[{"data":1,"prerenderedAt":63},["ShallowReactive",2],{"q-nurse-110-1-maternal-pediatric-045":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":33,"lastmod":62},"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":26},"nurse-110-1-產兒科護理學-045","nurse-110-1-maternal-pediatric-045",110,1,45,"小瑄，1 歲 1 個月，因不明原因發燒而入住兒童病房，測量小瑄的生命徵象時，下列護理措施何者較不適當？",{"A":14,"B":15,"C":16,"D":17},"採肛溫測量以獲得正確體溫","讓主要照顧者陪伴在身旁","先量呼吸、心跳再量體溫","血壓測量部位最常用為右上臂","A",null,[],"本題考點是嬰幼兒生命徵象測量的安全性與正確順序。考點在於選出較不適當的措施。依嬰幼兒解剖特性，肛溫測量有腸壁穿孔與交叉感染風險，並非優先或最正確的測溫方式，故「採肛溫測量以獲得正確體溫」較不適當，選 A。B 讓主要照顧者陪伴可減輕分離焦慮並利於配合，屬適當。C 先量呼吸與心跳再量體溫，可避免哭鬧影響數值，屬適當。D 血壓測量最常用右上臂，屬適當。故較不適當者為 A。","嬰幼兒生命徵象測量原則：由干擾最小到最大排序，先測安靜下的呼吸與心跳（心尖脈聽診 1 分鐘），再測體溫與血壓，因侵入或不適的測量易引發哭鬧使前面數值失準。測溫方式選擇上，肛溫雖較接近核心溫度但具穿孔與感染風險，多以耳溫、腋溫或額溫替代。血壓袖帶寬度須為上臂長度約三分之二，過窄讀值偏高、過寬偏低，掌握此細節可避免測量誤差。",[24,27,29,31],{"term":25,"count":26},"嬰幼兒生命徵象",2,{"term":28,"count":10},"肛溫風險",{"term":30,"count":10},"測量順序",{"term":32,"count":10},"血壓袖帶",[34,38,42,47,52,58],{"webId":35,"stem":36,"number":37,"year":9,"session":10},"nurse-110-1-maternal-pediatric-046","下列何者是造成兒童燒傷急救期（emergent period）休克的主要原因？",46,{"webId":39,"stem":40,"number":41,"year":9,"session":26},"nurse-110-2-maternal-pediatric-062","小玲，9 歲，於扁桃腺切除術（tonsillectomy）後，用手指著傷口並抱怨傷口疼痛，下列護理措施何者最適當？",62,{"webId":43,"stem":44,"number":45,"year":46,"session":10},"nurse-111-1-maternal-pediatric-076","小華，5 歲，罹患腎病症候群（nephrotic syndrome），全身出現水腫。為預防因水腫可能產生的皮膚完整性受損，下列護理指導何者不適當？",76,111,{"webId":48,"stem":49,"number":50,"year":51,"session":26},"nurse-112-2-maternal-pediatric-034","32 歲初產婦身高 160 公分，中午 12：00 入院時子宮頸變薄 50%，擴張為 4 公分，待產期間僅給予 Ringer 輸液 keep line，但子宮收縮頻率自然變快且強度也增加，10 分鐘內平均有 5 次以上收縮，分娩進展快速於下午 14：50 娩出 1 名男嬰，出生體重 2,700 公克。有關此位初產婦分娩特性的敘述，下列何者最適當？",34,112,{"webId":53,"stem":54,"number":55,"year":56,"session":57},"nurse-113-3-maternal-pediatric-008","潘女士，G 1 P 0 ，懷孕 41 週，因規則陣痛而入院待產，胎位為左枕前位（LOA），未接受硬脊膜外麻醉。現因宮縮強且密集，陰道內診發現子宮頸已擴張完全，胎兒高度+2。在此情境下，下列敘述何者不適當？",8,113,3,{"webId":59,"stem":60,"number":26,"year":61,"session":10},"nurse-115-1-maternal-pediatric-002","有關妊娠期間孕婦血液組成的變化，下列敘述何者正確？",115,"2026-09-04",1788510722002]