[{"data":1,"prerenderedAt":65},["ShallowReactive",2],{"q-nurse-106-2-maternal-pediatric-077":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":34,"lastmod":64},"產兒科護理學","maternal-pediatric",{"id":7,"webId":8,"year":9,"session":10,"subject":4,"number":11,"stem":12,"options":13,"answer":18,"answerNote":19,"images":20,"explanation":21,"explanationDeep":22,"topics":23,"freq":26},"nurse-106-2-產兒科護理學-077","nurse-106-2-maternal-pediatric-077",106,2,77,"有關水腦病嬰接受腦室－腹膜分流術（V-P shunt）後的各項護理，下列敘述何者正確？",{"A":14,"B":15,"C":16,"D":17},"頭圍測量方式：自枕部隆經耳垂至額頭上方","觀察是否有噴射狀嘔吐或尖銳哭聲的發生","協助病嬰採水平俯臥，以避免傷口受壓","避免抱起病嬰餵奶，以防脊髓液引流過快","B",null,[],"本題考點在水腦症腦室-腹膜引流術(V-P shunt)術後照護。術後須觀察顱內壓升高與分流阻塞\u002F感染徵象,嬰兒顱壓上升會出現噴射狀嘔吐、高頻尖銳哭聲、囟門膨出,故『觀察噴射狀嘔吐或尖銳哭聲』正確,選 B。A 錯:頭圍標準測量為繞經枕骨粗隆與眉間額部最大周徑,題述『經耳垂』不符。C 錯:術後應依醫囑避免患側受壓,『俯臥』非常規且需防傷口受壓,姿位不當。D 錯:術後可正常抱起餵奶,防引流過快應漸進調整體位而非禁止抱奶。核心在辨識顱內壓升高徵象。","V-P shunt 將腦脊髓液由腦室引流至腹腔吸收。術後兩大監測:分流阻塞(顱內壓再升高:嘔吐、尖銳哭、囟門膨、日落眼、意識變差)與感染(發燒、沿管路紅腫、腦膜炎徵象)。引流過快可致硬腦膜下出血或顱內低壓,故改變體位需漸進(由平躺漸抬高)。頭圍以 occipitofrontal circumference 標準測量並記錄趨勢。記憶:『shunt 術後看有沒有塞(顱壓升)、看有沒有感染;姿位要漸進防引流過快』。",[24,27,30,32],{"term":25,"count":26},"頭圍測量",3,{"term":28,"count":29},"腦室-腹膜引流術(V-P shunt)",1,{"term":31,"count":29},"顱內壓升高徵象(噴射性嘔吐\u002F尖銳哭聲)",{"term":33,"count":29},"分流阻塞與感染監測",[35,39,44,49,54,59],{"webId":36,"stem":37,"number":38,"year":9,"session":10},"nurse-106-2-maternal-pediatric-078","小明，7 歲，在練習游泳時，被同學推入泳池中，因溺水而窒息，經救生員急救後，送醫院治療，目前懷疑腦幹及延髓受損，有關小明的呼吸型態，下列何者較可能出現？",78,{"webId":40,"stem":41,"number":42,"year":43,"session":10},"nurse-107-2-maternal-pediatric-014","楊女士目前子宮頸口全開且完全變薄，當子宮收縮時感到非常疼痛。有關此時生產疼痛的主要來源，下列何者正確？",14,107,{"webId":45,"stem":46,"number":47,"year":48,"session":29},"nurse-108-1-maternal-pediatric-028","產後會陰傷口評估所使用的項目縮寫為何？",28,108,{"webId":50,"stem":51,"number":52,"year":53,"session":29},"nurse-109-1-maternal-pediatric-066","小瑋，6 歲，罹患膽道閉鎖，多年來等不到肝臟移植，面臨死亡，父母在與小瑋討論死亡時，下列敘述何者錯誤？",66,109,{"webId":55,"stem":56,"number":57,"year":58,"session":10},"nurse-110-2-maternal-pediatric-030","張女士，妊娠 8 週，因陰道斷續性少量出血到門診檢查。主訴有嚴重的噁心和嘔吐，醫師初步評估子宮大小超過懷孕週數，hCG 值偏高，超音波掃描未看到胎兒影像。張女士最可能的情況是：",30,110,{"webId":60,"stem":61,"number":62,"year":63,"session":10},"nurse-111-2-maternal-pediatric-064","小真，6 個月大，體重 7 公斤，剛接受完開心手術入住心臟外科加護病房，有關腎臟衰竭之臨床表徵，下列何者錯誤？",64,111,"2026-09-04",1788510699827]