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 nursing action at mealtimes is most appropriate for a patient with anorexia nervosa?
- ALet the patient eat alone in her room for privacy
- BSupervise the meal and observe the patient for an agreed period afterwards
- CTalk with the patient at length about calories during the meal
- DAllow the patient to choose to skip meals if she says she feels full or unwell
2.精神看護むずかしい
A patient asks the nurse to pray with her before her ECT. The nurse does not share her religion. What is the most appropriate response?
- AIgnore the request politely and change the subject to the procedure itself
- BRespect the request, join in if comfortable, and offer to call the chaplain
- CTell her that religion has no place in hospital care
- DTry to persuade her to adopt the nurse's own beliefs
3.臨床心理学ふつう
エリスの ABC モデルで、「B」は何を表しますか？
- Aストレス時の身体感覚
- B出来事の後に続く行動
- Cクライエントの生い立ち
- Dきっかけとなる出来事についての信念（Beliefs）
4.臨床心理学むずかしい
ある患者には 1 年間精神病症状があります。数週間は気分エピソードなしに幻覚があり、それ以外の時期には抑うつエピソードの間に精神病症状がみられました。最も可能性の高い診断はどれですか？
- A精神病性の特徴を伴ううつ病
- B妄想性障害
- C統合失調感情障害
- D双極 I 型障害
5.薬理学ふつう
A patient with diabetes is sweaty and shaky. Blood glucose is 3.0 mmol/L (54 mg/dL). The patient is awake and can swallow. What should the nurse do first?
- AGive the next scheduled dose of insulin
- BGive 15–20 g of fast-acting carbohydrate, such as juice
- CGive intramuscular glucagon at once
- DGive a large meal high in fat and protein to keep glucose up for longer
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?
- ATake folic acid before conception and seek specialist review of her medication
- BAvoid folic acid because it lowers drug levels
- CNo change is needed, as antiepileptics carry no risk in pregnancy
- DStop all antiepileptic drugs straight away as soon as she stops contraception
3溶液
1.精神看護
答え: B · Supervise the meal and observe the patient for an agreed period afterwards
これが答えになる理由
Supervised meals and observation afterwards reduce hiding or discarding food, vomiting and excessive exercise. Mealtimes should be calm, with conversation that is not focused on food or weight.
答え
B · Supervise the meal and observe the patient for an agreed period afterwards
2.精神看護
答え: B · Respect the request, join in if comfortable, and offer to call the chaplain
これが答えになる理由
Supporting spiritual needs can reduce distress. The nurse can respond with respect within her own comfort, and refer to chaplaincy or faith leaders, without imposing her own beliefs.
答え
B · Respect the request, join in if comfortable, and offer to call the chaplain
3.臨床心理学
答え: D · きっかけとなる出来事についての信念（Beliefs）
これが答えになる理由
ABC モデルでは、きっかけとなる出来事（Activating event）が、その人の信念（Beliefs）を通して感情的な結果（Consequences）をもたらします。非合理的な信念を変えれば結果も変わります。
答え
D · きっかけとなる出来事についての信念（Beliefs）
4.臨床心理学
答え: C · 統合失調感情障害
これが答えになる理由
統合失調感情障害は、統合失調症の症状と同時に気分エピソードがあり、さらに気分エピソードのない精神病症状が少なくとも 2 週間あるものです。精神病性うつ病では、精神病症状は気分エピソードの間にしか起こりません。
答え
C · 統合失調感情障害
5.薬理学
答え: B · Give 15–20 g of fast-acting carbohydrate, such as juice
これが答えになる理由
Conscious hypoglycaemia is treated with 15–20 g of fast-acting carbohydrate, with glucose rechecked after about 15 minutes. Fat slows absorption, and glucagon is kept for patients who cannot swallow.
答え
B · Give 15–20 g of fast-acting carbohydrate, such as juice
6.薬理学
答え: A · 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
A · Take folic acid before conception and seek specialist review of her medication
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