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 patient tells the nurse about abuse and asks them to keep it a secret. What should the nurse say?

  1. AThat they promise to keep it secret, so the patient keeps trusting them
  2. BThat they cannot promise secrecy if someone is at risk of harm
  3. CThat they will tell everyone on the ward so the patient is safe
  4. DThat they cannot listen to this and the patient should tell a doctor
2.护理学基础困难

An infusion pump alarms "occlusion". What should the nurse check first?

  1. AThe patient's blood glucose level
  2. BThe fluid prescription chart and the infusion rate written on it
  3. CThe battery level of the pump
  4. DThe clamps, the tubing for kinks and the cannula site
3.感染控制与患者安全中等

A nurse wants to set up a sterile field in the morning for a procedure that will take place after lunch. What is correct?

  1. ASet it up in the morning and leave it uncovered in an empty room
  2. BSet it up in the morning and ask a colleague to check it once
  3. CSet it up in the morning and cover it with a clean towel until the procedure starts
  4. DSet it up just before the procedure, because a waiting field may become contaminated
4.感染控制与患者安全困难

A patient was harmed by a medication error and asks the nurse what happened. Which approach is best?

  1. ATell the patient nothing happened to avoid worry
  2. BBe honest that an error occurred and involve the provider and team in disclosure per policy
  3. CTell the patient to make a formal complaint to find out
  4. DBlame the pharmacy for the error so that the nurse and the ward are not at fault
5.优先排序与委派中等

Two hours after birth, the nurse finds the uterus firm but above the umbilicus and pushed to the right. What should the nurse do first?

  1. AHelp the patient empty her bladder
  2. BAsk the patient to lie still for another hour
  3. CMassage the uterus firmly for ten minutes
  4. DGive a dose of oxytocin straight away
6.优先排序与委派困难

A child who had a tonsillectomy this morning is swallowing again and again while asleep. What should the nurse suspect?

  1. ANormal swallowing during sleep
  2. BBleeding from the operation site
  3. CA sore throat from the breathing tube
  4. DHunger after fasting for surgery
7.临床护理中等

Which measure helps prevent delirium in older inpatients?

  1. AKeeping the lights on all night
  2. BMoving the patient to a different bed each night to give them a change of scene
  3. CRestricting fluids to avoid incontinence
  4. DReorientation, glasses and hearing aids in use, and good sleep and hydration
8.临床护理困难

A patient going home with a leg cast is taught about cast care. Which statement shows a need for further teaching?

  1. A"I will come back if my toes go numb or turn blue."
  2. B"I will keep my leg raised on pillows for the first few days."
  3. C"I can push a knitting needle down the cast to scratch an itch."
  4. D"I will keep the cast dry."
9.实验室检查值与电解质中等

A stable adult who is not bleeding receives one unit of packed red cells. By about how much is the hemoglobin expected to rise?

  1. AAbout 3 g/dL (30 g/L)
  2. BAbout 5 g/dL (50 g/L)
  3. CAbout 0.1 g/dL (1 g/L)
  4. DAbout 1 g/dL (10 g/L)
10.实验室检查值与电解质困难

哪种结果模式符合 SIADH？

  1. A血清钠高、血清渗透压高、尿液非常稀
  2. B血清钠低、血清渗透压低、尿液浓缩
  3. C钠正常，尿液非常稀
  4. D血清钠低、血清渗透压高、尿液稀
11.药理学中等

ACE 抑制剂典型的常见副作用是什么？

  1. A心动过缓
  2. B血管扩张引起的脚踝水肿
  3. C干咳
  4. D低血糖
12.药理学困难

A patient with heart failure on furosemide is also given metolazone, a thiazide-like diuretic. Which risk increases most?

  1. AHypoglycaemia and weight gain
  2. BHyperkalaemia and fluid overload
  3. CSevere hypertension, tachycardia and fluid retention
  4. DSevere hypokalaemia, hyponatraemia and dehydration
13.内外科护理：心血管与呼吸中等

Why must anti-embolism stockings be measured and fitted correctly?

  1. ATight stockings work better, so the smallest size is always best
  2. BPoorly fitting stockings can cause pressure damage
  3. CCorrect fit is needed only to improve the appearance
  4. DLoose stockings make the patient's legs too warm at night
14.内外科护理：心血管与呼吸困难

During a thrombolytic infusion for an MI, the patient develops a sudden severe headache, vomiting and new confusion. What should the nurse do first?

