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

How should the nurse position herself when talking to an agitated patient?

  1. ADirectly face to face, as close as possible, to show confidence
  2. BAt a safe distance, slightly to the side, with a clear exit available
  3. CBetween the patient and the wall, so the patient can leave easily
  4. DBehind the patient and close to him, so that the patient does not feel threatened by eye contact
2.精神看護むずかしい

A caller says she is a patient's sister and asks how he is doing. The patient has not given consent to share information. What should the nurse do?

  1. ANeither confirm nor deny that he is there, and offer to pass on a message
  2. BGive a full update, because she is a close family member
  3. CTell her that he is on the ward but refuse to say anything else about his care or condition
  4. DAsk her to prove she is his sister and then share the details
3.臨床心理学ふつう

同僚に強い敵意をもっている人が、その同僚に過度に親しげに振る舞うときに見られる防衛機制はどれですか？

  1. A反動形成
  2. B否認
  3. C置き換え
  4. D合理化
4.臨床心理学むずかしい

22 歳の人に 2 か月間幻覚と妄想があり、その後完全に消失しました。気分エピソードはありませんでした。最も当てはまる診断はどれですか？

  1. A短期精神病性障害
  2. B統合失調症
  3. C統合失調症様障害
  4. D統合失調感情障害
5.薬理学ふつう

Why is propranolol usually avoided in patients with asthma?

  1. AIt blocks beta-2 receptors in the airways and can cause bronchospasm
  2. BIt causes tolerance to inhaled corticosteroids
  3. CIt increases mucus production by blocking histamine
  4. DIt stimulates alpha-1 receptors in the airways and raises blood pressure
6.薬理学むずかしい

A patient is switched from oral to intravenous morphine. Why is the IV dose lower than the oral dose?

  1. AThe oral route causes tolerance faster than the IV route
  2. BOral morphine has a large first-pass effect, so less reaches the blood
  3. CIV morphine is a stronger chemical form of the drug
  4. DIV morphine is excreted much more slowly by the kidney than oral morphine

3溶液

1.精神看護

答え: B · At a safe distance, slightly to the side, with a clear exit available

これが答えになる理由

Standing at an angle and outside arm's reach is less confrontational and safer. The nurse makes sure neither she nor the patient is trapped, so both have an exit.

答え

B · At a safe distance, slightly to the side, with a clear exit available
2.精神看護

答え: A · Neither confirm nor deny that he is there, and offer to pass on a message

これが答えになる理由

Without the patient's consent, the nurse should not disclose that a person is receiving mental health care. Offering to pass on a message respects confidentiality while allowing the patient to decide.

答え

A · Neither confirm nor deny that he is there, and offer to pass on a message
3.臨床心理学

答え: A · 反動形成

これが答えになる理由

反動形成は、受け入れがたい衝動をその正反対のものに変えるもので、しばしば誇張された形をとります。

答え

A · 反動形成
4.臨床心理学

答え: C · 統合失調症様障害

これが答えになる理由

統合失調症様障害は統合失調症の症状をもちますが、持続期間は 1 か月から 6 か月です。期間が、短期精神病性障害や統合失調症と区別する主な特徴です。

答え

C · 統合失調症様障害
5.薬理学

答え: A · It blocks beta-2 receptors in the airways and can cause bronchospasm

これが答えになる理由

Non-selective beta blockers block both beta-1 and beta-2 receptors. Blocking beta-2 receptors in the bronchi removes their relaxing effect and can trigger severe bronchospasm.

答え

A · It blocks beta-2 receptors in the airways and can cause bronchospasm
6.薬理学

答え: B · Oral morphine has a large first-pass effect, so less reaches the blood

これが答えになる理由

Much of an oral morphine dose is metabolised by the liver before reaching the systemic circulation. Equianalgesic tables are used, so the IV dose is a fraction of the oral dose.

答え

B · Oral morphine has a large first-pass effect, so less reaches the blood

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