[{"data":1,"prerenderedAt":67},["ShallowReactive",2],{"q-nurse-110-2-medical-surgical-073":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":37,"lastmod":66},"內外科護理學","medical-surgical",{"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-內外科護理學-073","nurse-110-2-medical-surgical-073",110,2,73,"王先生，58 歲，罹患糖尿病 2 年，藉由口服抗血糖藥物、飲食與運動控制血糖，今日在家昏倒救護車送入急診，心跳 118 次／分，血壓 85\u002F50 mmHg，呼吸速率 20 次／分，血糖為 650 mg\u002FdL。下列何者為最可能之診斷？",{"A":14,"B":15,"C":16,"D":17},"乳酸中毒","低血糖昏迷","糖尿病酮酸中毒（DKA）","高滲透壓高血糖狀態（HHS）","D",null,[],"本題考點在辨識高血糖急症中HHS與DKA的鑑別。依HHS診斷特徵,好發於第二型糖尿病、血糖常高於600 mg\u002FdL、血漿滲透壓升高但無明顯酮酸,王先生血糖650 mg\u002FdL並有脫水與循環衰竭(心跳118、血壓85\u002F50),符合高滲透壓高血糖狀態,故選D。(A)乳酸中毒以乳酸堆積與陰離子間隙增大為主,非本情境典型。(B)低血糖昏迷血糖應偏低,與650 mg\u002FdL相反。(C)DKA多見於第一型,伴明顯酮體與代謝性酸中毒,與本題無酮酸背景不符。考點在於年長第二型加極高血糖與脫水即優先想HHS。","HHS與DKA同屬高血糖急症,鑑別關鍵在「有無酮酸」與「滲透壓高低」。記憶法:HHS=Hyperosmolar,血糖常>600、血漿滲透壓>320 mOsm\u002Fkg、pH≥7.3、無或微量酮體,多見於年長第二型且尚有殘存胰島素可抑制脂肪分解;DKA則因胰島素絕對不足→脂肪分解生成酮體→代謝性酸中毒(pH\u003C7.3、陰離子間隙上升)。口訣「老、高、乾、無酮想HHS」。共同病生理是高血糖造成滲透性利尿→嚴重脫水→意識障礙,HHS因脫水更重,死亡率反而較DKA高。可連結概念:滲透性利尿、有效血漿滲透壓計算、補液與胰島素治療順序。",[24,27,30,32,35],{"term":25,"count":26},"血漿滲透壓",4,{"term":28,"count":29},"第二型糖尿病",3,{"term":31,"count":10},"滲透性利尿",{"term":33,"count":34},"高滲透壓高血糖狀態(HHS)",1,{"term":36,"count":34},"糖尿病酮酸中毒(DKA)",[38,42,47,52,57,62],{"webId":39,"stem":40,"number":41,"year":9,"session":10},"nurse-110-2-medical-surgical-074","承上題，有關王先生診斷可能出現的徵象，下列何者錯誤？",74,{"webId":43,"stem":44,"number":45,"year":46,"session":10},"nurse-111-2-medical-surgical-010","有關慢性胰臟炎典型徵象的敘述，下列何者錯誤？",10,111,{"webId":48,"stem":49,"number":50,"year":51,"session":34},"nurse-112-1-medical-surgical-024","有關喉癌病人接受全喉切除術的敘述，下列何者正確？",24,112,{"webId":53,"stem":54,"number":55,"year":56,"session":34},"nurse-113-1-medical-surgical-012","有關關節炎的敘述，下列何者正確？",12,113,{"webId":58,"stem":59,"number":60,"year":61,"session":10},"nurse-114-2-medical-surgical-016","下列何者為左心衰竭的臨床表徵？",16,114,{"webId":63,"stem":64,"number":45,"year":65,"session":34},"nurse-106-1-medical-surgical-010","有關消化性潰瘍常見用藥，下列何者錯誤？",106,"2026-09-04",1788510729482]