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 intoxicated with phencyclidine (PCP) is agitated and has nystagmus and high blood pressure. Which nursing approach is best?

  1. ATry to talk the patient down by discussing his feelings in detail
  2. BEncourage him to walk around the ward and join in activities to help burn off the drug
  3. CProvide a quiet, low-stimulation environment and keep staff and patient safe
  4. DPut him in a busy area so that staff can watch him more easily
2.精神看護むずかしい

During a ward community meeting, several patients complain that the ward is too noisy at night. What reflects a therapeutic milieu?

  1. ADiscuss the problem openly and involve patients in finding a solution
  2. BAsk the patients to write their complaints down and then do nothing
  3. CTell the patients that the rules cannot be changed
  4. DEnd the meeting so the complaint is not discussed further
3.臨床心理学ふつう

診断の信頼性とは何を指しますか？

  1. A患者が診断を受け入れるかどうか
  2. B異なる臨床家が同じ患者に同じ診断を下すかどうか
  3. C診断が病気の経過と転帰を正確に予測するかどうか
  4. D診断に医学的検査を使うかどうか
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海馬の完全な欠損
  2. B下垂体の腫瘍
  3. Cすべての患者での前頭葉の肥大
  4. D側脳室の拡大
5.薬理学ふつう

A patient starting sulfasalazine should be told about which harmless effect?

  1. ABlue colouring of the tongue and gums
  2. BGreen colouring of the sweat
  3. CWhite spots on the nails
  4. DOrange-yellow colouring of the urine
6.薬理学むずかしい

Which statement about raloxifene for postmenopausal osteoporosis is correct?

  1. AIt acts like oestrogen in all tissues, including the breast, and relieves hot flushes
  2. BIt has no effect on the risk of blood clots
  3. CIt acts like oestrogen on bone but blocks oestrogen in the breast, and raises clot risk
  4. DIt is a bisphosphonate taken weekly with water

3溶液

1.精神看護

答え: C · Provide a quiet, low-stimulation environment and keep staff and patient safe

これが答えになる理由

PCP can cause agitation, violence, psychosis, nystagmus and hypertension. Reducing stimulation and keeping enough staff present for safety are key; "talking down" is less effective than with other hallucinogens.

答え

C · Provide a quiet, low-stimulation environment and keep staff and patient safe
2.精神看護

答え: A · Discuss the problem openly and involve patients in finding a solution

これが答えになる理由

In a therapeutic milieu, the ward environment itself is used for treatment. Shared decision-making in community meetings builds responsibility, social skills and trust.

答え

A · Discuss the problem openly and involve patients in finding a solution
3.臨床心理学

答え: B · 異なる臨床家が同じ患者に同じ診断を下すかどうか

これが答えになる理由

信頼性は、臨床家の間や時間を通じた診断の一貫性です。妥当性は、診断が実在する意味のあるカテゴリーを反映しているかどうかです。

答え

B · 異なる臨床家が同じ患者に同じ診断を下すかどうか
4.臨床心理学

答え: D · 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

D · 側脳室の拡大
5.薬理学

答え: D · Orange-yellow colouring of the urine

これが答えになる理由

Sulfasalazine can colour urine and sometimes skin and contact lenses orange-yellow. More serious adverse effects include blood disorders and rash, so blood counts are monitored.

答え

D · Orange-yellow colouring of the urine
6.薬理学

答え: C · It acts like oestrogen on bone but blocks oestrogen in the breast, and raises clot risk

これが答えになる理由

Raloxifene preserves bone density and reduces the risk of oestrogen receptor-positive breast cancer. It can worsen hot flushes and increases the risk of venous thromboembolism.

答え

C · It acts like oestrogen on bone but blocks oestrogen in the breast, and raises clot risk

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