[{"data":1,"prerenderedAt":64},["ShallowReactive",2],{"q-nurse-109-2-psychiatric-community-037":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":34,"lastmod":63},"精神科與社區衛生護理學","psychiatric-community",{"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-109-2-精神科與社區衛生護理學-037","nurse-109-2-psychiatric-community-037",109,2,37,"張先生住院，因為暴力攻擊事件已進行約束 2 小時，醫療團隊共同討論是否應解除其約束，關於解除約束的評估，下列何項最適切？",{"A":14,"B":15,"C":16,"D":17},"張先生的被害妄想對象是同房病友，需要持續約束","張先生目前情緒穩定，團隊評估後可解除約束","考量夜班人力較少，應約束至白班人力足夠時再評估是否解除約束","考量張先生已約束 2 小時，應該解除約束給病人表現的機會","B",null,[],"本題考點在保護性約束的解除依據。約束屬限制人身自由的措施，應以病人當前狀態為判斷準則，一旦情緒穩定、對己對人的危險解除，經團隊評估即應盡速解除，故選 B。A 認為妄想對象是同房病友便持續約束，混淆了症狀存在與立即危險，妄想本身不等於必須持續約束的理由。C 以夜班人力不足為由延長約束，是以行政便利凌駕病人權益，違反最少限制原則。D 以「已約束 2 小時」的固定時間作為解除依據，同樣錯誤，約束的起訖不由時鐘決定而由病人狀態決定，故皆不適切。核心在於依病人危險程度動態評估。","約束遵循「最少限制原則」與「必要時最短時間」，須定期評估並記錄意識、情緒、肢體循環與皮膚完整性，危險解除即解除。可用「約束是手段不是目的，狀態達標就鬆綁」記憶，避免以人力或既定時間作藉口。可連結病人自主權、約束併發症預防與去約束評估流程延伸複習。",[24,27,30,32],{"term":25,"count":26},"最少限制原則",7,{"term":28,"count":29},"保護性約束",1,{"term":31,"count":29},"解除約束評估",{"term":33,"count":29},"病人狀態導向",[35,39,44,48,53,58],{"webId":36,"stem":37,"number":38,"year":9,"session":10},"nurse-109-2-psychiatric-community-038","李先生在門診出現言語謾罵、挑釁，當護理師前來說明時，隨即打護理師，並生氣的說：「我等 2 小時，都還沒看到我」，李先生的行為較屬於下列那一項？",38,{"webId":40,"stem":41,"number":42,"year":43,"session":29},"nurse-110-1-psychiatric-community-054","社區護理師在教導民眾預防三高的護理指導時，下列何者錯誤？",54,110,{"webId":45,"stem":46,"number":47,"year":43,"session":10},"nurse-110-2-psychiatric-community-068","回教信仰的新住民產婦拒吃婆婆煮的麻油豬肝，引起婆婆不悅，下列護理措施何者最適當？",68,{"webId":49,"stem":50,"number":51,"year":52,"session":29},"nurse-112-1-psychiatric-community-026","根據 DSM-5 診斷準則，人格障礙症（General Personality Disorder）的描述，下列何者最不適宜？",26,112,{"webId":54,"stem":55,"number":56,"year":57,"session":29},"nurse-113-1-psychiatric-community-020","下列何者不屬於神經發展障礙症（neurodevelopmental disorders）的疾病？",20,113,{"webId":59,"stem":60,"number":61,"year":62,"session":10},"nurse-114-2-psychiatric-community-014","思覺失調症病人陳述：「護理師，我聽到我媽媽在廁所說話，聲音吵死了」。下列護理師的回應何者最適當？",14,114,"2026-09-04",1788510718161]