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 with a weak left leg walks with a stick in the right hand. What is the correct sequence?

  1. AMove the stick and the left leg forward together, then the right leg
  2. BMove both legs forward together first, then bring the stick level with them
  3. CMove the stick and the right leg together, then the left leg
  4. DMove the right leg first, then the stick, then the left leg
2.护理学基础困难

Before giving a PRN dose of oral morphine, which assessment is most important?

  1. AThe patient's weight and height, recorded on admission
  2. BThe patient's blood glucose level
  3. CThe respiratory rate and level of sedation
  4. DThe patient's last bowel movement
3.感染控制与患者安全中等

A patient is on suicide precautions. Which room safety measure is appropriate?

  1. ARemove items that could be used for self-harm, such as belts and cords
  2. BLet the patient keep a personal razor for shaving, as long as staff are told
  3. CAllow glass bottles if the patient seems calm
  4. DKeep the door closed at all times so the patient has privacy
4.感染控制与患者安全困难

A patient restrained because of violent behavior is now calm, oriented and following instructions. What should the nurse do?

  1. ARemove one restraint each day to test the patient’s behavior
  2. BKeep the restraints until the order expires
  3. CRemove the restraints, because the reason for them has ended
  4. DKeep the restraints until the next provider visit
5.优先排序与委派中等

A nurse teaches a patient with COPD pursed-lip breathing. Which statement shows a need for further teaching?

  1. A“I will make my breath out about twice as long as my breath in.”
  2. B“I will breathe in through my mouth and out quickly through my nose.”
  3. C“I will breathe in slowly through my nose.”
  4. D“I will breathe out slowly through pursed lips.”
6.优先排序与委派困难

Which patient finding after a total knee replacement needs the nurse’s action first?

  1. AA small amount of dried blood on the dressing
  2. BSudden calf pain and swelling in the operated leg, with new breathlessness
  3. CAsks for an ice pack to help with swelling around the knee
  4. DPain of 4/10 when the physiotherapist bends the knee during the morning session
7.临床护理中等

Which is a recognised risk factor for postoperative nausea and vomiting?

  1. AA short operation under local anaesthetic
  2. BUse of opioids after surgery
  3. CBeing male
  4. DBeing a smoker
8.临床护理困难

A patient has a swollen, warm, tender calf on one side. Which action should the nurse avoid?

  1. AReporting the findings to the doctor
  2. BMeasuring and comparing calf circumference
  3. CChecking whether VTE prophylaxis was given
  4. DMassaging the calf
9.实验室检查值与电解质中等

A patient is scheduled for a liver biopsy. Which laboratory results should the nurse check before the procedure?

  1. APlatelet count and PT/INR
  2. BSerum sodium and chloride
  3. CHbA1c and lipid panel
  4. DTSH and free T4
10.实验室检查值与电解质困难

A patient with sepsis has the following new results. Which set best shows organ dysfunction?

  1. APlatelets 70 × 10³/µL, creatinine doubled, bilirubin raised
  2. BCalcium 9.4 mg/dL, phosphate 3.5 mg/dL, magnesium 1.9 mEq/L
  3. CHemoglobin 12.5 g/dL, sodium 138 mEq/L, glucose 105 mg/dL
  4. DWBC 11.5 × 10³/µL, potassium 4.2 mEq/L, albumin 3.8 g/dL
11.药理学中等

Which teaching about zolpidem is correct?

  1. ATake it in the morning so that it is out of the system by night
  2. BDrive soon after waking, as the drug has no next-day effect
  3. CTake it with alcohol to make it act faster
  4. DTake it right before bed, only if you can sleep a full night
12.药理学困难

A patient on disulfiram becomes flushed, nauseated and has palpitations after using a mouthwash. What is the most likely cause?

  1. AAn allergy to mint flavouring in the mouthwash
  2. BLow blood glucose from skipping breakfast
  3. CDisulfiram toxicity from taking too many tablets by mistake
  4. DAlcohol in the mouthwash caused a disulfiram–alcohol reaction
13.内外科护理：心血管与呼吸中等

A patient choosing between a mechanical and a biological heart valve asks about the main difference. Which answer is accurate?

