[{"data":1,"prerenderedAt":63},["ShallowReactive",2],{"q-nurse-112-1-fundamental-nursing-042":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":33,"lastmod":62},"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":11},"nurse-112-1-基本護理學與護理行政-042","nurse-112-1-fundamental-nursing-042",112,1,42,"王先生因車禍入院，前額有撕裂傷、左側手腳骨折、右前臂靜脈注射 0.9% N\u002FS I.V.F. 60 c.c.\u002Fhr、意識混亂，以簡單面罩提供氧氣，下列何者是測量血壓及體溫最適宜部位？",{"A":15,"B":16,"C":17,"D":18},"右手、耳溫","右腿、耳溫","右腿、口溫","右手、肛溫","B",null,[],"本題考點在於依病人傷情排除受限部位，選出測量血壓與體溫的最適宜位置。此病人左側手腳骨折（左肢不可測）、右前臂有靜脈注射 0.9% N\u002FS（右手不可綁壓脈帶以免影響輸液與讀值）、前額撕裂傷（不宜量額溫）、意識混亂（不宜口溫恐咬管或不配合）。逐項排除後，血壓只剩右腿可量，體溫以耳溫最安全，故正解 B（右腿、耳溫）。A、D 選右手違反患肢有 IV 的限制；C 選口溫違反意識混亂的安全原則。唯右腿加耳溫同時避開所有禁忌部位。","量血壓避開有動靜脈廔管、輸液、乳癌術後淋巴廓清、患肢骨折的肢體；量體溫避開會影響配合與安全的口溫（意識障礙、抽搐、張口困難）。此類題型解法固定為「逐一劃掉受限部位，剩下的就是答案」。",[25,27,29,31],{"term":26,"count":11},"血壓測量禁忌部位",{"term":28,"count":11},"體溫測量途徑選擇",{"term":30,"count":11},"靜脈注射肢體",{"term":32,"count":11},"意識障礙照護",[34,38,43,48,53,58],{"webId":35,"stem":36,"number":37,"year":10,"session":11},"nurse-112-1-fundamental-nursing-043","護理師為謝女士進行營養評估，謝女士出現下列那一項資料表示異常？",43,{"webId":39,"stem":40,"number":41,"year":10,"session":42},"nurse-112-2-fundamental-nursing-059","下列何者屬於護理長層級的管理決策？",59,2,{"webId":44,"stem":45,"number":46,"year":47,"session":11},"nurse-113-1-fundamental-nursing-023","約束病人的注意事項，下列何者錯誤？",23,113,{"webId":49,"stem":50,"number":51,"year":52,"session":42},"nurse-114-2-fundamental-nursing-021","間歇導尿法不適用於下列何種情況？",21,114,{"webId":54,"stem":55,"number":56,"year":57,"session":11},"nurse-106-1-fundamental-nursing-025","輸血最初 5 至 15 分鐘發生寒顫、心搏過速、呼吸困難、血壓下降、無尿，則病人可能發生何種反應？",25,106,{"webId":59,"stem":60,"number":41,"year":61,"session":11},"nurse-107-1-fundamental-nursing-059","某護理師上班時常常看手機上的訊息，也常常因來電須回到護理站接電話而中斷發藥。且常因需要完成護理紀錄而延遲下班，並常因照護的病人需要衛教而感到不知所措。情境中那一部分是屬於干擾時間管理的外在因素？",107,"2026-09-04",1788510741298]