精神科护理：速成包

公式表、每个专题的关键方法步骤和 6 道练习题，完整解答附在最后。

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1公式与方法

精神科护理

方法

  1. 判断是否存在即时风险：自杀、暴力、药物急症或躯体疾病。
  2. 先保障安全：观察、移除危险物品、缓和局面、停用有害药物、寻求帮助。
  3. 选择治疗性回应：承认感受、陈述现实，避免虚假的安慰和“为什么”式提问。
  4. 尊重权利：采用限制最少的方案，知情同意，以及保密及其限度。

2练习题

1.精神科护理中等

What should a patient starting zolpidem for insomnia be taught to report?

  1. ASleeping through the night without waking up
  2. BFeeling slightly more rested and alert the next morning than before starting the medicine
  3. CDoing things while not fully awake, such as sleepwalking or driving, with no memory of it
  4. DFeeling sleepy about 30 minutes after taking it at bedtime
2.精神科护理困难

A 50-year-old man has believed for a year that his wife is unfaithful. He works normally, his speech is organised and he has no hallucinations. Which diagnosis is most likely?

  1. ASchizophrenia
  2. BDelusional disorder
  3. CSchizophreniform disorder
  4. DBipolar I disorder
3.临床心理学中等

哪种副作用是第一代（典型）抗精神病药的长期风险？

  1. A像苯二氮䓬类一样的躯体依赖
  2. B吃奶酪后的高血压危象
  3. C5-羟色胺综合征
  4. D迟发性运动障碍
4.临床心理学困难

一项研究把一种新疗法与等待名单对照组比较，发现效果很大。为什么这可能高估了该疗法的特异性效果？

  1. A等待名单对照组总是接受同样的治疗
  2. B等待名单完全消除了安慰剂效应，因此任何获益必然来自治疗本身
  3. C等待名单控制了时间推移，但没有控制关注、期望或治疗联盟
  4. D等待名单参与者不能被随机分组
5.药理学中等

Why is hypovolaemia corrected with IV fluids before or while starting a vasopressor?

  1. AVasopressors cannot keep perfusion up if the circulation is under-filled
  2. BVasopressors cause the patient to retain too much fluid
  3. CFluids stop the vasopressor causing a fever
  4. DVasopressors only work when they are diluted in large fluid volumes
6.药理学困难

Why is vancomycin given by mouth, not intravenously, for Clostridioides difficile infection?

  1. AIntravenous vancomycin causes C. difficile infection
  2. BOral vancomycin is absorbed into the blood better than IV vancomycin
  3. COral vancomycin is not absorbed, so it reaches high levels in the colon
  4. DThe oral form is cheaper but has the same effect as IV

3溶液

1.精神科护理

答案: C · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it

为什么是这个答案

Zolpidem and similar "Z-drugs" can cause complex sleep behaviours, such as sleep-walking, sleep-driving or cooking while not fully awake, which can cause serious injury. These must be reported and the drug stopped.

答案

C · Doing things while not fully awake, such as sleepwalking or driving, with no memory of it
2.精神科护理

答案: B · Delusional disorder

为什么是这个答案

Delusional disorder involves one or more delusions for at least 1 month, without other prominent symptoms of schizophrenia, and functioning is not markedly impaired apart from the effects of the delusion. Jealous delusions are one recognised type.

答案

B · Delusional disorder
3.临床心理学

答案: D · 迟发性运动障碍

为什么是这个答案

长期阻断多巴胺可导致迟发性运动障碍，表现为面部、舌和四肢不自主的重复运动，且可能不可逆。

答案

D · 迟发性运动障碍
4.临床心理学

答案: C · 等待名单控制了时间推移，但没有控制关注、期望或治疗联盟

为什么是这个答案

等待名单设计表明治疗优于不治疗，但希望和与治疗师接触等共同因素没有得到控制。要检验特异性成分，需要积极疗法对照或注意-安慰剂对照。

答案

C · 等待名单控制了时间推移，但没有控制关注、期望或治疗联盟
5.药理学

答案: A · Vasopressors cannot keep perfusion up if the circulation is under-filled

为什么是这个答案

Vasoconstriction without adequate volume reduces organ blood flow and can cause ischaemia. Fluid resuscitation restores preload, and vasopressors are then used for persistent hypotension.

答案

A · Vasopressors cannot keep perfusion up if the circulation is under-filled
6.药理学

答案: C · Oral vancomycin is not absorbed, so it reaches high levels in the colon

为什么是这个答案

Oral vancomycin stays in the gut and acts directly on C. difficile in the colon. IV vancomycin is not excreted into the gut in useful amounts, so it does not treat this infection.

答案

C · Oral vancomycin is not absorbed, so it reaches high levels in the colon

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