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

一名患者几乎不会说英语。在重要的知情同意谈话中，应由谁来翻译？

  1. A专业的医疗口译员
  2. B任何懂几个该语言单词的工作人员
  3. C邻床的探视者
  4. D患者年幼的孩子
2.护理学基础困难

A patient has been taught breathing exercises before surgery. Which statement shows a need for further teaching?

  1. A"I'll ask for pain relief if pain stops me breathing deeply."
  2. B"I'll take some slow deep breaths every hour."
  3. C"I'll avoid coughing so I don't hurt my stitches."
  4. D"I'll hold a pillow over the wound when I cough."
3.感染控制与患者安全中等

戴无菌手套时，护士应如何戴上第二只手套？

  1. A用裸手捏住指尖把第二只手套拉上
  2. B用已戴手套的手抓住第二只手套的内面
  3. C将已戴手套的手指插入第二只手套的袖口下面并拉上
  4. D用裸手调整第一只手套的外面
4.感染控制与患者安全困难

A 2-year-old living in a house built many decades ago has anemia, irritability and poor appetite. Which cause should the nurse suspect?

  1. AIron overload from eating too much red meat
  2. BLead poisoning from old paint dust or chips
  3. CCarbon dioxide from a gas cooker
  4. DA food allergy to cow’s milk proteins
5.优先排序与委派中等

A patient has heart failure. Which instruction about daily weights is best to give the nursing assistant?

  1. A“Weigh him each morning before breakfast, on the same scale, and tell me the result.”
  2. B“Weigh him after lunch, fully dressed, with his shoes on.”
  3. C“Only weigh him if his ankles look more swollen than they did yesterday afternoon.”
  4. D“Weigh him at any time today, on whichever scale is free.”
6.优先排序与委派困难

A patient with a head injury has a pupil on one side that is now large and does not react to light. What should the nurse do?

  1. ADim the room lights so the pupil can get smaller
  2. BRecheck it at the next routine observation in four hours
  3. CReport it at once, as it may mean the brain is being compressed
  4. DDocument it, because pupils often differ slightly after a head injury
7.临床护理中等

Which side effect of regular opioids usually needs preventive treatment from the start?

  1. AConstipation
  2. BExcessive hunger
  3. CHigh blood pressure
  4. DDiarrhoea
8.临床护理困难

A patient has a blood pressure of 220/130 mmHg with headache, confusion and visual disturbance. Why is the blood pressure lowered in a controlled way rather than as fast as possible?

  1. ARapid lowering causes hyperglycaemia
  2. BBlood pressure cannot be lowered with drugs
  3. CA sudden drop can reduce blood flow to the brain, heart and kidneys
  4. DRapid lowering always causes the hypertension to come back much worse
9.实验室检查值与电解质中等

How often is the INR usually checked when warfarin is first started?

  1. AEvery few days, until it is stable
  2. BOnce a year, at a routine visit
  3. CEvery hour, during the first week
  4. DOnly if bleeding occurs at home
10.实验室检查值与电解质困难

A patient with diabetes had a glucose of 58 mg/dL (3.2 mmol/L), took 15 g of fast-acting carbohydrate and, 15 minutes later, the glucose is 64 mg/dL (3.6 mmol/L). The patient is alert. What should the nurse do next?

  1. AGive a protein snack only and recheck tomorrow
  2. BWait until the next meal before giving anything
  3. CGive a long-acting insulin dose to stabilize it
  4. DGive another 15 g of fast carbohydrate and recheck
11.药理学中等

华法林的作用机制是：

  1. A激活抗凝血酶
  2. B通过不可逆抑制 COX-1 来阻断血小板聚集
  3. C阻断维生素 K 依赖性凝血因子的合成
  4. D直接抑制凝血酶
12.药理学困难

为什么正在使用硝酸酯类药物治疗心绞痛的患者禁用西地那非？

  1. A西地那非阻断血管中硝酸酯向一氧化氮的转化
  2. B合用会引起危险的高钾血症
  3. C两者都升高血管平滑肌中的 cGMP，可能引起严重低血压
  4. D硝酸酯类阻断西地那非在肝脏中的代谢
13.内外科护理：心血管与呼吸中等

A patient takes both digoxin and furosemide. Why does the nurse watch the potassium level closely?

  1. ALow potassium increases the risk of digoxin toxicity
  2. BHigh potassium is the main effect of furosemide
  3. CPotassium has no link with either medicine
  4. DLow potassium makes digoxin stop working completely
14.内外科护理：心血管与呼吸困难

On day 2 after a surgical tracheostomy, the tube falls out. The patient is breathing but distressed. What should the nurse do first?

