δ = 8%

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: U = 1.39 mL/kg/h

出入量：入量计入所有进入体内的液体（口服液体、静脉输液、静脉用药及冲管液、管饲）；冰屑按其体积的一半计。出量计入尿液、引流液、呕吐物和其他丢失。平衡 = 总入量 − 总出量；平衡为负表示净丢失。 这些数字仅供练习；在临床工作中务必遵循当地规程，高危剂量须经双人核对。

总尿量

300 + 350 + 150 = 800 mL

每千克每小时

U = 800/(48·12) = 1.389 ≈ 1.39 mL/kg/h

答案

U = 1.39 mL/kg/h
32.静脉输液与液体平衡

答案: V = 150 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

12:45 → 19:45 = 7 h

已输入体积

50·7 = 350 mL

剩余体积

V = 500 − 350 = 150 mL

答案

V = 150 mL
33.临床评估评分

答案: M = 1

格拉斯哥昏迷量表：把三个方面的最佳反应相加。睁眼 E：4 自发，3 对声音或言语，2 对压迫，1 无。言语 V：5 定向正常，4 意识模糊，3 用词不恰当，2 发出无法理解的声音，1 无。运动 M：6 遵嘱动作，5 定位，4 正常屈曲（回缩），3 异常屈曲，2 伸展，1 无。总分为 3 至 15。头部损伤后，13–15 通常称为轻度，9–12 为中度，3–8 为重度。

运动评分

M = 5 − 2 − 2 = 1
M1: 完全没有动作

答案

M = 1
34.临床评估评分

答案: 中

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 28/min → 3
SpO₂ 97% → 0
吸氧 → 2
SBP 124 mmHg → 0
HR 88/min → 0
清醒 (A) → 0
T 37.5 °C → 0

总分和红色分值

NEWS2 = 3 + 0 + 2 + 0 + 0 + 0 + 0 = 5
至少有一个参数得 3 分。

风险组

中

答案

中

总分 5 或以上需要紧急的临床响应。

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