精神看護学：直前対策パック

公式集、全トピックの解法の要点、6 問の演習問題。完全な解答は巻末にあります。

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1公式と解法

精神看護

解き方

  1. 差し迫ったリスクがあるかを判断します：自殺、暴力、薬物による緊急事態、身体疾患。
  2. まず安全を確保します：観察する、手段を取り除く、鎮静化（デエスカレーション）を図る、有害な薬を中止する、助けを呼ぶ。
  3. 治療的な応答を選びます：感情を受け止め、現実を伝え、根拠のない安心づけや「なぜ」という質問は避けます。
  4. 権利を尊重します：最も制限の少ない方法、同意、そして限界のある守秘義務。

2演習問題

1.精神看護ふつう

A patient taking phenelzine, an MAOI, is being taught before discharge. Which statement shows a need for further teaching?

  1. A"I'll avoid aged cheese and cured meats."
  2. B"A sudden severe headache is a reason to get help straight away."
  3. C"I'll tell any new doctor or dentist that I take an MAOI."
  4. D"I can take any cold and flu remedy from the pharmacy."
2.精神看護むずかしい

A young man spends hours a day checking his nose in mirrors and has asked for several operations, although others see nothing unusual about it. What is the most likely diagnosis?

  1. AAnorexia nervosa
  2. BIllness anxiety disorder
  3. CBody dysmorphic disorder
  4. DDelusional disorder, jealous type
3.臨床心理学ふつう

ある患者は、身体症状がほとんどないかまったくなく、検査を繰り返しても正常であるにもかかわらず、重い病気にかかっていることに強い不安を感じています。最も当てはまる診断はどれですか？

  1. A病気不安症
  2. B作為症
  3. C機能性神経症状症
  4. D身体症状症
4.臨床心理学むずかしい

統合失調症の人の集団で、対照群と比べて繰り返し報告されてきた脳の所見はどれですか？

  1. A下垂体の腫瘍
  2. B海馬の完全な欠損
  3. C側脳室の拡大
  4. Dすべての患者での前頭葉の肥大
5.薬理学ふつう

Why is aspirin avoided in children and teenagers with viral illnesses such as flu or chickenpox?

  1. AIt is linked to Reye's syndrome, which harms the liver and brain
  2. BIt stops the vaccine from working
  3. CIt causes severe, permanent hearing loss in young children
  4. DIt causes grey baby syndrome
6.薬理学むずかしい

A woman with epilepsy who takes an antiepileptic drug plans to become pregnant. Which advice is standard?

  1. ANo change is needed, as antiepileptics carry no risk in pregnancy
  2. BAvoid folic acid because it lowers drug levels
  3. CTake folic acid before conception and seek specialist review of her medication
  4. DStop all antiepileptic drugs straight away as soon as she stops contraception

3溶液

1.精神看護

答え: D · "I can take any cold and flu remedy from the pharmacy."

これが答えになる理由

Decongestants such as pseudoephedrine are sympathomimetics and can cause a hypertensive crisis with MAOIs. Patients should check any new medicine, including over-the-counter remedies, with a pharmacist or prescriber.

答え

D · "I can take any cold and flu remedy from the pharmacy."
2.精神看護

答え: C · Body dysmorphic disorder

これが答えになる理由

Body dysmorphic disorder is a preoccupation with perceived defects in appearance, with repetitive behaviours such as mirror checking or seeking reassurance. It is related to OCD, and cosmetic surgery rarely relieves it.

答え

C · Body dysmorphic disorder
3.臨床心理学

答え: A · 病気不安症

これが答えになる理由

病気不安症は、身体症状がごくわずかであるにもかかわらず、重い病気にかかっている、またはかかるのではないかというとらわれです。身体症状症は、苦痛な症状とそれについての過剰な思考が中心です。

答え

A · 病気不安症
4.臨床心理学

答え: C · 側脳室の拡大

これが答えになる理由

統合失調症では平均して脳室の拡大と灰白質の減少がみられます。これらの差は集団の平均であり、個人の診断には使えません。

答え

C · 側脳室の拡大
5.薬理学

答え: A · It is linked to Reye's syndrome, which harms the liver and brain

これが答えになる理由

Aspirin given during viral infections in young people is associated with Reye's syndrome, causing acute encephalopathy and liver failure. Paracetamol or ibuprofen is used for fever instead.

答え

A · It is linked to Reye's syndrome, which harms the liver and brain
6.薬理学

答え: C · Take folic acid before conception and seek specialist review of her medication

これが答えになる理由

Folic acid before and in early pregnancy reduces the risk of neural tube defects. Medication should be reviewed before conception, but drugs should not be stopped suddenly because uncontrolled seizures are also dangerous.

答え

C · Take folic acid before conception and seek specialist review of her medication

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