  1. ACall for expert help and give oxygen to both the face and the stoma
  2. BCover the stoma completely with a sealed dressing and wait for help
  3. CLeave the patient alone while fetching a new tube
  4. DForce the tube back through the stoma immediately with firm pressure
15.内外科护理：神经、内分泌与肾脏中等

A patient uses a continuous glucose monitor. Which statement is correct?

  1. AIt makes finger-prick checks unnecessary in every situation
  2. BIt measures glucose directly in the blood every second of the day
  3. CIt reads glucose in fluid under the skin, a little behind blood glucose
  4. DIt works by giving small doses of insulin automatically
16.内外科护理：神经、内分泌与肾脏困难

Two days after surgery, an 80-year-old woman is quiet, sleepy, slow to answer and eating little. Her daughter says she is "not herself". What should the nurse suspect?

  1. AHypoactive delirium
  2. BNormal tiredness after an operation
  3. CSimple low mood about being in hospital
  4. DThe start of Alzheimer's disease
17.内外科护理：消化、围手术期与肿瘤中等

Which presentation fits acute diverticulitis?

  1. ACentral chest pain spreading to the left arm
  2. BRight upper abdominal pain after fatty meals
  3. CLeft lower abdominal pain, fever and a raised CRP
  4. DPainless jaundice with a palpable gallbladder
18.内外科护理：消化、围手术期与肿瘤困难

一名肺癌患者出现面部肿胀、颈静脉怒张，平卧时呼吸困难加重。可能是哪种急症？

  1. A上腔静脉阻塞
  2. B脊髓压迫
  3. C大面积肺栓塞
  4. D恶性肿瘤相关高钙血症
19.产科护理中等

A pregnant woman asks why she needs a whooping cough (pertussis) vaccine in pregnancy. Which answer is correct?

  1. AIt prevents the baby from developing rubella
  2. BIt is a live vaccine that gives the baby lifelong immunity to whooping cough
  3. CHer antibodies cross the placenta and protect the newborn
  4. DIt protects her from pre-eclampsia
20.产科护理困难

妊娠 38 周时，一名女性打电话说，自昨天起胎儿的活动比平时少得多。最佳建议是什么？

  1. A等到下周的下一次常规预约
  2. B喝一杯冰冷的甜饮料，只有 3 天没有胎动时才打电话
  3. C接近足月时胎动减少是正常的，无需处理
  4. D今天来院评估胎心率
21.儿科护理中等

Which signs suggest meningitis in a young infant?

  1. AA clear runny nose, a mild cough and normal feeding
  2. BA sunken fontanelle with heavy wet nappies
  3. CA bulging fontanelle, a high-pitched cry, poor feeding and irritability
  4. DNeck stiffness and a positive Kernig's sign, as in older children and adults
22.儿科护理困难

一名儿童因发热、颈部僵硬和压之不褪色的皮疹入院。优先事项是什么？

  1. A等待腰椎穿刺后再进行任何治疗
  2. B开始飞沫隔离，并紧急请医生会诊，以免延误抗生素治疗
  3. C让孩子住在与其他儿童共用的病室内，4 小时后再检查皮疹和体温
  4. D给予退热药，4 小时后再检查
23.精神科护理中等

What is the key difference between factitious disorder and malingering?

  1. AThere is no real difference between them, and both terms mean exactly the same thing
  2. BIn factitious disorder, the aim is to be seen as ill; in malingering, the aim is an external reward
  3. CIn factitious disorder, the symptoms are not produced on purpose at all
  4. DMalingering is a severe mental disorder, while factitious disorder is not classed as a mental disorder at all
24.精神科护理困难

A patient on daily methadone maintenance has had abdominal surgery. Which statement about his pain management is correct?

  1. AHis usual methadone should continue, and additional analgesia is usually needed for acute pain
  2. BHis methadone should be stopped while he is in hospital
  3. CHis usual methadone dose will fully control his post-operative pain, so no other analgesia should be given
  4. DHe should get no opioids at all, because of his history
25.护理数学与单位换算中等
169 cm1 in = 2.54 cmh = ? in

练习题（虚构数值，不作为临床指导）。 一位患者身高 169 cm。按 1 in = 2.54 cm，求以英寸表示的身高h。取到一位小数。

169 cm1 in = 2.54 cm
h = in
26.护理数学与单位换算困难
00:0019:5008:45t = ?

