[{"data":1,"prerenderedAt":63},["ShallowReactive",2],{"q-nurse-106-2-fundamental-nursing-013":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":34,"lastmod":62},"基本護理學與護理行政","fundamental-nursing","基本護理學(包括護理原理、護理技術)與護理行政",{"id":8,"webId":9,"year":10,"session":11,"subject":4,"number":12,"stem":13,"options":14,"answer":19,"answerNote":20,"images":21,"explanation":22,"explanationDeep":23,"topics":24,"freq":11},"nurse-106-2-基本護理學與護理行政-013","nurse-106-2-fundamental-nursing-013",106,2,13,"有關護理計畫的擬定，下列何者錯誤？",{"A":15,"B":16,"C":17,"D":18},"病人入院即需立即擬訂護理計畫","護理計畫會隨著護理對象健康問題的改變而重新修訂","病人及其親友不需參與護理計畫的擬定","護理計畫包含非獨立性護理措施","C",null,[],"本題考點為護理計畫擬定的原則，屬找出錯誤敘述題。依以病人為中心的護理原則，病人及其親友應共同參與護理計畫的擬定，以提高照護契合度與遵從性，故錯誤者為 C。A 正確，病人入院即應及時擬訂護理計畫以指引照護；B 正確，計畫須隨健康問題變化而動態修訂；D 正確，護理計畫涵蓋獨立性與非獨立性（需醫囑）護理措施。C 主張病人與親友「不需參與」，違反個案參與原則，忽略病人自主與照護連續性，故為錯誤敘述。","護理計畫依 ADPIE 展開，特色為個別化、動態、可評值，並鼓勵病人與家屬共同參與以提升遵從性。措施可分獨立性（護理師可自主執行）與非獨立性／合作性（需醫囑或跨團隊配合），兩者皆屬完整護理計畫的一環。",[25,27,29,32],{"term":26,"count":11},"護理計畫",{"term":28,"count":11},"獨立性護理措施",{"term":30,"count":31},"個案參與",1,{"term":33,"count":31},"動態修訂",[35,39,44,48,52,57],{"webId":36,"stem":37,"number":38,"year":10,"session":11},"nurse-106-2-fundamental-nursing-014","病人術後第一天 24 小時輸入輸出量紀錄為大量點滴輸入 1200 mL，小便 1500 mL，傷口引流液 550 mL，鼻胃管引流液 550 mL，輸血 200 mL，下列護理處置何者最適宜？",14,{"webId":40,"stem":41,"number":42,"year":43,"session":31},"nurse-107-1-fundamental-nursing-030","黃老太太 88 歲全身癱瘓，身上有異味及汗臭味，下列何項護理措施最不恰當？",30,107,{"webId":45,"stem":46,"number":47,"year":43,"session":11},"nurse-107-2-fundamental-nursing-044","長期臥床者在床上使用便盆時，易使用伐耳沙伐氏操作（Valsalva’s maneuver）用力排便，此時心血管系統會呈現何種改變？①胸內壓上升 ②靜脈血快速大量流回心臟 ③血壓下降 ④心輸出量減少",44,{"webId":49,"stem":50,"number":11,"year":51,"session":31},"nurse-109-1-fundamental-nursing-002","有關壓力與疾病之關係，下列敘述何者錯誤？",109,{"webId":53,"stem":54,"number":55,"year":56,"session":31},"nurse-110-1-fundamental-nursing-046","有關等長運動的敘述，下列何者錯誤？",46,110,{"webId":58,"stem":59,"number":60,"year":61,"session":31},"nurse-111-1-fundamental-nursing-080","護理長依據同仁的某項特性進行考核，易產生下列何種偏誤？",80,111,"2026-09-04",1788510697401]