[{"data":1,"prerenderedAt":63},["ShallowReactive",2],{"q-nurse-110-2-maternal-pediatric-079":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-110-2-產兒科護理學-079","nurse-110-2-maternal-pediatric-079",110,2,79,"陳小妹，於學校上體育課時，出現強直陣攣型痙攣（tonic-clonic seizure）發作，下列護理措施何者最不適當？",{"A":14,"B":15,"C":16,"D":17},"壓額抬下巴，通暢呼吸道","移開可能造成損傷的物品","勿強行放置壓舌板於口內","觀察並記錄發作型態與時間","A",null,[],"本題考點是強直陣攣型痙攣發作當下的急救處置。考點在於發作時以保護安全、防止外傷與維持呼吸道為原則，且不強行介入口腔或頸部。選項A「壓額抬下巴，通暢呼吸道」最不適當，痙攣發作時肌肉強直，強行壓額抬下巴可能造成傷害且無助益，正確做法是移除周遭危險物、讓病人側臥待抽搐停止後再評估呼吸道，故A為答案。B移開可能造成損傷的物品，防止外傷，正確；C勿強行放置壓舌板於口內，避免牙齒、口腔損傷與吸入，正確；D觀察並記錄發作型態與持續時間，供診斷評估，正確。故唯A為不適當處置。","全身強直陣攣發作處置原則:保護不約束—移開危險物、頭下墊軟物、鬆解衣領、側臥利分泌物引流防吸入、不放任何物入口、不強壓肢體、記錄發作型態與時間。發作中因肌肉強直，強行操作氣道反致傷害;多數發作數分鐘內自行停止，超過5分鐘或連續發作屬癲癇重積須就醫。記憶:移、側、鬆、記;不塞、不壓、不約束。可連結:發作後意識混亂期(postictal)照護與安全。",[24,27,29,31],{"term":25,"count":26},"強直陣攣痙攣",1,{"term":28,"count":26},"發作急救",{"term":30,"count":26},"側臥防吸入",{"term":32,"count":26},"禁塞口腔物",[34,38,43,48,53,58],{"webId":35,"stem":36,"number":37,"year":9,"session":10},"nurse-110-2-maternal-pediatric-080","王小妹，8 個月大，被診斷為熱性痙攣（febrile convulsion），下列敘述何者最適當？",80,{"webId":39,"stem":40,"number":41,"year":42,"session":10},"nurse-111-2-maternal-pediatric-016","王女士，G 1 P 0 ，子宮頸口開 10 公分，待產時宮縮疼痛，下列措施何者最適當？",16,111,{"webId":44,"stem":45,"number":46,"year":47,"session":26},"nurse-112-1-maternal-pediatric-030","有關維持新生兒出生即刻體溫穩定的措施，下列何者不適當？",30,112,{"webId":49,"stem":50,"number":51,"year":52,"session":26},"nurse-113-1-maternal-pediatric-018","方小妹，39週頭產式出生，下列何者新生兒身體評估結果為異常發現？",18,113,{"webId":54,"stem":55,"number":56,"year":57,"session":10},"nurse-114-2-maternal-pediatric-022","林女士第一胎，子宮頸口全開後，即使在無子宮收縮時，也可在會陰部看到胎兒頭髮，此現象稱為：",22,114,{"webId":59,"stem":60,"number":41,"year":61,"session":26},"nurse-106-1-maternal-pediatric-016","王女士，46 歲，因子宮肌瘤接受子宮切除手術，有關術後出院照護指導內容，下列何者適當？",106,"2026-09-04",1788510730399]