精神看護
解き方
- 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。
- 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。
- 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。
- 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。
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。
1公式と解法
2演習問題
1.精神看護ふつう
Which feature helps distinguish normal grief from major depression?
- AIn grief, the person cannot feel any positive emotions or enjoy any memories of the person who died
- BGrief always lasts less than 2 weeks
- CIn grief, painful feelings come in waves and self-esteem is usually kept
- DIn grief, the person feels worthless and hopeless all the time
2.精神看護むずかしい
In the working phase of the relationship, a patient who has been talking openly starts missing sessions and changes the subject whenever her childhood is mentioned. What is the best interpretation?
- AShe is being rude to the nurse on purpose and should be warned
- BShe no longer needs any help, so the sessions should end at once
- CShe may be showing resistance as painful topics come closer, which the nurse can gently explore
- DThe nurse has made a serious mistake and should hand her care to a colleague immediately
3.臨床心理学ふつう
対人関係、自己像、感情の不安定さと著しい衝動性を特徴とするパーソナリティ障害はどれですか？
- A自己愛性パーソナリティ障害
- B境界性パーソナリティ障害
- Cシゾイドパーソナリティ障害
- D回避性パーソナリティ障害
4.臨床心理学むずかしい
セラピストが、パニック症のクライエントに安全行動を使わせずに、いすで回転して意図的にめまいを起こさせます。この技法は何と呼ばれ、なぜ用いられますか？
- A嫌悪療法。パニックを身体的な不快感と結びつけて学習させるため
- B自由連想。無意識の恐怖を明らかにするため
- Cフラッディング。トラウマを忘れるため
- D内受容感覚曝露。身体感覚が危険ではないことを学ぶため
5.薬理学ふつう
A patient starting niacin (nicotinic acid) complains of flushing and warmth after doses. Which advice may reduce this?
- ATake the niacin with a hot drink so that it dissolves and acts faster
- BTake it on an empty stomach in a hot bath
- CTake aspirin 30 minutes before the niacin, if the prescriber agrees
- DDouble the dose to build tolerance faster
6.薬理学むずかしい
Why is strict aseptic technique and a limited hang time needed for propofol infusions?
- ALight exposure changes propofol into an opioid
- BPropofol breaks down into a toxic gas after a few hours
- CPropofol becomes more potent the longer it hangs
- DIts lipid emulsion lets bacteria grow if it is contaminated
3溶液
1.精神看護
答え: C · In grief, painful feelings come in waves and self-esteem is usually kept
これが答えになる理由
In grief, sadness tends to come in waves linked to reminders of the loss, and positive memories and humour are possible. Pervasive worthlessness, self-loathing and hopelessness suggest depression.
答え
C · In grief, painful feelings come in waves and self-esteem is usually kept
2.精神看護
答え: C · She may be showing resistance as painful topics come closer, which the nurse can gently explore
これが答えになる理由
Resistance, such as avoiding topics or missing sessions, is common in the working phase when anxiety-provoking issues arise. The nurse notes the pattern without blame and explores it with the patient at her pace.
答え
C · She may be showing resistance as painful topics come closer, which the nurse can gently explore
3.臨床心理学
答え: B · 境界性パーソナリティ障害
これが答えになる理由
境界性パーソナリティ障害には、不安定な対人関係と同一性、感情の不安定性、見捨てられ不安、衝動性、反復する自傷が含まれます。DBT は十分な裏づけのある治療法です。
答え
B · 境界性パーソナリティ障害
4.臨床心理学
答え: D · 内受容感覚曝露。身体感覚が危険ではないことを学ぶため
これが答えになる理由
内受容感覚曝露は、恐れている身体感覚を引き起こし、クライエントが破局的な予測を検証して馴化できるようにするものです。パニック症の CBT の中核的な要素です。
答え
D · 内受容感覚曝露。身体感覚が危険ではないことを学ぶため
5.薬理学
答え: C · Take aspirin 30 minutes before the niacin, if the prescriber agrees
これが答えになる理由
Niacin causes prostaglandin-mediated vasodilation and flushing. Aspirin beforehand, taking it with food and avoiding hot drinks and alcohol reduce this effect.
答え
C · Take aspirin 30 minutes before the niacin, if the prescriber agrees
6.薬理学
答え: D · Its lipid emulsion lets bacteria grow if it is contaminated
これが答えになる理由
Propofol is formulated in a soybean oil emulsion, which is a good growth medium for bacteria. Contaminated propofol has caused sepsis, so it is handled aseptically and tubing and containers are changed at set intervals.
答え
D · Its lipid emulsion lets bacteria grow if it is contaminated
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