  1. AMechanical valves wear out within one year
  2. BMechanical valves last longer but need lifelong anticoagulation
  3. CBiological valves last longer but need lifelong warfarin
  4. DBoth types need no medicines after surgery
14.内外科护理：心血管与呼吸困难

A day after a myocardial infarction, a patient has frequent ventricular ectopic beats on the monitor. Which blood results should be checked first?

  1. AAmylase and lipase
  2. BFerritin and vitamin B12
  3. CAlbumin and bilirubin
  4. DPotassium and magnesium
15.内外科护理：神经、内分泌与肾脏中等

A patient's potassium stays low despite replacement. Which other level should be checked?

  1. AAmylase
  2. BFerritin
  3. CMagnesium
  4. DBilirubin
16.内外科护理：神经、内分泌与肾脏困难

A patient with a head injury now has a blood pressure of 190/70 mmHg, a pulse of 48/min and irregular breathing. How should the nurse interpret this?

  1. AHypovolaemic shock from internal bleeding
  2. BCushing's triad, a late sign of raised intracranial pressure
  3. CNeurogenic shock from a spinal cord injury
  4. DA normal stress response to pain, anxiety and the noise of the ward
17.内外科护理：消化、围手术期与肿瘤中等

Which diet is usually recommended for a patient with cirrhosis and hepatic encephalopathy?

  1. AOnly clear fluids for several weeks
  2. BNo food at all until the confusion settles
  3. CNormal protein and enough calories, with a late-evening snack
  4. DA very low-protein diet for the rest of their life to lower ammonia
18.内外科护理：消化、围手术期与肿瘤困难

Why is folinic acid (leucovorin) given after high-dose methotrexate?

  1. ATo increase the anticancer effect on the tumour
  2. BTo rescue normal cells from methotrexate toxicity
  3. CTo prevent hair loss during treatment
  4. DTo treat the patient's anaemia only
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. AEarlier testing always gives false negatives for all conditions
  2. BSome results, such as PKU, need milk feeds first
  3. CThe baby's blood cannot be sampled before day 3
  4. DThe heel cannot be pricked until the cord falls off
20.产科护理困难

A woman at 8 weeks takes valproate for epilepsy. She asks whether she should stop it. Which response is best?

  1. ADo not stop it suddenly; arrange urgent specialist review
  2. BStop the drug today because it causes birth defects
  3. CHalve the dose herself to reduce the risk to the baby
  4. DContinue as usual because epilepsy drugs are all safe in pregnancy
21.儿科护理中等

一名儿童在同一次就诊时需要接种几种不同的疫苗。一般原则是什么？

  1. A所有疫苗应混在同一支注射器里
  2. B每月只能接种一种疫苗
  3. C应将每种疫苗分半剂，分散在几周内接种
  4. D可以在同一次就诊时接种，选择不同的注射部位
22.儿科护理困难

Which statement by the parent of a child with peanut allergy shows a need for further teaching?

  1. A"I'll call an ambulance every time I use the auto-injector, even if she seems to recover quickly."
  2. B"I'll read food labels for peanuts every time I shop."
  3. C"If she has a bad reaction, I'll give an antihistamine and wait an hour before using the auto-injector."
  4. D"I'll check the use-by date on her auto-injectors regularly and replace them before they expire."
23.精神科护理中等

A 78-year-old woman who started citalopram two weeks ago is newly confused and drowsy. Which laboratory result would best explain this?