  1. ASlow the infusion and give an antiemetic
  2. BGive a second dose to finish the treatment
  3. CContinue the infusion, as headache is a common side effect
  4. DStop the infusion and call for urgent medical help
15.内外科护理：神经、内分泌与肾脏中等

A patient with migraine takes painkillers or triptans on most days and now has a headache almost every day. What is the likely problem?

  1. AAn allergy to the painkillers
  2. BNormal progress of migraine
  3. CMedication overuse headache
  4. DA brain tumour, which is almost certain
16.内外科护理：神经、内分泌与肾脏困难

A prescription reads "Insulin 10U". Why is this a safety problem?

  1. AThere is no problem as long as the nurse can read it
  2. B"U" can be misread as a zero, giving a tenfold dose
  3. CInsulin doses must always be written in millilitres
  4. D"U" means the insulin must be given intravenously
17.内外科护理：消化、围手术期与肿瘤中等

A routine wound swab grows bacteria, but the wound shows no signs of infection. What does this usually mean?

  1. AThe wound must be closed with sutures again
  2. BThe swab result means the wound is infected
  3. CThe patient needs IV antibiotics straight away, whatever the wound looks like
  4. DThe wound is colonised; antibiotics are not usually needed
18.内外科护理：消化、围手术期与肿瘤困难

A patient is booked for a urea breath test for H. pylori. Which medicine should usually be stopped 2 weeks before the test?

  1. ALevothyroxine
  2. BAmlodipine
  3. COmeprazole
  4. DParacetamol (acetaminophen)
19.产科护理中等

一名对风疹无免疫力的产妇在出院前接种疫苗。必须给予哪项建议？

  1. A停止母乳喂养 4 周
  2. B2 天内远离新生儿
  3. C6 个月后重复接种疫苗
  4. D至少 4 周内避免怀孕
20.产科护理困难

Why does the ductus arteriosus normally close after birth?

  1. ARising prostaglandins and falling oxygen levels
  2. BRising oxygen levels and falling prostaglandins
  3. CPressure in the pulmonary artery rises
  4. DThe cord is cut, which closes it directly
21.儿科护理中等

一名婴儿在 29 周出生，现在 2 个月大。常规的 2 月龄疫苗应在何时接种？

  1. A仅在 1 岁生日之后
  2. B仅当婴儿达到矫正月龄 2 个月时
  3. C仅当婴儿体重达到 5 kg 之后
  4. D现在，按婴儿的实际月龄
22.儿科护理困难

The nurse has taught the parents of a child with type 1 diabetes. Which statement shows a need for further teaching?

  1. A"We'll give the school a copy of her hypo plan and glucagon."
  2. B"We'll check her glucose before driving to her swimming lesson."
  3. C"For a low, I'll give her a chocolate bar, because it's the fastest sugar."
  4. D"We'll recheck her glucose about 15 minutes after treating a low."
23.精神科护理中等

A patient says, "Nobody at work likes me." Which nurse response best reflects cognitive restructuring?

  1. A"What evidence do you have that nobody likes you?"
  2. B"I'm sure everybody likes you."
  3. C"You should find a new job where people like you."
  4. D"Why do you care what people at work think?"
24.精神科护理困难

A patient with PTSD is having a nightmare and thrashing in bed. What is the safest way for the nurse to wake him?

  1. AHold his arms down firmly so that he cannot hit anyone or hurt himself while he is still asleep
  2. BStand at a safe distance, say his name clearly and tell him where he is
  3. CShake him firmly by the shoulders until he is fully awake
  4. DTurn on all the lights and shout loudly so that he wakes up quickly
25.护理数学与单位换算中等
12345678910111222:15?12:15 PM9:15 PM10:15 PM10:15 AM

练习题（虚构数值，不作为临床指导）。 一个剂量记录在 22:15（24 小时制）。哪个条目是 12 小时制中的同一时间？点击它。

22:15
  1. 112:15 PM
  2. 29:15 PM
  3. 310:15 PM
  4. 410:15 AM
26.护理数学与单位换算困难
8 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 8 mg/h。请把这个剂量速率D用 mcg/min 表示。取到一位小数。

