[{"data":1,"prerenderedAt":72},["ShallowReactive",2],{"q-nurse-108-1-psychiatric-community-003":3},{"subject":4,"prev":5,"next":8,"subjectSlug":11,"subjectFullName":4,"question":12,"related":44,"lastmod":71},"精神科與社區衛生護理學",{"webId":6,"number":7},"nurse-108-1-psychiatric-community-002",2,{"webId":9,"number":10},"nurse-108-1-psychiatric-community-004",4,"psychiatric-community",{"id":13,"webId":14,"year":15,"session":16,"subject":4,"number":17,"stem":18,"scenario":19,"carryOver":19,"options":20,"answer":25,"answerNote":19,"images":26,"explanation":27,"explanationDeep":28,"topics":29,"freq":7,"concepts":40},"nurse-108-1-精神科與社區衛生護理學-003","nurse-108-1-psychiatric-community-003",108,1,3,"服役的林先生對軍中訓練的要求一直無法達成，常出現失眠、肚子痛等現象。某日要出外打靶的早上，林先生突然雙腳麻痺無法站立，緊急送醫並無發現任何異常的病理報告，因此轉介精神科治療，下列何者為林先生使用的心理防衛機轉？",null,{"A":21,"B":22,"C":23,"D":24},"退化","轉化","否定","昇華","B",[],"本題考點是轉化(conversion)這個防衛機轉的判定要件。依精神分析觀點,轉化是把無法用言語處理的心理衝突,轉換成沒有器質性病理基礎的身體症狀,藉此象徵性地解決困境。題幹中林先生的衝突是達不到訓練要求,症狀在最具威脅性的打靶當天出現,呈現雙腳麻痺無法站立,且病理檢查完全正常,符合心因性、與神經解剖分布不一致的表現,故選 B。A 退化是退回較早期發展階段的行為,如成人出現幼稚、依賴表現,並非產生神經學症狀;C 否定是不承認已發生的事實或診斷,題幹並無否認情節;D 昇華是把不被接受的衝動轉為社會認可的建設性活動,與失能症狀方向相反。","轉化症狀有兩個經典的伴隨現象值得記:一是原發性獲益(primary gain),症狀讓潛意識衝突不必被面對,焦慮因而下降;二是續發性獲益(secondary gain),症狀使個案免除責任並獲得關注,本題「免去打靶」即為典型。另有一個常考的描述是泰然漠視(la belle indifférence),即個案對嚴重失能顯得不成比例地平靜。鑑別上要與詐病(malingering)和人為疾患(factitious disorder)區分:轉化是潛意識產生、非自願;詐病是有意識偽裝且有明確外在動機;人為疾患是有意識製造症狀但動機在取得病人角色。DSM-5 將其歸類為功能性神經症狀障礙症。可連結概念:身體症狀及相關障礙症、壓力與身心症、原發性與續發性獲益。",[30,32,34,36,38],{"term":31,"count":7},"功能性神經症狀障礙症",{"term":33,"count":16},"轉化 conversion",{"term":35,"count":16},"原發性與續發性獲益",{"term":37,"count":16},"退化 regression",{"term":39,"count":16},"昇華 sublimation",[41],{"id":42,"name":43},"trauma-stress-disorders","創傷壓力與身體症狀相關障礙症",[45,47,51,56,61,66],{"webId":9,"stem":46,"number":10,"year":15,"session":16},"有關佩普洛（Peplau）概念的敘述，下列何者正確？①護病關係的介紹期、認同期、工作期及結束期，是重疊及連接的　②強調護理人員使用治療性人際溝通技巧和病人建立關係　③協助病人將現在的經驗與其他經驗統合　④透過轉移關係來幫助病人了解自己",{"webId":48,"stem":49,"number":50,"year":15,"session":7},"nurse-108-2-psychiatric-community-020","照護雙相情緒障礙症病人，因病人情緒高昂與挑釁，護理師出現生氣厭煩情緒，此時護理師該如何處理自己的情感反轉移？",20,{"webId":52,"stem":53,"number":54,"year":55,"session":16},"nurse-109-1-psychiatric-community-034","有關社區精神心理衛生之護理措施中三級（段）預防，下列說明何者正確？",34,109,{"webId":57,"stem":58,"number":59,"year":60,"session":16},"nurse-110-1-psychiatric-community-072","有關視力保健的護理指導，下列何者較適當？",72,110,{"webId":62,"stem":63,"number":64,"year":65,"session":7},"nurse-111-2-psychiatric-community-036","下列何者屬於社區心理衛生工作的初級預防？",36,111,{"webId":67,"stem":68,"number":69,"year":70,"session":7},"nurse-112-2-psychiatric-community-070","有關職業肌肉骨骼疾病的危險因子，下列何者最不適當？",70,112,"2026-09-29",1790672290518]