  1. AA low serum sodium
  2. BA low serum cholesterol
  3. CA high serum potassium
  4. DA high haemoglobin
24.精神科护理困难

一名处于躁狂发作的患者在活动室里打断其他患者并且声音越来越大。最恰当的护理措施是什么？

  1. A当着所有人的面与患者争论其行为，直到患者同意停止
  2. B把音乐开大声以分散大家的注意力
  3. C平静地引导患者到刺激较少、较安静的区域，并设定清晰、简单的限制
  4. D鼓励进行竞争性的团体游戏来消耗精力
25.护理数学与单位换算中等
6.1212 mL? mL取整到 0.1 mL

练习题（虚构数值，不作为临床指导）。 一次注射的剂量计算得到 6.1212 mL。 本练习的规则是：1 mL 或以上的体积取到最接近的十分之一 mL。你记录的数值x是多少？

6.1212 mL
x = mL
26.护理数学与单位换算困难
00:0022:1505:25t = ?

练习题（虚构数值，不作为临床指导）。 一次输注从 22:15 开始，到次日早晨 05:25 结束（24 小时制）。它运行了多少分钟t？

22:1505:25
t = min
27.剂量计算中等
024681010 mL

一名体重 28 kg 的儿童按 2.5 mg/kg 处方用药。原液浓度为 50 mg/mL。请抽取剂量：应给多少体积 V？

28 kg2.5 mg/kg50 mg/mL
V = mL
28.剂量计算困难
00.10.20.30.40.50.60.70.80.911 mL

处方剂量为 1.52 mg。安瓿每 mL 含 2000 微克。请用 1 mL 注射器抽取剂量：应给多少体积 V？

1.52 mg2000 mcg/mL
V = mL
29.静脉输液速度中等
1000 mL10 gtt/mL8 h? gtt/min

用滴系数为 10 滴/mL 的输液器在 8 小时内输入 1000 mL。求滴速 R（滴/分）。 取整到最接近的整数。

1000 mL8 h10 gtt/mL
R = gtt/min
30.静脉输液速度困难
200 mL20 gtt/mL32 gtt/mint = ? h

一组输液以 32 滴/分的速度经 20 滴/mL 的输液器滴注。袋中还剩 200 mL。还需多少小时 t 才会滴完？ 保留一位小数。

32 gtt/min20 gtt/mL200 mL
t = h
31.静脉输液与液体平衡中等
入量出量12 小时班次水300 mL果汁150 mL静脉输液100 mL/h × 12 h静脉抗生素1 × 50 mL尿液350 mL尿液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 12 小时班次中的出入量。静脉输液在整个班次中按所示速率输注。求液体平衡 B = 入量 − 出量，以 mL 计（答案为负表示净丢失）。

水: 300 mL果汁: 150 mL静脉输液: 100 mL/h × 12 h静脉抗生素: 1 × 50 mL尿液: 350 mL尿液: 200 mL
B = mL
32.静脉输液与液体平衡困难
500 mL150 mL 已输入50 mL/h07:00t = ? h

练习题（虚构数值，不作为临床指导）。 一袋 500 mL 的液体用输液泵以 50 mL/h 输注。到 07:00 时已输入 150 mL。还要多少小时 t 袋子才会输完？ 保留一位小数。

500 mL150 mL 已输入50 mL/h
t = h
33.临床评估评分中等
16490SBPDBPmmHgHR 127/min · SI = ?

练习题（虚构数值，不作为临床指导）。 一位患者的脉搏为 127 次/分，血压为 164/90 mmHg。求休克指数SI = HR/SBP。取到两位小数。

HR 127/minBP 164/90 mmHg
SI =
34.临床评估评分困难
体重过轻健康体重超重肥胖 I 级肥胖 II 级肥胖 III 级

练习题（虚构数值，不作为临床指导）。 一名成人体重 86 kg，身高 151 cm。计算 BMI 并点击 WHO 体重分类。

86 kg151 cm
  1. 1体重过轻
  2. 2健康体重
  3. 3超重
  4. 4肥胖 I 级
  5. 5肥胖 II 级
  6. 6肥胖 III 级

3溶液

1.护理学基础

答案: A · Move the stick and the left leg forward together, then the right leg

为什么是这个答案

The stick and the weak leg move together so the stick takes part of the load, then the strong leg steps through.