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

一名体重 20 kg 的儿童按 5 mg/kg 处方用药。原液浓度为 25 mg/mL。请抽取剂量：应给多少体积 V？

20 kg5 mg/kg25 mg/mL
V = mL
28.剂量计算困难
20k 件500 mL? mL/h1250 件/h

一袋输液在 500 mL 中含 20000 单位药物。医嘱为每小时 1250 单位。泵速 R 应设为多少 mL/h？

20000 件/500 mL1250 件/h
R = mL/h
29.静脉输液速度中等
1000 mL20 gtt/mL10 h? gtt/min

用滴系数为 20 滴/mL 的输液器在 10 小时内输入 1000 mL。求滴速 R（滴/分）。 取整到最接近的整数。

1000 mL10 h20 gtt/mL
R = gtt/min
30.静脉输液速度困难
300 mL60 gtt/mL28 gtt/mint = ? h

一组输液以 28 滴/分的速度经 60 滴/mL 的输液器滴注。袋中还剩 300 mL。还需多少小时 t 才会滴完？ 保留一位小数。

28 gtt/min60 gtt/mL300 mL
t = h
31.静脉输液与液体平衡中等
入量出量8 小时班次汤200 mL果汁120 mL冰屑240 mL静脉输液100 mL/h × 8 h静脉抗生素2 × 100 mL尿液425 mL尿液150 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。求总入量 I，以 mL 计。 冰屑按其体积的一半计。

汤: 200 mL果汁: 120 mL冰屑: 240 mL静脉输液: 100 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
500 mL120 mL/h开始 10:1512:15: ? mL

练习题（虚构数值，不作为临床指导）。 一袋 500 mL 的液体于 10:15 开始用输液泵以 120 mL/h 输注。到 12:15 时袋中还剩多少 mL V？

500 mL120 mL/h10:15 → 12:15
V = mL
33.临床评估评分中等
14889SBPDBPmmHgHR 119/min · SI = ?

练习题（虚构数值，不作为临床指导）。 一位患者的脉搏为 119 次/分，血压为 148/89 mmHg。求休克指数SI = HR/SBP。取到两位小数。

HR 119/minBP 148/89 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 10 次/分，SpO₂ 96%正在补充吸氧，血压 118/70 mmHg，脉搏 130 次/分，清醒，体温 38.4 °C。患者属于哪个临床风险组？点击它。

RR 10SpO₂ 96%O₂SBP 118HR 130AT 38.4 °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 · That they cannot promise secrecy if someone is at risk of harm

为什么是这个答案

Nurses must not promise secrecy when there is a risk of harm. They listen, stay calm, explain what will happen, record the disclosure and follow safeguarding procedures.

答案

B · That they cannot promise secrecy if someone is at risk of harm
2.护理学基础

答案: D · The clamps, the tubing for kinks and the cannula site

为什么是这个答案

An occlusion alarm means the flow is blocked, for example by a closed clamp, kinked tubing, a bent arm or a blocked cannula. The nurse checks from the bag to the patient.

答案

D · The clamps, the tubing for kinks and the cannula site
3.感染控制与患者安全

答案: D · Set it up just before the procedure, because a waiting field may become contaminated

为什么是这个答案

The longer a sterile field is exposed, the more likely it is to be contaminated, and an unattended field cannot be considered sterile. It is prepared just before use.

答案

D · Set it up just before the procedure, because a waiting field may become contaminated
4.感染控制与患者安全

答案: B · Be honest that an error occurred and involve the provider and team in disclosure per policy

为什么是这个答案

Open, honest disclosure of errors is an ethical duty and part of a safety culture. The nurse follows policy, which usually involves the provider and risk team, and does not hide or blame.

答案

B · Be honest that an error occurred and involve the provider and team in disclosure per policy
5.优先排序与委派

答案: A · Help the patient empty her bladder

为什么是这个答案

A uterus that is high and displaced to one side usually means a full bladder. A full bladder stops the uterus contracting well, so the nurse helps the patient void and reassesses.

答案

A · Help the patient empty her bladder
6.优先排序与委派

答案: B · Bleeding from the operation site

为什么是这个答案

Frequent swallowing after tonsillectomy is a classic sign of bleeding. The nurse checks the throat with a light, looks at vital signs and reports at once.

