[{"data":1,"prerenderedAt":64},["ShallowReactive",2],{"q-nurse-106-2-medical-surgical-052":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":33,"lastmod":63},"內外科護理學","medical-surgical",{"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-內外科護理學-052","nurse-106-2-medical-surgical-052",106,2,52,"評估使用呼吸器病人其氣管內管位置正確性的方式，下列何者最適當？",{"A":14,"B":15,"C":16,"D":17},"評估病人的膚色","監測病人的呼吸速率","確認 cuff 內氣體的量","聽診雙側呼吸音","D",null,[],"本題考點為確認氣管內管(ETT)位置的最適床邊評估方法。氣管內管若誤入右主支氣管或食道會造成單側或無效通氣,床邊快速確認應靠聽診雙側肺部呼吸音是否對稱且上腹無氣過水聲,故 D 最適當。A 膚色變化(發紺)是缺氧的晚期非特異表現,反應慢;B 呼吸速率無法定位導管;C 確認 cuff 氣體量只關乎氣囊密封,與導管深度位置無關。最確定的位置確認仍為胸部 X 光,但床邊即時評估以雙側呼吸音聽診最為適當,故選 D。","ETT 位置確認的層次:即時床邊→呼氣末二氧化碳(EtCO₂\u002Fcapnography,確認在氣道而非食道最可靠)、雙側呼吸音對稱、胸廓對稱起伏;最終定位→胸部 X 光(管尖應在氣管隆突上約 2–4 cm)。單側呼吸音消失最常見原因是插太深進右主支氣管(右支氣管較直較陡)。本題選項未列 capnography,故雙側呼吸音聽診為最佳解。",[24,27,29,31],{"term":25,"count":26},"氣管內管定位",1,{"term":28,"count":26},"雙側呼吸音聽診",{"term":30,"count":26},"右主支氣管插管過深",{"term":32,"count":26},"胸部 X 光確認",[34,38,43,48,53,58],{"webId":35,"stem":36,"number":37,"year":9,"session":10},"nurse-106-2-medical-surgical-053","評估疑似肺栓塞病人時，最可能發現下列何種症狀？",53,{"webId":39,"stem":40,"number":41,"year":42,"session":26},"nurse-107-1-medical-surgical-069","有關服用甲狀腺素之敘述，下列何者正確？",69,107,{"webId":44,"stem":45,"number":46,"year":47,"session":26},"nurse-108-1-medical-surgical-003","有關顱內壓升高的治療，下列何者錯誤？",3,108,{"webId":49,"stem":50,"number":51,"year":52,"session":26},"nurse-109-1-medical-surgical-041","有關大面積重度燒傷初期（48 小時內），對於心臟血管系統造成的影響，下列何者錯誤？",41,109,{"webId":54,"stem":55,"number":56,"year":57,"session":10},"nurse-110-2-medical-surgical-005","有關頭眼反射（oculocephalic reflex）的敘述，下列何者錯誤？",5,110,{"webId":59,"stem":60,"number":61,"year":62,"session":10},"nurse-111-2-medical-surgical-039","有關補充鐵劑的敘述，下列何者正確？",39,111,"2026-09-04",1788510698743]