答案

A · Move the stick and the left leg forward together, then the right leg
2.护理学基础

答案: C · The respiratory rate and level of sedation

为什么是这个答案

Opioids can cause sedation and respiratory depression. Checking breathing and alertness before each dose, as well as the pain score, keeps the patient safe.

答案

C · The respiratory rate and level of sedation
3.感染控制与患者安全

答案: A · Remove items that could be used for self-harm, such as belts and cords

为什么是这个答案

Patients at risk of suicide need a safe environment, with belts, cords, sharp objects and glass removed, and observation at the level ordered. Privacy is secondary to safety in this situation.

答案

A · Remove items that could be used for self-harm, such as belts and cords
4.感染控制与患者安全

答案: C · Remove the restraints, because the reason for them has ended

为什么是这个答案

Restraints are used only as long as needed to keep people safe. Once the patient no longer presents a danger, the restraints are removed, even if the order has not yet expired.

答案

C · Remove the restraints, because the reason for them has ended
5.优先排序与委派

答案: B · “I will breathe in through my mouth and out quickly through my nose.”

为什么是这个答案

Pursed-lip breathing means breathing in through the nose and out slowly through pursed lips, making exhalation longer. This keeps airways open and reduces air trapping.

答案

B · “I will breathe in through my mouth and out quickly through my nose.”
6.优先排序与委派

答案: B · Sudden calf pain and swelling in the operated leg, with new breathlessness

为什么是这个答案

Calf pain and swelling suggest deep vein thrombosis, and new breathlessness raises concern for a pulmonary embolism. This needs immediate assessment and escalation; the other findings are expected.

答案

B · Sudden calf pain and swelling in the operated leg, with new breathlessness
7.临床护理

答案: B · Use of opioids after surgery

为什么是这个答案

Known risk factors include opioids, female sex, being a non-smoker, previous PONV or motion sickness and longer general anaesthetics. High-risk patients may be given preventive antiemetics.

答案

B · Use of opioids after surgery
8.临床护理

答案: D · Massaging the calf

为什么是这个答案

Unilateral calf swelling and tenderness suggests DVT. Massaging the leg is avoided in case it dislodges the clot; the patient needs medical review and investigation.

答案

D · Massaging the calf
9.实验室检查值与电解质

答案: A · Platelet count and PT/INR

为什么是这个答案

Liver biopsy carries a risk of bleeding, and liver disease often lowers platelets and clotting factors. Platelets and PT/INR are checked beforehand, and abnormal results are reported so they can be corrected or the procedure postponed.核对依据: Liver biopsy · MedlinePlus (NIH) (2025)

答案

A · Platelet count and PT/INR
10.实验室检查值与电解质

答案: A · Platelets 70 × 10³/µL, creatinine doubled, bilirubin raised

为什么是这个答案

In sepsis, falling platelets (coagulation), a rising creatinine (kidney) and a raised bilirubin (liver) show organ dysfunction, which indicates severe disease. The other sets are normal or near normal.核对依据: Bacterial Sepsis · StatPearls (NCBI Bookshelf) (2023); Laboratory Evaluation of Sepsis · StatPearls (NCBI Bookshelf) (2023)

答案

A · Platelets 70 × 10³/µL, creatinine doubled, bilirubin raised
11.药理学

答案: D · Take it right before bed, only if you can sleep a full night

为什么是这个答案

Zolpidem can cause next-day impairment and complex sleep behaviours such as sleep-walking or sleep-driving. Alcohol and other sedatives increase these risks.

答案

D · Take it right before bed, only if you can sleep a full night
12.药理学

答案: D · Alcohol in the mouthwash caused a disulfiram–alcohol reaction

为什么是这个答案

Disulfiram reactions can occur with small amounts of alcohol in mouthwash, cough syrups, sauces or aftershave. Patients are taught to check labels and avoid all alcohol-containing products.

