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 4-year-old asks when her grandmother, who died last week, will come back. How should the nurse explain this to the parents?

  1. AYoung children often do not yet see death as permanent, so simple, honest words help
  2. BThe child should not be told anything about the death until she is older
  3. CThe child does not care about her grandmother and has not been affected by the death
  4. DThe child is in denial and needs psychiatric treatment
2.精神看護むずかしい

A teenager says she cuts herself "to feel better, not to die." Which statement about this is correct?

  1. ANon-suicidal self-injury still increases the long-term risk of suicide, so risk is assessed each time
  2. BSelf-injury without suicidal intent never needs any assessment
  3. CShe should be told that cutting is only attention-seeking behaviour
  4. DSelf-injury without suicidal intent shows that she has no mental health problems that need any treatment
3.臨床心理学ふつう

ある男性は社会的に抑制的で、自分は不適格だと感じ、批判を恐れて人と接する仕事を避けていますが、親密な関係は望んでいます。最も当てはまる障害はどれですか？

  1. Aシゾイドパーソナリティ障害
  2. B回避性パーソナリティ障害
  3. C演技性パーソナリティ障害
  4. D反社会性パーソナリティ障害
4.臨床心理学むずかしい

セラピストがクライエントに「自分はいつも失敗する」という考えを支持する証拠と反する証拠を評価するよう求めました。これは何という技法ですか？

  1. A認知再構成
  2. B自由連想
  3. Cトークン・エコノミー
  4. D系統的脱感作
5.薬理学ふつう

Before starting a TNF-alpha inhibitor such as adalimumab, which test is required?

  1. AA bone density scan
  2. BAn echocardiogram in every patient
  3. CA glucose tolerance test
  4. DScreening for latent tuberculosis
6.薬理学むずかしい

Why is pethidine (meperidine) avoided in older people and in kidney impairment?

  1. AIt causes severe hypoglycaemia in these groups
  2. BIts metabolite norpethidine builds up and can cause seizures
  3. CIt is not absorbed from the gut when kidney function is poor
  4. DIt has no pain-relieving effect in older people

3溶液

1.精神看護

答え: A · Young children often do not yet see death as permanent, so simple, honest words help

これが答えになる理由

Preschool children often see death as temporary or reversible. Clear, simple language, such as "her body stopped working", and avoiding phrases like "gone to sleep" help the child understand.

答え

A · Young children often do not yet see death as permanent, so simple, honest words help
2.精神看護

答え: A · Non-suicidal self-injury still increases the long-term risk of suicide, so risk is assessed each time

これが答えになる理由

Self-harm is a strong predictor of later suicide, even when the person does not intend to die. Each episode needs a compassionate assessment of risk, triggers and the function of the behaviour.

答え

A · Non-suicidal self-injury still increases the long-term risk of suicide, so risk is assessed each time
3.臨床心理学

答え: B · 回避性パーソナリティ障害

これが答えになる理由

回避性パーソナリティ障害（C 群）には、否定的評価への過敏さと社会的抑制が含まれます。シゾイドパーソナリティ障害では、親密な関係への欲求がほとんどみられません。

答え

B · 回避性パーソナリティ障害
4.臨床心理学

答え: A · 認知再構成

これが答えになる理由

認知再構成では、自動思考を特定し、証拠を検討して、過度の一般化などのゆがみをバランスのとれた考えに置き換えます。

答え

A · 認知再構成
5.薬理学

答え: D · Screening for latent tuberculosis

これが答えになる理由

TNF inhibitors can reactivate latent TB, so patients are screened with a TB blood test or skin test and chest X-ray. Hepatitis B is usually checked as well.

答え

D · Screening for latent tuberculosis
6.薬理学

答え: B · Its metabolite norpethidine builds up and can cause seizures

これが答えになる理由

Norpethidine is excreted by the kidney and is a CNS stimulant. When it accumulates, it causes tremor, agitation and seizures, so other opioids are preferred.

答え

B · Its metabolite norpethidine builds up and can cause seizures

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