[{"data":1,"prerenderedAt":64},["ShallowReactive",2],{"q-nurse-109-2-fundamental-nursing-038":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":34,"lastmod":63},"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-109-2-基本護理學與護理行政-038","nurse-109-2-fundamental-nursing-038",109,2,38,"執行成人女性無菌導尿技術之敘述，下列何者正確？",{"A":15,"B":16,"C":17,"D":18},"消毒順序為中央尿道口→近側小陰唇內面→遠側小陰唇內面","存留導尿管水囊注入約 12～15 mL 的無菌生理食鹽水","單次導尿量不可超過 1,000 mL，以免腹壓快速下降","存留導尿管應固定在大腿內側","D",null,[],"本題考點為成人女性存留導尿的無菌技術。女性存留導尿管應固定於大腿內側，以減少尿道壓迫與張力、防止尿道損傷與瘻管，故選D。選項A消毒順序相反，無菌原則須由外而內、由遠而近，應為遠側小陰唇內面→近側小陰唇內面→中央尿道口，最污染的尿道口最後消毒；選項B水囊應注入約10 mL無菌蒸餾水，而非12至15 mL生理食鹽水（鹽水久留恐結晶阻塞）；選項C以單次導尿不可超過1000 mL作單一準則並不精確，過量引流恐致腹壓驟降與黏膜出血，臨床採分段緩慢引流。判斷主軸為固定部位與消毒方向。","無菌導尿要點：嚴格無菌並由外而內、由遠而近消毒（避免把外側菌帶入尿道口）；女性固定於大腿內側、男性固定於下腹部使陰莖朝上，以減少尿道壓迫與瘻管；水囊注入無菌蒸餾水約10 mL（鹽水久留恐結晶）；膀胱過度膨脹時分段緩慢引流，避免腹壓驟降致黏膜出血或休克。留置導尿是院內泌尿道感染主因，強調密閉引流與會陰照護。",[25,28,30,32],{"term":26,"count":27},"女性存留導尿無菌技術",1,{"term":29,"count":27},"導尿管固定部位",{"term":31,"count":27},"消毒由遠而近",{"term":33,"count":27},"水囊注入蒸餾水",[35,39,44,48,53,58],{"webId":36,"stem":37,"number":38,"year":10,"session":11},"nurse-109-2-fundamental-nursing-039","一位心房纖維震顫病史的病人，其橈動脈 52 次／分鐘、搏動規律，病人無感到頭暈及疲倦，為了確認病人是否出現脈搏短絀的問題，下列何者為最適當之立即性處置？",39,{"webId":40,"stem":41,"number":42,"year":43,"session":27},"nurse-110-1-fundamental-nursing-055","下列何者不是病人的權利？",55,110,{"webId":45,"stem":46,"number":47,"year":43,"session":11},"nurse-110-2-fundamental-nursing-069","下列那一項疾病不是藉由空氣傳染？",69,{"webId":49,"stem":50,"number":51,"year":52,"session":27},"nurse-112-1-fundamental-nursing-027","有關冷熱應用適應症，下列何者最適宜？",27,112,{"webId":54,"stem":55,"number":56,"year":57,"session":27},"nurse-113-1-fundamental-nursing-021","有關導尿管的選擇原則，下列何者錯誤？",21,113,{"webId":59,"stem":60,"number":61,"year":62,"session":11},"nurse-114-2-fundamental-nursing-015","有關冷、熱的生理反應，下列敘述何者錯誤？",15,114,"2026-09-04",1788510715814]