答案

D · Alcohol in the mouthwash caused a disulfiram–alcohol reaction
13.内外科护理：心血管与呼吸

答案: B · Mechanical valves last longer but need lifelong anticoagulation

为什么是这个答案

Mechanical valves are very durable but are thrombogenic, so lifelong warfarin is needed. Biological (tissue) valves usually do not need long-term anticoagulation but wear out over time and may need replacement. Age, lifestyle and bleeding risk guide the choice.

答案

B · Mechanical valves last longer but need lifelong anticoagulation
14.内外科护理：心血管与呼吸

答案: D · Potassium and magnesium

为什么是这个答案

Low potassium and low magnesium both increase ventricular irritability and the risk of VT and VF after an MI. They are checked and corrected, usually keeping potassium in the upper part of the normal range. The patient is also assessed for ischaemia and haemodynamic change.

答案

D · Potassium and magnesium
15.内外科护理：神经、内分泌与肾脏

答案: C · Magnesium

为什么是这个答案

Hypomagnesaemia increases potassium loss in the urine and makes hypokalaemia hard to correct. Magnesium is checked and replaced as well.

答案

C · Magnesium
16.内外科护理：神经、内分泌与肾脏

答案: B · Cushing's triad, a late sign of raised intracranial pressure

为什么是这个答案

Cushing's triad is hypertension with a widening pulse pressure, bradycardia and irregular respiration. It shows that the brainstem is being compressed and herniation may be imminent, so it is an emergency.

答案

B · Cushing's triad, a late sign of raised intracranial pressure
17.内外科护理：消化、围手术期与肿瘤

答案: C · Normal protein and enough calories, with a late-evening snack

为什么是这个答案

Protein restriction worsens malnutrition and muscle loss and is no longer routinely advised. Adequate protein and energy, small frequent meals and a late-evening snack are recommended.

答案

C · Normal protein and enough calories, with a late-evening snack
18.内外科护理：消化、围手术期与肿瘤

答案: B · To rescue normal cells from methotrexate toxicity

为什么是这个答案

Methotrexate inhibits dihydrofolate reductase. Timed folinic acid bypasses this block in normal cells, reducing toxicity such as mucositis and myelosuppression, while methotrexate levels and kidney function are monitored.

答案

B · To rescue normal cells from methotrexate toxicity
19.产科护理

答案: B · 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

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

答案: A · Do not stop it suddenly; arrange urgent specialist review

为什么是这个答案

Valproate is strongly teratogenic, but stopping antiepileptics suddenly can cause seizures that harm mother and fetus. She needs urgent specialist review to change treatment safely, ideally before conception.

答案

A · Do not stop it suddenly; arrange urgent specialist review
21.儿科护理

答案: D · 可以在同一次就诊时接种，选择不同的注射部位

为什么是这个答案

一次就诊接种几种疫苗是安全有效的，并可避免延误。应使用不同的注射器和部位，如在同一肢体，至少相距约 2.5 cm。除非产品是专门设计的，否则切勿混合疫苗。

答案

D · 可以在同一次就诊时接种，选择不同的注射部位
22.儿科护理

答案: C · "If she has a bad reaction, I'll give an antihistamine and wait an hour before using the auto-injector."

为什么是这个答案

Adrenaline is the first treatment for anaphylaxis and must be given without delay; antihistamines do not treat airway swelling or shock. Checking expiry dates, reading labels and calling emergency services after use are correct.

答案

C · "If she has a bad reaction, I'll give an antihistamine and wait an hour before using the auto-injector."
23.精神科护理

答案: A · A low serum sodium

为什么是这个答案

SSRIs can cause hyponatraemia through SIADH, especially in older adults. Confusion, falls and drowsiness after starting an SSRI should prompt a sodium check.

