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

A woman has new anxiety, weight loss, a tremor, heat intolerance and a fast heart rate. Which test is most important before diagnosing an anxiety disorder?

  1. ASerum lithium level
  2. BAn MRI of the knee
  3. CUrine drug screen only
  4. DThyroid function tests
2.精神科护理困难

A patient with dementia with Lewy bodies is having vivid visual hallucinations. A new nurse suggests asking for haloperidol. What is the main concern?

  1. AHaloperidol will make his hallucinations more frequent
  2. BHaloperidol does not work in older patients at all
  3. CThere is no concern, because haloperidol is the treatment of choice for hallucinations in all types of dementia
  4. DThese patients can have severe, sometimes life-threatening, sensitivity reactions to antipsychotics
3.临床心理学中等

一个人回避公交车、商店、空旷的停车场和排队，因为一旦惊恐发作可能难以逃离。哪种诊断最合适？

  1. A广泛性焦虑障碍
  2. B作为特定恐惧症的幽闭恐惧症
  3. C社交焦虑障碍
  4. D广场恐惧症
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双相 I 型障碍
  2. B妄想障碍
  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

Why are many drugs started at lower doses in older adults?

  1. AOlder adults always weigh more than younger adults, so drugs last longer
  2. BKidney and liver clearance often decline, and sensitivity to drugs increases
  3. CLower doses are cheaper for older patients
  4. DOlder adults absorb no drugs from the stomach
6.药理学困难

Before starting long-term bisphosphonate treatment, a patient is advised to have a dental check-up. Why?

  1. ABisphosphonates stain the teeth black if taken for many years
  2. BBisphosphonates cause severe gum overgrowth
  3. CBisphosphonates dissolve tooth enamel within weeks
  4. DThey are linked to osteonecrosis of the jaw after dental surgery

3溶液

1.精神科护理

答案: D · Thyroid function tests

为什么是这个答案

Hyperthyroidism can mimic anxiety with tremor, palpitations, weight loss and heat intolerance. Medical causes of psychiatric symptoms should always be considered.

答案

D · Thyroid function tests
2.精神科护理

答案: D · These patients can have severe, sometimes life-threatening, sensitivity reactions to antipsychotics

为什么是这个答案

People with dementia with Lewy bodies often react badly to antipsychotics, especially first-generation drugs like haloperidol, with severe rigidity, falls, confusion and even death. Non-drug approaches come first.

答案

D · These patients can have severe, sometimes life-threatening, sensitivity reactions to antipsychotics
3.临床心理学

答案: D · 广场恐惧症

为什么是这个答案

广场恐惧症是对至少两类情境（公共交通、开放空间、封闭空间、人群或排队、独自外出）的恐惧，因为在这些情境中可能无法逃离或得不到帮助。

答案

D · 广场恐惧症
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: B · Kidney and liver clearance often decline, and sensitivity to drugs increases

为什么是这个答案

Ageing reduces kidney function, changes body composition and often slows liver metabolism. Many drugs also have stronger effects on the ageing brain, so doses are started low and increased slowly.

答案

B · Kidney and liver clearance often decline, and sensitivity to drugs increases
6.药理学

答案: D · They are linked to osteonecrosis of the jaw after dental surgery

为什么是这个答案

Osteonecrosis of the jaw is a rare but serious adverse effect, mostly after invasive dental work. Dental problems are treated before starting, and good oral hygiene is maintained.

答案

D · They are linked to osteonecrosis of the jaw after dental surgery

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