练习题（虚构数值，不作为临床指导）。 一次输注从 19:50 开始，到次日早晨 08:45 结束（24 小时制）。它运行了多少小时t？答案以小数表示小时数，取到两位小数。

19:5008:45
t = 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
250 mg/5 mLV = ? mL

一名体重 14 kg 的儿童，医嘱为口服混悬液每次 12.5 mg/kg，该混悬液每 5 mL 含 250 mg。你应给多少体积 V？

14 kg12.5 mg/kg250 mg/5 mL
V = mL
29.静脉输液速度中等
10 gtt/mL60 mL/h? gtt/min

医嘱要求以 60 mL/h 输液，但没有输液泵。改用滴系数为 10 gtt/mL 的输液器重力滴注。求滴速 R，以每分钟滴数表示。

60 mL/h10 gtt/mL
R = gtt/min
30.静脉输液速度困难
100 mg250 mL10 mL/h? mcg/min

100 mg 药物溶于 250 mL 的输液以 10 mL/h 运行。患者每分钟接受多少微克 D？

100 mg/250 mL10 mL/h
D = mcg/min
31.静脉输液与液体平衡中等
入量出量12 小时班次牛奶200 mL果汁150 mL冰屑100 mL静脉输液80 mL/h × 12 h静脉抗生素2 × 100 mL尿液325 mL尿液175 mL尿液425 mL尿液350 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。求总入量 I，以 mL 计。 冰屑按其体积的一半计。

牛奶: 200 mL果汁: 150 mL冰屑: 100 mL静脉输液: 80 mL/h × 12 h静脉抗生素: 2 × 100 mL
I = mL
32.静脉输液与液体平衡困难
1000 mL800 mL 已输入60 mL/h07:30t = ? h

练习题（虚构数值，不作为临床指导）。 一袋 1000 mL 的液体用输液泵以 60 mL/h 输注。到 07:30 时已输入 800 mL。还要多少小时 t 袋子才会输完？ 保留一位小数。

1000 mL800 mL 已输入60 mL/h
t = h
33.临床评估评分中等
11865SBPDBPmmHgHR 67/min · SI = ?

练习题（虚构数值，不作为临床指导）。 一位患者的脉搏为 67 次/分，血压为 118/65 mmHg。求休克指数SI = HR/SBP。取到两位小数。

HR 67/minBP 118/65 mmHg
SI =
34.临床评估评分困难
85?SBPDBPmmHgMAP = 65

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 65 mmHg。一位患者的收缩压为 85 mmHg。使用 MAP = (SBP + 2·DBP)/3，仍能使 MAP 达到 65 mmHg 的最低舒张压DBP是多少？

MAP 65 mmHgSBP 85 mmHg
DBP = mmHg

3溶液

1.护理学基础

答案: A · 专业的医疗口译员

为什么是这个答案

专业口译员能准确翻译并保守秘密。家庭成员，尤其是孩子，可能遗漏内容、加入自己的看法，或因这些信息而承受负担。

答案

A · 专业的医疗口译员
2.护理学基础

答案: C · "I'll avoid coughing so I don't hurt my stitches."

为什么是这个答案

Avoiding coughing lets secretions collect and raises the risk of chest infection. Splinting the wound, deep breathing and good pain control are correct.

答案

C · "I'll avoid coughing so I don't hurt my stitches."
3.感染控制与患者安全

答案: C · 将已戴手套的手指插入第二只手套的袖口下面并拉上

为什么是这个答案

第一只手套只能用裸手接触其袖口的内面。已戴手套的手随后只接触第二只手套的外面，即翻折袖口的下方。手套内面一旦接触皮肤就不再无菌。

答案

C · 将已戴手套的手指插入第二只手套的袖口下面并拉上
4.感染控制与患者安全

答案: B · Lead poisoning from old paint dust or chips

为什么是这个答案

Lead-based paint in older housing is the main source of lead exposure in young children, who put dust and chips in their mouths. Lead can cause anemia, behavior changes and developmental problems, and a blood lead level confirms it.

答案

B · Lead poisoning from old paint dust or chips
5.优先排序与委派

答案: A · “Weigh him each morning before breakfast, on the same scale, and tell me the result.”

为什么是这个答案

Daily weights are measured at the same time, on the same scale and in similar clothing so that changes show real fluid gain. A quick rise in weight can be an early sign of worsening heart failure.

