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

一名 19 岁的患者刚开始服用抗抑郁药。护士在最初几周应特别密切监测什么？

  1. A新出现或加重的自杀念头或行为
  2. B体重快速增加
  3. C脱发
  4. D眼睛颜色改变
2.精神科护理困难

A patient who takes fluoxetine in the evening says he has had trouble falling asleep since starting it. What should the nurse suggest?

  1. ADrink a small glass of wine or beer before bed to help him fall asleep
  2. BDiscuss with the prescriber whether he can take it in the morning instead
  3. CStop the fluoxetine at once and tell the prescriber at his next appointment
  4. DTake a double dose at night to make him sleepy
3.临床心理学中等

关于抑郁的单胺假说，哪项说法最准确？

  1. A它预测抗抑郁药服药后几小时内就能改善情绪
  2. B它把抑郁与单胺活性低联系起来，但难以解释药物起效的延迟
  3. C它证明抑郁仅由额叶多巴胺水平低引起
  4. D它已通过直接测量活体患者大脑中的 5-羟色胺水平得到完全证实
4.临床心理学困难

治疗师说："与其和'我是个失败者'这个想法作斗争，不如把它仅仅当作一个想法来觉察，然后去做对你重要的事。"这最能代表哪种疗法？

  1. A经典精神分析
  2. B系统脱敏
  3. C理性情绪行为疗法
  4. D接纳承诺疗法（ACT）
5.药理学中等

A patient with diabetes is sweaty and shaky. Blood glucose is 3.0 mmol/L (54 mg/dL). The patient is awake and can swallow. What should the nurse do first?

  1. AGive 15–20 g of fast-acting carbohydrate, such as juice
  2. BGive intramuscular glucagon at once
  3. CGive the next scheduled dose of insulin
  4. DGive a large meal high in fat and protein to keep glucose up for longer
6.药理学困难

A patient taking carbimazole or methimazole (thiamazole) for Graves' disease reports a sore throat and fever. What should the nurse suspect and do?

  1. AAgranulocytosis; stop the drug and check the white cell count urgently
  2. BThyroid storm; double the next dose of the drug
  3. CHypothyroidism; add levothyroxine at once
  4. DA common cold; advise rest and fluids and continue the drug as usual

3溶液

1.精神科护理

答案: A · 新出现或加重的自杀念头或行为

为什么是这个答案

在儿童和年轻成人中，抗抑郁药在治疗早期可能增加自杀想法。需要密切监测，尤其是在最初几周和调整剂量之后。

答案

A · 新出现或加重的自杀念头或行为
2.精神科护理

答案: B · Discuss with the prescriber whether he can take it in the morning instead

为什么是这个答案

Fluoxetine can be activating and cause insomnia. Taking it in the morning, with the prescriber's agreement, often helps. Stopping suddenly or using alcohol is unsafe.

答案

B · Discuss with the prescriber whether he can take it in the morning instead
3.临床心理学

答案: B · 它把抑郁与单胺活性低联系起来，但难以解释药物起效的延迟

为什么是这个答案

该假说源于药物对单胺的作用。起效前数周的延迟提示，受体适应等下游变化也起作用。

答案

B · 它把抑郁与单胺活性低联系起来，但难以解释药物起效的延迟
4.临床心理学

答案: D · 接纳承诺疗法（ACT）

为什么是这个答案

ACT（海斯）运用接纳、认知解离和基于价值的行动。与传统认知疗法不同，它不试图驳斥想法的内容。

答案

D · 接纳承诺疗法（ACT）
5.药理学

答案: A · Give 15–20 g of fast-acting carbohydrate, such as juice

为什么是这个答案

Conscious hypoglycaemia is treated with 15–20 g of fast-acting carbohydrate, with glucose rechecked after about 15 minutes. Fat slows absorption, and glucagon is kept for patients who cannot swallow.

答案

A · Give 15–20 g of fast-acting carbohydrate, such as juice
6.药理学

答案: A · Agranulocytosis; stop the drug and check the white cell count urgently

为什么是这个答案

Thionamides can cause agranulocytosis, which leaves the patient unable to fight infection. Sore throat, fever or mouth ulcers need an urgent full blood count, and the drug is stopped while waiting.

答案

A · Agranulocytosis; stop the drug and check the white cell count urgently

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