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 action reflects trauma-informed care?

  1. AAsking the patient to repeat the full trauma story to each new staff member
  2. BUsing physical restraint early to prevent any loss of control
  3. CExplaining each procedure in advance and offering choices wherever possible
  4. DMaking all decisions for the patient so that she does not feel burdened
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. AIgnore the request politely and change the subject to the procedure itself
  2. BTry to persuade her to adopt the nurse's own beliefs
  3. CTell her that religion has no place in hospital care
  4. DRespect the request, join in if comfortable, and offer to call the chaplain
3.临床心理学中等

正念认知疗法（MBCT）证据最充分的用途是：

  1. A预防复发性抑郁患者的复发
  2. B治愈痴呆
  3. C治疗患有 ADHD 的幼儿的注意问题
  4. D治疗急性精神病
4.临床心理学困难

一名男子说在一次激烈争吵后他的左臂瘫痪了，但神经系统检查结果与任何已知神经疾病都不相符。最可能的 DSM-5 诊断是什么？

  1. A躯体变形障碍
  2. B功能性神经症状障碍（转换障碍）
  3. C疾病焦虑障碍
  4. D诈病
5.药理学中等

1000 mL of IV fluid is to be given over 8 hours with a pump. What rate should be set?

  1. A250 mL/h
  2. B100 mL/h
  3. C125 mL/h
  4. D80 mL/h
6.药理学困难

A patient with severe liver cirrhosis takes oral propranolol, a drug with a high first-pass metabolism. What effect is expected?

  1. ALess drug is absorbed from the gut, so a higher dose is needed
  2. BMore drug reaches the circulation, so a lower dose may be needed
  3. CThe first-pass effect increases, so the drug becomes inactive
  4. DThe drug is excreted faster by the kidney, so it works for a shorter time

3溶液

1.精神科护理

答案: C · Explaining each procedure in advance and offering choices wherever possible

为什么是这个答案

Trauma-informed care assumes that many patients have trauma histories. It focuses on safety, trust, choice and collaboration, and on avoiding practices that can re-traumatise, such as unnecessary restraint.

答案

C · Explaining each procedure in advance and offering choices wherever possible
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 · 预防复发性抑郁患者的复发

为什么是这个答案

MBCT 把正念练习与认知疗法相结合。试验表明，它能减少既往有三次或以上抑郁发作者的复发。

答案

A · 预防复发性抑郁患者的复发
4.临床心理学

答案: B · 功能性神经症状障碍（转换障碍）

为什么是这个答案

功能性神经症状障碍包括与公认神经疾病不相符的运动或感觉症状。诊断既不要求证明存在心理原因，也不要求证明症状是伪装的。

答案

B · 功能性神经症状障碍（转换障碍）
5.药理学

答案: C · 125 mL/h

为什么是这个答案

1000 mL ÷ 8 h = 125 mL/h. Infusion pumps are set in mL per hour.

答案

C · 125 mL/h
6.药理学

答案: B · More drug reaches the circulation, so a lower dose may be needed

为什么是这个答案

In cirrhosis, less of the oral dose is removed by the liver on its first pass, partly because blood bypasses the liver through shunts. Bioavailability and plasma levels rise, so doses of such drugs often need to be reduced.

答案

B · More drug reaches the circulation, so a lower dose may be needed

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