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

What is assertive community treatment (ACT)?

  1. ACompulsory hospital treatment for people who refuse medicine
  2. BIntensive team-based support at home for people with severe mental illness and frequent admissions
  3. CA short course of assertiveness training for people with mild social anxiety
  4. DA self-help group run entirely by former patients, without any professional staff or support at all
2.精神看護むずかしい

A woman arrives in the emergency department after a sexual assault and has a cut on her head that is bleeding. What is the priority?

  1. ACall the police and wait until they arrive before doing anything else, so that no evidence is lost by mistake
  2. BAsk her for a detailed account of the assault before any care
  3. CAssess and treat her physical injuries, then offer forensic examination with her consent
  4. DCollect forensic evidence before treating any injuries
3.臨床心理学ふつう

マウラーの恐怖症の二要因モデルでは、恐怖症はどのように維持されますか？

  1. A他者による接近行動への罰が、恐怖そのものを強めること
  2. B報酬によって恐怖が正の強化を受ける
  3. C恐怖は他者の観察だけで学習される
  4. D回避が不安を減らし、それが回避を負の強化する
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非構造化面接
  2. B構造化臨床面接
  3. C投影法検査
  4. D自由連想のセッション
5.薬理学ふつう

Why is simvastatin traditionally taken in the evening?

  1. AIt is inactivated by sunlight during the day
  2. BIt causes too much drowsiness to be taken in the morning
  3. CIt must be taken with the largest meal of the day
  4. DIt is short-acting, and cholesterol synthesis peaks at night
6.薬理学むずかしい

A patient on stable warfarin is prescribed a course of metronidazole. What is the likely effect, and what should the nurse expect?

  1. AThe INR stays the same, as these drugs do not interact
  2. BThe INR falls, so the risk of clotting increases
  3. CMetronidazole replaces warfarin, so warfarin is stopped
  4. DThe INR rises, so closer INR monitoring is needed

3溶液

1.精神看護

答え: B · Intensive team-based support at home for people with severe mental illness and frequent admissions

これが答えになる理由

ACT teams provide frequent, flexible, multidisciplinary support in people's homes and communities, including help with medicines, housing and daily living. It aims to reduce hospital admissions.

答え

B · Intensive team-based support at home for people with severe mental illness and frequent admissions
2.精神看護

答え: C · Assess and treat her physical injuries, then offer forensic examination with her consent

これが答えになる理由

Medical care for injuries comes first. Forensic examination is offered, explained and carried out only with consent, and the nurse supports the survivor's control over each step.

答え

C · Assess and treat her physical injuries, then offer forensic examination with her consent
3.臨床心理学

答え: D · 回避が不安を減らし、それが回避を負の強化する

これが答えになる理由

恐怖は古典的条件づけで獲得され、恐れる対象を避けると不安が下がるため維持されます。これにより回避が負の強化を受けます。

答え

D · 回避が不安を減らし、それが回避を負の強化する
4.臨床心理学

答え: B · 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

B · 構造化臨床面接
5.薬理学

答え: D · It is short-acting, and cholesterol synthesis peaks at night

これが答えになる理由

The liver makes most cholesterol overnight, and short-acting statins such as simvastatin work best when taken in the evening. Atorvastatin and rosuvastatin can be taken at any time of day.

答え

D · It is short-acting, and cholesterol synthesis peaks at night
6.薬理学

答え: D · The INR rises, so closer INR monitoring is needed

これが答えになる理由

Metronidazole inhibits the metabolism of warfarin (mainly via CYP2C9), so warfarin levels and the INR rise. The bleeding risk increases, and the INR is checked more often during and after the course.

答え

D · The INR rises, so closer INR monitoring is needed

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