[{"data":1,"prerenderedAt":65},["ShallowReactive",2],{"q-nurse-110-2-fundamental-nursing-006":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":35,"lastmod":64},"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-110-2-基本護理學與護理行政-006","nurse-110-2-fundamental-nursing-006",110,2,6,"游奶奶接受雙側膝關節置換術，術後第一天使用自控式嗎啡疼痛控制器止痛，白班護生王同學照顧游奶奶，9:40 am 尚未備口服藥物，實習指導老師詢問下，王同學表示：「奶奶還在睡覺，剛剛測量的生命徵象 BP 為 122∕64 mmHg、TPR：36.4°C、64 次／分、8 次／分，我想奶奶昨天開刀應該讓她休息一下，我不忍心叫她起床吃藥」，針對上述情境，下列處置何者最適當？",{"A":15,"B":16,"C":17,"D":18},"應讓病人有足夠的休息，以利術後復原","服藥時間已超過應暫停給此次服藥","護生具有關懷之心應給予正向鼓勵","立即再次確認病人生命徵象之正確性","D",null,[],"本題考點在於使用嗎啡自控式止痛（PCA）病人的呼吸監測判讀。考點在於題中呼吸為每分鐘8次，明顯低於成人正常12至20次，而鴉片類藥物會抑制呼吸中樞，護理判斷須先確認測量數據的正確性再處置，故選D立即再次確認生命徵象之正確性。A讓病人休息忽略了呼吸過慢的警訊，處置不當。B以超時為由暫停給藥，同樣忽略呼吸抑制的評估，不當。C僅給予護生正向鼓勵，延誤了對異常呼吸的判讀，故皆非最適當。","鴉片類藥物作用於延腦μ受體，降低呼吸中樞對二氧化碳的敏感度，造成呼吸速率變慢變淺，是PCA最需警覺的副作用。護理過程強調評估先行，異常數值須先核實再介入。記憶口訣：opioid過量三徵＝呼吸抑制、瞳孔縮小、意識改變，解毒劑為naloxone。可連結：PCA安全、呼吸抑制、護理評估流程。",[25,28,31,33],{"term":26,"count":27},"生命徵象評估",3,{"term":29,"count":30},"自控式止痛PCA",1,{"term":32,"count":30},"鴉片類呼吸抑制",{"term":34,"count":30},"正常呼吸速率",[36,40,45,49,54,59],{"webId":37,"stem":38,"number":39,"year":10,"session":11},"nurse-110-2-fundamental-nursing-007","承上題，游奶奶術後第一天生命徵象的改變，下列敘述何者正確？",7,{"webId":41,"stem":42,"number":43,"year":44,"session":30},"nurse-111-1-fundamental-nursing-023","若病人手臂靜脈不明顯且不易穿刺，可以採取下列那些措施以擴張血管？",23,111,{"webId":46,"stem":47,"number":48,"year":44,"session":11},"nurse-111-2-fundamental-nursing-037","有關影響體溫的因素，下列敘述何者正確？①老人的體溫往往稍高 ②焦慮時體溫會上升 ③甲狀腺功能不足，體溫會偏高 ④女生排卵時，體溫會稍高",37,{"webId":50,"stem":51,"number":52,"year":53,"session":11},"nurse-112-2-fundamental-nursing-075","關於有效授權的原則，下列敘述何者正確？",75,112,{"webId":55,"stem":56,"number":57,"year":58,"session":27},"nurse-113-3-fundamental-nursing-049","泌尿道感染發生率在杜納貝迪恩（Donabedian）醫療品質評估模式中，屬於下列何項品質指標？",49,113,{"webId":60,"stem":61,"number":62,"year":63,"session":30},"nurse-115-1-fundamental-nursing-043","王護理師產後三個月持續哺乳中，但每日上班非常忙碌，沒有時間可以擠乳，向護理長提出抗議，依勞動基準法護理長應如何處理較合宜？",43,115,"2026-09-04",1788510728069]