答案

A · “Weigh him each morning before breakfast, on the same scale, and tell me the result.”
6.优先排序与委派

答案: C · Report it at once, as it may mean the brain is being compressed

为什么是这个答案

A newly fixed, dilated pupil suggests pressure on the third cranial nerve from rising intracranial pressure or a bleed. It is a neurological emergency that needs immediate escalation.

答案

C · Report it at once, as it may mean the brain is being compressed
7.临床护理

答案: A · Constipation

为什么是这个答案

Opioids slow gut movement, and constipation persists with long-term use. A regular laxative is usually prescribed together with the opioid.

答案

A · Constipation
8.临床护理

答案: C · A sudden drop can reduce blood flow to the brain, heart and kidneys

为什么是这个答案

In a hypertensive emergency, autoregulation in vital organs is reset to higher pressures. Lowering BP too fast can cause ischaemia, so it is reduced gradually under close monitoring.

答案

C · A sudden drop can reduce blood flow to the brain, heart and kidneys
9.实验室检查值与电解质

答案: A · Every few days, until it is stable

为什么是这个答案

When warfarin is started or its dose changes, the INR is checked frequently (often every few days) until it is stable in the target range. After that, the interval can be extended, often up to every 4 weeks or longer if very stable.

答案

A · Every few days, until it is stable
10.实验室检查值与电解质

答案: D · Give another 15 g of fast carbohydrate and recheck

为什么是这个答案

The "15-15 rule" is repeated until the glucose is at least 70 mg/dL (3.9 mmol/L); UK guidance uses 4.0 mmol/L and 15–20 g of carbohydrate. Then a snack or meal with complex carbohydrate and protein is given if the next meal is not soon, to prevent recurrence.

答案

D · Give another 15 g of fast carbohydrate and recheck
11.药理学

答案: C · 阻断维生素 K 依赖性凝血因子的合成

为什么是这个答案

华法林抑制维生素 K 环氧化物还原酶，减少因子 II、VII、IX 和 X 的合成。用 INR 监测，用维生素 K 逆转。

答案

C · 阻断维生素 K 依赖性凝血因子的合成
12.药理学

答案: C · 两者都升高血管平滑肌中的 cGMP，可能引起严重低血压

为什么是这个答案

硝酸酯类通过一氧化氮增加 cGMP 的生成，西地那非阻断 PDE5 对其的分解。两者合用会导致过度血管扩张和血压危险地下降。

答案

C · 两者都升高血管平滑肌中的 cGMP，可能引起严重低血压
13.内外科护理：心血管与呼吸

答案: A · Low potassium increases the risk of digoxin toxicity

为什么是这个答案

Digoxin binds to the Na⁺/K⁺-ATPase pump at the site potassium normally uses. When potassium is low, more digoxin binds, so toxicity and arrhythmias become more likely. Loop diuretics commonly cause hypokalaemia, so the combination needs monitoring.

答案

A · Low potassium increases the risk of digoxin toxicity
14.内外科护理：心血管与呼吸

答案: A · Call for expert help and give oxygen to both the face and the stoma

为什么是这个答案

In the first days after a tracheostomy, the tract is immature and the tube can easily be misplaced into the tissues. Emergency guidance is to call for an airway expert, apply oxygen to face and stoma and assess breathing. Reinsertion is done only by trained staff.

答案

A · Call for expert help and give oxygen to both the face and the stoma
15.内外科护理：神经、内分泌与肾脏

答案: C · It reads glucose in fluid under the skin, a little behind blood glucose

为什么是这个答案

CGM sensors measure interstitial glucose, which lags several minutes behind blood glucose, especially when levels change fast. A finger-prick check is advised when symptoms do not match the reading.

答案

C · It reads glucose in fluid under the skin, a little behind blood glucose
16.内外科护理：神经、内分泌与肾脏

答案: A · Hypoactive delirium

为什么是这个答案

Hypoactive delirium presents with drowsiness, withdrawal and slowness rather than agitation, so it is often missed. It has a worse prognosis than the hyperactive form. A family report of a sudden change is important, and a screening tool such as the 4AT or the CAM (Confusion Assessment Method) can be used.

答案

A · Hypoactive delirium
17.内外科护理：消化、围手术期与肿瘤

答案: C · Left lower abdominal pain, fever and a raised CRP

为什么是这个答案

Diverticulitis usually causes left iliac fossa pain and tenderness with fever, raised inflammatory markers and a change in bowel habit. CT confirms the diagnosis and shows complications such as abscess.

