[{"data":1,"prerenderedAt":66},["ShallowReactive",2],{"q-nurse-109-1-maternal-pediatric-053":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":34,"lastmod":65},"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":10},"nurse-109-1-產兒科護理學-053","nurse-109-1-maternal-pediatric-053",109,1,53,"小明，3 歲，被機車撞倒，頭部受傷，有關腦壓增高的早期臨床表徵，不包括下列何者？",{"A":14,"B":15,"C":16,"D":17},"痙攣、頭痛","斜眼、複視","噴射狀嘔吐","瞳孔大小不對稱","D",null,[],"本題考點在於區分顱內壓增高（IICP）的早期與晚期臨床表徵。依 IICP 病生理，早期因腦組織受壓、腦脊髓液循環受阻，會出現頭痛、痙攣、噴射狀嘔吐，以及外展神經（CN VI）受壓造成的斜視、複視。瞳孔大小不對稱（不等）屬於晚期徵象，機轉是腦幹受壓或顳葉鉤回疝（uncal herniation）壓迫動眼神經（CN III），代表腦壓已進一步惡化、可能發生腦疝，故不列入早期表徵，選 D。A 的痙攣、頭痛為腦壓上升早期的皮質刺激症狀。B 的斜眼、複視源自 CN VI 麻痺，屬早期。C 的噴射狀嘔吐因延腦嘔吐中樞受壓，亦為早期典型表現，三者皆早期，唯 D 為晚期惡化徵象。","記憶對比：早期看「刺激」（頭痛、痙攣、嘔吐、視力模糊、複視），晚期看「腦幹受壓」（瞳孔不等且對光反射消失、Cushing 三徵：血壓上升、脈搏變慢、呼吸不規則）。瞳孔一旦不等大常代表同側動眼神經受鉤回疝壓迫，是需警覺腦疝的紅旗。嬰幼兒因囟門與顱縫未閉合，早期還可見前囟膨出、頭圍增大、落日眼，緩衝了成人的急性表現。",[24,26,28,30,32],{"term":25,"count":10},"顱內壓增高早期表徵",{"term":27,"count":10},"動眼神經 CN III",{"term":29,"count":10},"外展神經 CN VI",{"term":31,"count":10},"顳葉鉤回疝",{"term":33,"count":10},"Cushing 三徵",[35,39,44,49,54,60],{"webId":36,"stem":37,"number":38,"year":9,"session":10},"nurse-109-1-maternal-pediatric-054","協助病童接受腰椎穿刺檢查過程中，下列護理措施何者不恰當？",54,{"webId":40,"stem":41,"number":42,"year":9,"session":43},"nurse-109-2-maternal-pediatric-070","小美 5 歲，出現發燒、臉色蒼白、虛弱、肚子痛，經醫師確診為神經母細胞瘤第三期，下列敘述何者最不適當？",70,2,{"webId":45,"stem":46,"number":47,"year":48,"session":43},"nurse-110-2-maternal-pediatric-004","懷孕期間由於生理機能改變，使得藥物在孕婦體內的吸收、分布、代謝與排泄均有改變，下列敘述何者正確？",4,110,{"webId":50,"stem":51,"number":52,"year":53,"session":43},"nurse-111-2-maternal-pediatric-042","有關自閉症兒童的敘述，下列何者護理照護較為正確？",42,111,{"webId":55,"stem":56,"number":57,"year":58,"session":59},"nurse-112-3-maternal-pediatric-006","素食者在懷孕期較易缺乏下列何項維生素？",6,112,3,{"webId":61,"stem":62,"number":63,"year":64,"session":59},"nurse-113-3-maternal-pediatric-050","有關單側性發展性髖關節發育不良（developmental hip dysplasia, DDH）病童的臨床表徵，下列何者錯誤？",50,113,"2026-09-04",1788510713618]