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 says, "The doctor says I'm getting better, but I don't think anyone here really knows me." Which nurse response is most therapeutic?

  1. A"Why do you think the doctor is wrong about you?"
  2. B"The doctor is very experienced, so you should trust her."
  3. C"You feel that people here don't really know you?"
  4. D"Everyone here knows you well, so don't worry."
2.精神看護むずかしい

A patient who stopped drinking 24 hours ago has a generalised tonic-clonic seizure in bed. What is the nurse's first action?

  1. AProtect the airway and keep him safe from injury
  2. BGive oral thiamine with a glass of water
  3. CRestrain his arms and legs to stop the movements
  4. DPut something in his mouth to stop him biting his tongue
3.臨床心理学ふつう

ある人は鼻の小さなしみが醜いと毎日何時間も悩み、絶えず鏡を確認していますが、他の人には何もおかしな点が見えません。当てはまる診断はどれですか？

  1. A神経性やせ症
  2. B社交不安症
  3. C病気不安症
  4. D醜形恐怖症（身体醜形障害）
4.臨床心理学むずかしい

弁証法的行動療法（DBT）はもともと何のために開発されましたか？

  1. A双極症
  2. B認知症
  3. C限局性恐怖症
  4. D自傷を伴う境界性パーソナリティ障害
5.薬理学ふつう

In which patient is bupropion contraindicated?

  1. AA patient with seasonal allergies
  2. BA patient who wants to stop smoking
  3. CA patient with high blood cholesterol and a family history of it
  4. DA patient with a seizure disorder or an eating disorder
6.薬理学むずかしい

A patient on long-term prednisolone has been vomiting for two days and could not take her tablets. She is now hypotensive and confused, with low sodium and high potassium. What is the most urgent treatment?

  1. AOral prednisolone with a glass of water
  2. BIV hydrocortisone and IV fluids
  3. CIV furosemide
  4. DIV insulin with glucose only

3溶液

1.精神看護

答え: C · "You feel that people here don't really know you?"

これが答えになる理由

Reflecting the patient's concern invites them to explore it. Defending the doctor, reassuring falsely or asking "why" all close the conversation down.

答え

C · "You feel that people here don't really know you?"
2.精神看護

答え: A · Protect the airway and keep him safe from injury

これが答えになる理由

During a seizure, the nurse protects the airway, removes nearby hazards, does not restrain or put anything in the mouth, and calls for help. Alcohol withdrawal seizures are most likely in the first 48 hours.

答え

A · Protect the airway and keep him safe from injury
3.臨床心理学

答え: D · 醜形恐怖症（身体醜形障害）

これが答えになる理由

醜形恐怖症は、わずかであるか観察できない外見上の欠点へのとらわれで、鏡の確認や保証を求めるといった反復行動を伴います。

答え

D · 醜形恐怖症（身体醜形障害）
4.臨床心理学

答え: D · 自傷を伴う境界性パーソナリティ障害

これが答えになる理由

DBT は CBT にマインドフルネス、感情調節、苦痛耐性のスキルを組み合わせたもので、当初は境界性パーソナリティ障害と慢性的な自殺傾向をもつ人のために作られました。

答え

D · 自傷を伴う境界性パーソナリティ障害
5.薬理学

答え: D · A patient with a seizure disorder or an eating disorder

これが答えになる理由

Bupropion increases the risk of seizures, especially with bulimia or anorexia, where electrolyte disturbances are common. It is used for depression and as a smoking cessation aid.

答え

D · A patient with a seizure disorder or an eating disorder
6.薬理学

答え: B · IV hydrocortisone and IV fluids

これが答えになる理由

This suggests an adrenal crisis triggered by missed steroids and illness. Treatment is immediate IV or IM hydrocortisone, IV fluids with glucose as needed, and treating the cause.

答え

B · IV hydrocortisone and IV fluids

ExamProblems · examproblems.com/courses/mental-health-nursing