答案

C · Left lower abdominal pain, fever and a raised CRP
18.内外科护理：消化、围手术期与肿瘤

答案: A · 上腔静脉阻塞

为什么是这个答案

肿瘤可压迫或侵犯上腔静脉，引起面部和手臂肿胀、胸壁静脉扩张、头痛和呼吸困难。应让患者坐起并紧急评估；治疗包括类固醇、支架置入以及放疗或化疗。

答案

A · 上腔静脉阻塞
19.产科护理

答案: C · Her antibodies cross the placenta and protect the newborn

为什么是这个答案

Maternal pertussis antibodies cross the placenta and protect the newborn before it can be immunised. Whooping cough can be fatal in young infants.

答案

C · Her antibodies cross the placenta and protect the newborn
20.产科护理

答案: D · 今天来院评估胎心率

为什么是这个答案

胎动减少可能是胎儿窘迫的警示。应尽快评估，通常在当天，检查胎心率并根据需要做进一步检查。接近足月时胎动通常不会减少。

答案

D · 今天来院评估胎心率
21.儿科护理

答案: C · A bulging fontanelle, a high-pitched cry, poor feeding and irritability

为什么是这个答案

Young infants with meningitis may have non-specific signs: fever or low temperature, poor feeding, lethargy or irritability, a high-pitched cry and a bulging fontanelle. Neck stiffness is often absent at this age.

答案

C · A bulging fontanelle, a high-pitched cry, poor feeding and irritability
22.儿科护理

答案: B · 开始飞沫隔离，并紧急请医生会诊，以免延误抗生素治疗

为什么是这个答案

发热伴压之不褪色的皮疹提示脑膜炎球菌败血症。不得延误抗生素，在孩子接受有效抗生素约 24 小时之前应采取飞沫隔离。

答案

B · 开始飞沫隔离，并紧急请医生会诊，以免延误抗生素治疗
23.精神科护理

答案: B · In factitious disorder, the aim is to be seen as ill; in malingering, the aim is an external reward

为什么是这个答案

In both, symptoms are produced or exaggerated on purpose. In factitious disorder the motivation is internal, the sick role; in malingering it is external, such as money, drugs or avoiding duties.

答案

B · In factitious disorder, the aim is to be seen as ill; in malingering, the aim is an external reward
24.精神科护理

答案: A · His usual methadone should continue, and additional analgesia is usually needed for acute pain

为什么是这个答案

Maintenance methadone prevents withdrawal but does not treat acute pain. Patients with opioid tolerance often need more analgesia than usual. Withholding pain relief is unsafe and unethical.

答案

A · His usual methadone should continue, and additional analgesia is usually needed for acute pain
25.护理数学与单位换算

答案: h = 66.5 in

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。

厘米换算为英寸

h = 169/2.54 = 66.54 ≈ 66.5 in

答案

h = 66.5 in
26.护理数学与单位换算

答案: t = 12.92 h

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

19:50 → 24:00 = 250 min

午夜之后

00:00 → 08:45 = 525 min

合计

250 + 525 = 775 min
t = 775/60 = 12.92 h

答案

t = 12.92 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: V = 3.5 mL

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。

按体重计算剂量

12.5·14 = 175 mg

体积

V = (175/250)·5 = 3.5 mL

答案

V = 3.5 mL
29.静脉输液速度

答案: R = 10 gtt/min

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.

每分钟毫升数

60/60 = 1 mL/min

滴速

R = 1·10 = 10 gtt/min

答案

R = 10 gtt/min
30.静脉输液速度

答案: D = 66.67 mcg/min

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

浓度

100000 mcg/250 mL = 400 mcg/mL

每小时剂量

10·400 = 4000 mcg/h

每分钟剂量

D = 4000/60 = 66.67 mcg/min

答案

D = 66.67 mcg/min
31.静脉输液与液体平衡

答案: I = 1560 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 + 150 = 350 mL
冰屑: 100/2 = 50 mL
静脉输液: 80·12 = 960 mL
静脉抗生素: 2·100 = 200 mL
I = 1560 mL

答案

I = 1560 mL
32.静脉输液与液体平衡

答案: t = 3.3 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

1000 − 800 = 200 mL

时间

t = 200/60 = 3.333 ≈ 3.3 h

答案

t = 3.3 h

约为 3 h 20 min，所以袋子大约在 10:50 输完。

33.临床评估评分

答案: SI = 0.57

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 = 67/118 = 0.5678 ≈ 0.57

答案

SI = 0.57

在通常的 0.5–0.7 之内或之下。

34.临床评估评分

答案: DBP = 55 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 = (3·65 − 85)/2 = 110/2 = 55 mmHg

答案

DBP = 55 mmHg

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