答案

A · A low serum sodium
24.精神科护理

答案: C · 平静地引导患者到刺激较少、较安静的区域，并设定清晰、简单的限制

为什么是这个答案

躁狂患者受益于平静、低刺激的环境、坚定而一致的限制，以及简单、非竞争性的活动。

答案

C · 平静地引导患者到刺激较少、较安静的区域，并设定清晰、简单的限制
25.护理数学与单位换算

答案: x = 6.1 mL

取整：看舍入位后面的那个数字：5 或更大则进位，4 或更小则保持原数字不变。只对最终答案取整，绝不对中间步骤取整。典型的考试规则：1 mL 或以上的体积取到十分位，低于 1 mL 的体积取到百分位，滴速取整到整滴，体重取到一位小数；务必遵循题目所规定的规则。

十分位位上的数字

6.1212 → 1

只看下一位数字

6.1212 → 2
2 小于或等于 4，所以 1 不变。
后面的数字（12）不考虑：只取整一次，不要逐位取整。

取整

x = 6.1 mL

答案

x = 6.1 mL
26.护理数学与单位换算

答案: t = 430 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

22:15 → 24:00 = 105 min

午夜之后

00:00 → 05:25 = 325 min

合计

t = 105 + 325 = 430 min

答案

t = 430 min
27.剂量计算

答案: V = 1.4 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 = 2.5·28 = 70 mg

体积

V = 70/50 = 1.4 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 = 1.4 mL
28.剂量计算

答案: V = 0.76 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。

单位相同

1.52 mg = 1520 mcg

体积

V = 1520/2000 = 0.76 mL

答案

V = 0.76 mL
29.静脉输液速度

答案: R = 21 gtt/min

输注速率：输液泵按 mL/h = 体积/时间（小时）设定。重力滴注按每分钟滴数计：gtt/min = 体积 (mL) × 滴系数 (gtt/mL)/时间 (min)。 滴系数印在输液器包装上：普通输液器为 10、15 或 20 gtt/mL（输血器在美国常为 10 gtt/mL，在英国为 15），微量输液器为 60 gtt/mL。务必使用题目或包装给出的滴系数。

以分钟计的时间

8·60 = 480 min

滴速

R = 1000·10/480 = 20.83 ≈ 21 gtt/min

答案

R = 21 gtt/min

床旁取最接近的整滴：21 滴/分。

30.静脉输液速度

答案: t = 2.1 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）

32·60/20 = 96 mL/h

剩余时间

t = 200/96 = 2.083 ≈ 2.1 h

答案

t = 2.1 h
31.静脉输液与液体平衡

答案: B = 1150 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: 300 + 150 = 450 mL
静脉输液: 100·12 = 1200 mL
静脉抗生素: 1·50 = 50 mL
总入量 = 1700 mL

总出量

350 + 200 = 550 mL

平衡

B = 1700 − 550 = 1150 mL

答案

B = 1150 mL

为正：摄入的液体多于排出的液体。

32.静脉输液与液体平衡

答案: t = 7 h

输液时间：时间 (h) = 待输体积 (mL)/速率 (mL/h)；使用袋中剩余的体积，而不是袋的容量。已输入体积 = 速率 × 时间。把小数小时换算为小时和分钟时，用小数部分 × 60（0.5 h = 30 min，而不是 50 min）。 这些数字仅供练习；在临床工作中务必遵循当地规程，高危剂量须经双人核对。

剩余体积

500 − 150 = 350 mL

时间

t = 350/50 = 7 h

答案

t = 7 h

约为 7 h 00 min，所以袋子大约在 14:00 输完。

33.临床评估评分

答案: SI = 0.77

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 = 127/164 = 0.7744 ≈ 0.77

答案

SI = 0.77

高于通常的 0.5–0.7。

34.临床评估评分

答案: 肥胖 II 级

体质指数：BMI = 体重（kg）/身高（m）²，身高要先换算为米。使用磅和英寸时，BMI = 703 × 体重（lb）/身高（in）²。WHO 成人分类：低于 18.5 为体重过轻，18.5–24.9 为健康体重，25.0–29.9 为超重，30.0–34.9 为肥胖 I 级，35.0–39.9 为肥胖 II 级，40 及以上为肥胖 III 级。

BMI

BMI = 86/1.51² = 37.72

分类

肥胖 II 级

答案

肥胖 II 级

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