答案

B · Bleeding from the operation site
7.临床护理

答案: D · Reorientation, glasses and hearing aids in use, and good sleep and hydration

为什么是这个答案

Multicomponent prevention, including orientation, sensory aids, hydration, nutrition, mobility, sleep and avoiding unnecessary moves or drugs, reduces delirium.

答案

D · Reorientation, glasses and hearing aids in use, and good sleep and hydration
8.临床护理

答案: C · "I can push a knitting needle down the cast to scratch an itch."

为什么是这个答案

Pushing objects under a cast can injure the skin and cause infection or pressure sores. Elevation, keeping the cast dry and reporting numbness, colour change or increasing pain are correct.

答案

C · "I can push a knitting needle down the cast to scratch an itch."
9.实验室检查值与电解质

答案: D · About 1 g/dL (10 g/L)

为什么是这个答案

In an average-sized adult without ongoing bleeding or hemolysis, one unit of red cells raises the hemoglobin by about 1 g/dL (and the hematocrit by about 3%). A smaller rise suggests ongoing blood loss or red cell destruction.核对依据: Blood Transfusion · StatPearls (NCBI Bookshelf) (2026)

答案

D · About 1 g/dL (10 g/L)
10.实验室检查值与电解质

答案: B · 血清钠低、血清渗透压低、尿液浓缩

为什么是这个答案

抗利尿激素过多导致水潴留，稀释血液（钠和渗透压低），而尿液反常地浓缩。钠高伴尿液非常稀是尿崩症的模式。核对依据: Syndrome of inappropriate antidiuretic hormone secretion · MedlinePlus (NIH) (2025)

答案

B · 血清钠低、血清渗透压低、尿液浓缩
11.药理学

答案: C · 干咳

为什么是这个答案

ACE 也会降解缓激肽。抑制该酶后，缓激肽在气道中蓄积，部分患者会出现持续干咳。

答案

C · 干咳
12.药理学

答案: D · Severe hypokalaemia, hyponatraemia and dehydration

为什么是这个答案

Combining a loop and a thiazide diuretic gives a strong synergistic diuresis. This can cause marked electrolyte loss and volume depletion, so weight, electrolytes and kidney function are monitored closely.

答案

D · Severe hypokalaemia, hyponatraemia and dehydration
13.内外科护理：心血管与呼吸

答案: B · Poorly fitting stockings can cause pressure damage

为什么是这个答案

Stockings that are the wrong size or that roll down can act like a tourniquet and cause skin and pressure damage. They are measured to the leg, checked daily, and avoided in significant peripheral arterial disease, severe neuropathy or leg skin damage.

答案

B · Poorly fitting stockings can cause pressure damage
14.内外科护理：心血管与呼吸

答案: D · Stop the infusion and call for urgent medical help

为什么是这个答案

Sudden neurological change during or after thrombolysis suggests intracranial haemorrhage. The infusion is stopped immediately, help is called, and urgent CT and reversal are considered. Neurological observations continue.

答案

D · Stop the infusion and call for urgent medical help
15.内外科护理：神经、内分泌与肾脏

答案: C · Medication overuse headache

为什么是这个答案

Frequent use of painkillers or triptans can cause medication overuse headache. Treatment involves withdrawing the overused drug under guidance and starting a preventive treatment if needed.

答案

C · Medication overuse headache
16.内外科护理：神经、内分泌与肾脏

答案: B · "U" can be misread as a zero, giving a tenfold dose

为什么是这个答案

A handwritten "U" can look like a 0, turning 10 units into 100. The word "units" must be written in full. Insulin errors are a well-known cause of serious harm.

答案

B · "U" can be misread as a zero, giving a tenfold dose
17.内外科护理：消化、围手术期与肿瘤

答案: D · The wound is colonised; antibiotics are not usually needed

为什么是这个答案

Bacteria on the surface without clinical signs of infection is colonisation. Antibiotics are guided by clinical signs such as spreading redness, pain, heat, pus or systemic illness, not by a swab alone.

答案

D · The wound is colonised; antibiotics are not usually needed
18.内外科护理：消化、围手术期与肿瘤

答案: C · Omeprazole

为什么是这个答案

PPIs suppress H. pylori and can give false-negative breath or stool tests, so they are usually stopped 2 weeks before. Antibiotics are usually stopped 4 weeks before testing.

