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 the main difference between disulfiram and naltrexone in alcohol dependence?

  1. ADisulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward
  2. BDisulfiram reduces craving; naltrexone causes vomiting when alcohol is drunk
  3. CBoth work in exactly the same way, so they are fully interchangeable
  4. DNaltrexone is used only for alcohol withdrawal; disulfiram is used only for treating an alcohol overdose
2.精神看護むずかしい

A patient who believes he is a famous religious leader becomes upset when other patients laugh at him. What is the most appropriate nursing action?

  1. AProtect him from ridicule, avoid arguing and focus on real activities
  2. BEncourage the other patients to explain why the belief is wrong
  3. CAgree that he is the religious leader so that he feels respected
  4. DAsk him to prove his identity in front of the group, so that the laughing stops
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妄想
  3. C会話の貧困
  4. D社会的引きこもり
4.臨床心理学むずかしい

統合失調症のドーパミン仮説を支持する観察はどれですか？

  1. Aセロトニン濃度だけで症状を予測できる
  2. B抗精神病薬は中脳辺縁系経路のドーパミン活動を高め、症状を軽減する
  3. Cすべての患者が抗うつ薬に同じようによく反応する
  4. Dアンフェタミンなどドーパミンを増やす薬物が精神病症状を引き起こしうる
5.薬理学ふつう

Which patient should usually not use the combined oral contraceptive pill?

  1. AA 22-year-old non-smoker with acne
  2. BA 38-year-old woman who smokes 20 cigarettes a day
  3. CA 30-year-old non-smoker with no medical problems
  4. DA 25-year-old woman with heavy periods
6.薬理学むずかしい

A patient who used heroin a few hours ago is given a first dose of buprenorphine and quickly develops severe withdrawal. Why?

  1. ABuprenorphine causes an allergic reaction in heroin users
  2. BBuprenorphine has no effect at opioid receptors
  3. CBuprenorphine is a high-affinity partial agonist that displaces heroin
  4. DBuprenorphine is a pure antagonist like naloxone with no agonist effect

3溶液

1.精神看護

答え: A · Disulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward

これが答えになる理由

Disulfiram blocks the breakdown of acetaldehyde, so drinking causes flushing, nausea and palpitations. Naltrexone blocks opioid receptors and reduces the pleasurable effect of alcohol.

答え

A · Disulfiram causes an unpleasant reaction to alcohol; naltrexone reduces craving and reward
2.精神看護

答え: A · Protect him from ridicule, avoid arguing and focus on real activities

これが答えになる理由

Arguing or agreeing strengthens a delusion. The nurse protects the patient's dignity, responds to his feelings and focuses on real, present activities and concerns.

答え

A · Protect him from ridicule, avoid arguing and focus on real activities
3.臨床心理学

答え: B · 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

B · 妄想
4.臨床心理学

答え: D · アンフェタミンなどドーパミンを増やす薬物が精神病症状を引き起こしうる

これが答えになる理由

アンフェタミンは精神病を誘発することがあり、D2 を遮断する抗精神病薬は陽性症状を減らします。陰性症状はうまく説明できないため、仮説は修正されてきました。

答え

D · アンフェタミンなどドーパミンを増やす薬物が精神病症状を引き起こしうる
5.薬理学

答え: B · A 38-year-old woman who smokes 20 cigarettes a day

これが答えになる理由

Smoking over the age of 35 greatly increases the risk of myocardial infarction and stroke with combined hormonal contraception. Progestogen-only or non-hormonal methods are preferred.

答え

B · A 38-year-old woman who smokes 20 cigarettes a day
6.薬理学

答え: C · Buprenorphine is a high-affinity partial agonist that displaces heroin

これが答えになる理由

Buprenorphine binds mu receptors more strongly than heroin but activates them less, so it can precipitate withdrawal. Induction is started when the patient already has mild to moderate withdrawal signs.

答え

C · Buprenorphine is a high-affinity partial agonist that displaces heroin

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