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

Which postpartum presentation is a psychiatric emergency?

  1. ATiredness and worry about feeding the baby in the first week
  2. BFeeling tearful at times but enjoying the baby and sleeping well when she can
  3. CTearfulness and mood swings on the third day after birth
  4. DConfusion, hallucinations and rapidly changing mood a few days after birth
2.精神看護むずかしい

A colleague suggests putting a loud but non-violent patient in seclusion "because he's annoying everyone". What is the correct response?

  1. AIt is acceptable as long as the patient agrees afterwards
  2. BIt is acceptable as long as the seclusion lasts for less than an hour
  3. CIt is acceptable, because it will make the ward quieter and safer for the other patients
  4. DIt would be inappropriate, because seclusion is only a last resort for serious risk of harm
3.臨床心理学ふつう

集団の中でまれであるとき、その行動を異常と判断する異常性の基準はどれですか？

  1. A理想的な精神的健康からの逸脱
  2. B適切に機能できないこと
  3. C社会規範からの逸脱
  4. D統計的な稀少性
4.臨床心理学むずかしい

診断に至るため、決まった質問を決まった順番で行う面接は何と呼ばれますか？

  1. A投影法検査
  2. B非構造化面接
  3. C構造化臨床面接
  4. D自由連想のセッション
5.薬理学ふつう

A patient is starting olanzapine. Which monitoring is most important over the following months?

  1. AHearing tests and vision tests every month
  2. BWeight, blood glucose and blood lipids
  3. CINR and platelet count
  4. DPeak expiratory flow
6.薬理学むずかしい

A patient on lisinopril for hypertension starts taking ibuprofen every day for knee pain. What is the main concern?

  1. AA higher risk of a dry cough than with lisinopril alone
  2. BFaster liver metabolism of lisinopril, so it stops working
  3. CA large fall in blood pressure, with fainting and falls on standing up
  4. DWeaker blood pressure control, kidney injury and high potassium

3溶液

1.精神看護

答え: D · Confusion, hallucinations and rapidly changing mood a few days after birth

これが答えになる理由

Postpartum psychosis usually begins within days to weeks of birth and can include confusion, delusions and hallucinations. It carries risks to mother and baby and needs immediate assessment, often in hospital.

答え

D · Confusion, hallucinations and rapidly changing mood a few days after birth
2.精神看護

答え: D · It would be inappropriate, because seclusion is only a last resort for serious risk of harm

これが答えになる理由

Seclusion is a restrictive intervention used only to contain severe behaviour likely to cause harm to others, as a last resort, for the shortest time. Using it for convenience or punishment breaches patients' rights.

答え

D · It would be inappropriate, because seclusion is only a last resort for serious risk of harm
3.臨床心理学

答え: D · 統計的な稀少性

これが答えになる理由

統計的な稀少性は、平均から大きく離れた行動を異常と定義します。その弱点は、非常に高い IQ のように望ましいまれな特性もあることです。

答え

D · 統計的な稀少性
4.臨床心理学

答え: C · 構造化臨床面接

これが答えになる理由

SCID などの構造化面接は診断基準に結びついた標準的な質問を行うため、非構造化面接に比べて信頼性が高くなります。

答え

C · 構造化臨床面接
5.薬理学

答え: B · Weight, blood glucose and blood lipids

これが答えになる理由

Olanzapine and several other atypical antipsychotics cause weight gain, insulin resistance and dyslipidaemia. Weight, waist size, glucose and lipids are checked regularly.

答え

B · Weight, blood glucose and blood lipids
6.薬理学

答え: D · Weaker blood pressure control, kidney injury and high potassium

これが答えになる理由

NSAIDs block prostaglandins that dilate the afferent arteriole and promote sodium loss. With an ACE inhibitor this can reduce blood pressure control and cause kidney injury and hyperkalaemia, especially if a diuretic is also used.

答え

D · Weaker blood pressure control, kidney injury and high potassium

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