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

An 86-year-old nursing home resident becomes acutely confused over two days. Which cause should be considered first?

  1. AA sudden onset of Alzheimer's disease
  2. BA first episode of schizophrenia caused by moving into the home
  3. CThe normal ageing process
  4. DAn infection such as a urinary tract infection, or a medicine side effect
2.精神看護むずかしい

A resident with Alzheimer's disease becomes very agitated and hits out when staff try to help him bathe. What is the best approach?

  1. AGet more staff to hold him so the bath can be finished quickly
  2. BStop, try again later or in a different way, and explain each step calmly
  3. CSkip bathing for the rest of his stay
  4. DAsk the doctor for a sedative to be given before every bath so that he stays calm and cooperative
3.臨床心理学ふつう

次のうち統合失調症の陽性症状はどれですか？

  1. A感情の平板化
  2. B社会的引きこもり
  3. C妄想
  4. D会話の貧困
4.臨床心理学むずかしい

あるクライエントには、制御できない感覚と苦痛を伴うむちゃ食いが 3 か月間、少なくとも週 1 回ありますが、嘔吐、下剤、過剰な運動はありません。当てはまる診断はどれですか？

  1. A過食性障害
  2. B回避・制限性食物摂取症
  3. C神経性過食症
  4. D神経性やせ症、過食・排出型
5.薬理学ふつう

Why should NSAIDs be used with caution in some people with asthma?

  1. AThey can trigger bronchospasm in aspirin-sensitive asthma
  2. BThey increase the clearance of salbutamol
  3. CThey block the anti-inflammatory effect of inhaled corticosteroids
  4. DThey cause mucus plugs by drying the airways
6.薬理学むずかしい

A patient on disulfiram becomes flushed, nauseated and has palpitations after using a mouthwash. What is the most likely cause?

  1. ALow blood glucose from skipping breakfast
  2. BAn allergy to mint flavouring in the mouthwash
  3. CAlcohol in the mouthwash caused a disulfiram–alcohol reaction
  4. DDisulfiram toxicity from taking too many tablets by mistake

3溶液

1.精神看護

答え: D · An infection such as a urinary tract infection, or a medicine side effect

これが答えになる理由

Acute confusion in an older adult suggests delirium, which has an underlying cause. Common causes include infections, medicines (especially anticholinergics and sedatives), dehydration, hypoxia, pain and urinary retention.

答え

D · An infection such as a urinary tract infection, or a medicine side effect
2.精神看護

答え: B · Stop, try again later or in a different way, and explain each step calmly

これが答えになる理由

Bathing can feel frightening or undignified. Changing the timing, approach or method, for example a bed bath or shower, giving simple explanations and keeping him covered and warm often reduces distress without force.

答え

B · Stop, try again later or in a different way, and explain each step calmly
3.臨床心理学

答え: C · 妄想

これが答えになる理由

陽性症状は付け加わるもの（幻覚、妄想、まとまりのない会話）で、陰性症状は失われるもの（感情の平板化、意欲低下、思考の貧困）です。

答え

C · 妄想
4.臨床心理学

答え: A · 過食性障害

これが答えになる理由

過食性障害では、苦痛を伴う反復するむちゃ食いがみられますが、定期的な代償行動はありません。神経性過食症には代償行動が、神経性やせ症には著しい低体重が必要です。

答え

A · 過食性障害
5.薬理学

答え: A · They can trigger bronchospasm in aspirin-sensitive asthma

これが答えになる理由

In aspirin-exacerbated respiratory disease, COX inhibition increases leukotriene production, causing bronchospasm. These patients should avoid aspirin and other non-selective NSAIDs.

答え

A · They can trigger bronchospasm in aspirin-sensitive asthma
6.薬理学

答え: C · Alcohol in the mouthwash caused a disulfiram–alcohol reaction

これが答えになる理由

Disulfiram reactions can occur with small amounts of alcohol in mouthwash, cough syrups, sauces or aftershave. Patients are taught to check labels and avoid all alcohol-containing products.

答え

C · Alcohol in the mouthwash caused a disulfiram–alcohol reaction

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