[{"data":1,"prerenderedAt":66},["ShallowReactive",2],{"q-nurse-107-1-fundamental-nursing-048":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":36,"lastmod":65},"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":27},"nurse-107-1-基本護理學與護理行政-048","nurse-107-1-fundamental-nursing-048",107,1,48,"75 歲王先生診斷中風，左側肢體肌力 1 分，右側 5 分，身上有點滴持續灌注、鼻胃管、及氣切管並連接呼吸器使用中，王先生意識不清，會不自主的將管路拔除，下列處置何者正確？",{"A":15,"B":16,"C":17,"D":18},"告訴王先生再拔掉管路就要予以雙手約束","只要有醫囑不需有家屬的同意書就能進行約束","可將王先生的雙手均約束在床欄上避免拔管","約束時應每二小時鬆開一次並改變王先生姿勢","D",null,[],"本題考點在意識不清、頻拔管病人的身體約束倫理與安全原則。依約束護理規範,D「約束時應每二小時鬆開一次並改變姿勢」正確,可促進循環、觀察皮膚並維護關節活動。A以言語威脅違反病人尊嚴與治療性溝通;B約束除醫囑外仍須告知並取得家屬同意書,非僅憑醫囑即可;C不可將約束帶綁在活動床欄上,床欄升降會拉扯致傷,應固定於床架且打活結。故選D。","身體約束原則:最後手段、最短時間、醫囑加知情同意、選最少限制的方式、固定於床架打可快速鬆解的活結、每2小時鬆開評估循環與皮膚並記錄。目的在安全而非懲罰。",[25,28,30,32,34],{"term":26,"count":27},"知情同意",8,{"term":29,"count":11},"身體約束原則",{"term":31,"count":11},"每2小時鬆開",{"term":33,"count":11},"約束固定於床架",{"term":35,"count":11},"病人安全與尊嚴",[37,41,46,51,56,60],{"webId":38,"stem":39,"number":40,"year":10,"session":11},"nurse-107-1-fundamental-nursing-049","有關管灌飲食的注意事項，下列敘述何者錯誤？",49,{"webId":42,"stem":43,"number":44,"year":10,"session":45},"nurse-107-2-fundamental-nursing-065","組織中的溝通是持續性的，意指：",65,2,{"webId":47,"stem":48,"number":49,"year":50,"session":11},"nurse-108-1-fundamental-nursing-079","某醫院評核臨床護理師技術操作標準之考核表是以勾選「達成或未達成」評值該項目，請問這是屬於下列何種考核方法？",79,108,{"webId":52,"stem":53,"number":54,"year":55,"session":45},"nurse-109-2-fundamental-nursing-037","蘇太太中風、肢體偏癱住院，家屬認為病人乃因天冷保暖不足才會中風，因此給予其穿四件衣服、戴毛帽，現病人冒汗，身上有異味，護理師欲協助減少衣物，但家屬拒絕，下列護理措施何者最為合適？",37,109,{"webId":57,"stem":58,"number":11,"year":59,"session":11},"nurse-111-1-fundamental-nursing-001","Maslow 的需要階層理論中，最高層級的需要為何？",111,{"webId":61,"stem":62,"number":63,"year":64,"session":11},"nurse-112-1-fundamental-nursing-035","楊爺爺，罹患肺心症，呼吸每分鐘 28～30 次，護理師協助採取坐臥式（Fowler’s position）的理由，下列何者不適宜？",35,112,"2026-09-04",1788510702132]