答案

C · Omeprazole
19.产科护理

答案: D · 至少 4 周内避免怀孕

为什么是这个答案

风疹疫苗含有减毒活病毒，因此接种后至少 4 周内应避免怀孕。它与母乳喂养并不冲突。

答案

D · 至少 4 周内避免怀孕
20.产科护理

答案: B · Rising oxygen levels and falling prostaglandins

为什么是这个答案

Higher blood oxygen and lower prostaglandin levels after birth cause the ductus arteriosus to constrict. Prostaglandin infusions are used to keep it open in duct-dependent heart defects.

答案

B · Rising oxygen levels and falling prostaglandins
21.儿科护理

答案: D · 现在，按婴儿的实际月龄

为什么是这个答案

在大多数免疫程序中，早产儿按实际月龄（出生后的年龄）而不是矫正月龄接种疫苗。一些极早产儿在医院接种第一批疫苗，并监测呼吸暂停。

答案

D · 现在，按婴儿的实际月龄
22.儿科护理

答案: C · "For a low, I'll give her a chocolate bar, because it's the fastest sugar."

为什么是这个答案

Hypoglycaemia is treated with fast-acting carbohydrate such as glucose tablets or a sugary drink. Chocolate contains fat, which slows absorption, so it is not a good first treatment. The other statements are correct.

答案

C · "For a low, I'll give her a chocolate bar, because it's the fastest sugar."
23.精神科护理

答案: A · "What evidence do you have that nobody likes you?"

为什么是这个答案

Cognitive restructuring helps the patient examine the evidence for and against a negative automatic thought, then develop a more balanced view. Reassurance or advice does not help the patient learn this skill.

答案

A · "What evidence do you have that nobody likes you?"
24.精神科护理

答案: B · Stand at a safe distance, say his name clearly and tell him where he is

为什么是这个答案

A person waking from a trauma nightmare may react defensively. Staying out of reach, using the person's name and orienting him to time and place keeps both the patient and staff safe.

答案

B · Stand at a safe distance, say his name clearly and tell him where he is
25.护理数学与单位换算

答案: 10:15 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

10:15 PM

答案

10:15 PM
26.护理数学与单位换算

答案: D = 133.3 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 = 8 mg/h × (1000 mcg/1 mg) × (1 h/60 min)

计算

D = 8000/60 = 133.3 mcg/min

答案

D = 133.3 mcg/min
27.剂量计算

答案: V = 4 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 = 5·20 = 100 mg

体积

V = 100/25 = 4 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 = 4 mL
28.剂量计算

答案: R = 31.25 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

20000/500 = 40 件/mL

泵速

R = 1250/40 = 31.25 mL/h

答案

R = 31.25 mL/h
29.静脉输液速度

答案: R = 33 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 = 1000·20/600 = 33.33 ≈ 33 gtt/min

答案

R = 33 gtt/min

床旁取最接近的整滴：33 滴/分。

30.静脉输液速度

答案: t = 10.7 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。

速度（mL/h）

28·60/60 = 28 mL/h

剩余时间

t = 300/28 = 10.71 ≈ 10.7 h

答案

t = 10.7 h
31.静脉输液与液体平衡

答案: I = 1440 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: 200 + 120 = 320 mL
冰屑: 240/2 = 120 mL
静脉输液: 100·8 = 800 mL
静脉抗生素: 2·100 = 200 mL
I = 1440 mL

答案

I = 1440 mL
32.静脉输液与液体平衡

答案: V = 260 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

10:15 → 12:15 = 2 h

已输入体积

120·2 = 240 mL

剩余体积

V = 500 − 240 = 260 mL

答案

V = 260 mL
33.临床评估评分

答案: SI = 0.8

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 = 119/148 = 0.8041 ≈ 0.8

答案

SI = 0.8

高于通常的 0.5–0.7。

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 10/min → 1
SpO₂ 96% → 0
吸氧 → 2
SBP 118 mmHg → 0
HR 130/min → 2
清醒 (A) → 0
T 38.4 °C → 1

总分和红色分值

NEWS2 = 1 + 0 + 2 + 0 + 2 + 0 + 1 = 6
没有参数得 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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