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

Which approach is most effective when setting limits with a patient who repeatedly breaks ward rules?

  1. AState the rule and the consequence clearly, and make sure all staff apply it consistently
  2. BChange the rules for this patient to avoid conflict
  3. CGive a long explanation each time the rule is broken and allow the patient to negotiate a new consequence
  4. DLet each nurse decide on the day whether to apply the rules
2.精神科护理困难

A patient asks the nurse to pray with her before her ECT. The nurse does not share her religion. What is the most appropriate response?

  1. ATry to persuade her to adopt the nurse's own beliefs
  2. BTell her that religion has no place in hospital care
  3. CIgnore the request politely and change the subject to the procedure itself
  4. DRespect the request, join in if comfortable, and offer to call the chaplain
3.临床心理学中等

一个人对老板很生气，回到家却冲伴侣大喊大叫。这体现了哪种防御机制？

  1. A置换（转移）
  2. B升华
  3. C反向形成
  4. D投射
4.临床心理学困难

一位患者有精神病性症状已一年；有几周时间出现幻觉而没有任何心境发作，其他时候精神病性症状则出现在重性抑郁发作期间。最可能的诊断是什么？

  1. A妄想障碍
  2. B双相 I 型障碍
  3. C伴精神病性特征的重性抑郁障碍
  4. D分裂情感性障碍
5.药理学中等

A nurse has a needlestick injury from a patient with HIV. When should post-exposure prophylaxis start?

  1. AAfter one week, when the risk of infection is clearer
  2. BOnly after the nurse's HIV test turns positive
  3. CAs soon as possible, and within 72 hours at the latest
  4. DOnly if the patient's viral load is above a set level
6.药理学困难

A woman with chronic hypertension who takes lisinopril is now pregnant. What is the key concern?

  1. ALisinopril works better in pregnancy, so the dose should be increased
  2. BLisinopril has no known fetal effects and should be continued
  3. CAll antihypertensives must be stopped in pregnancy
  4. DACE inhibitors harm fetal kidneys, so a safer drug is used

3溶液

1.精神科护理

答案: A · State the rule and the consequence clearly, and make sure all staff apply it consistently

为什么是这个答案

Effective limit setting is clear, calm and consistent across the whole team. The behaviour expected and the consequence are stated in advance and applied without anger or punishment.

答案

A · State the rule and the consequence clearly, and make sure all staff apply it consistently
2.精神科护理

答案: D · Respect the request, join in if comfortable, and offer to call the chaplain

为什么是这个答案

Supporting spiritual needs can reduce distress. The nurse can respond with respect within her own comfort, and refer to chaplaincy or faith leaders, without imposing her own beliefs.

答案

D · Respect the request, join in if comfortable, and offer to call the chaplain
3.临床心理学

答案: A · 置换（转移）

为什么是这个答案

置换把冲动从具有威胁性的对象转移到威胁较小的对象上。投射则是把自己无法接受的情感归于他人。

答案

A · 置换（转移）
4.临床心理学

答案: D · 分裂情感性障碍

为什么是这个答案

分裂情感性障碍包括心境发作与精神分裂症症状同时存在，另有至少两周没有心境发作的精神病性症状。在精神病性抑郁中，精神病性症状只出现在心境发作期间。

答案

D · 分裂情感性障碍
5.药理学

答案: C · As soon as possible, and within 72 hours at the latest

为什么是这个答案

Post-exposure prophylaxis aims to stop infection becoming established. It works best when started within hours, is not started after 72 hours, and is usually taken for 28 days.

答案

C · As soon as possible, and within 72 hours at the latest
6.药理学

答案: D · ACE inhibitors harm fetal kidneys, so a safer drug is used

为什么是这个答案

ACE inhibitors and ARBs cause fetal kidney damage, oligohydramnios and other problems, especially later in pregnancy. Drugs such as labetalol, nifedipine or methyldopa are used instead.

答案

D · ACE inhibitors harm fetal kidneys, so a safer drug is used

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