[{"data":1,"prerenderedAt":65},["ShallowReactive",2],{"q-nurse-112-2-psychiatric-community-004":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":35,"lastmod":64},"精神科與社區衛生護理學","psychiatric-community",{"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-112-2-精神科與社區衛生護理學-004","nurse-112-2-psychiatric-community-004",112,2,4,"有關鋰鹽的敘述，下列何者正確？",{"A":14,"B":15,"C":16,"D":17},"每日治療劑量之鋰鹽，建議分成 2～3 次服用","藥物主要由肝臟代謝，服藥階段須注意病人肝功能","急性躁期的血中藥物濃度建議維持在 0.6～1.0 mEq\u002FL","濃度超過 4 mEq\u002FL，須停藥與補充水分，但不建議透析治療","A",null,[],"本題考點是鋰鹽（lithium）的給藥原則與藥物動力學特性。選項 A 正確：每日治療劑量建議分成 2～3 次服用，理由是鋰鹽的治療指數狹窄（治療濃度與中毒濃度非常接近），分次給藥可削平血中尖峰濃度、降低尖峰帶來的毒性，並讓血中濃度較平穩，故選 A。B 錯：鋰鹽幾乎不經肝臟代謝，而是以原型主要由腎臟排除，因此臨床監測重點在腎功能與體液電解質，而非肝功能。C 錯：急性躁症期建議血中濃度維持在約 1.0～1.5 mEq\u002FL，而非 0.6～1.0 mEq\u002FL（後者較接近維持期）。D 錯：血中濃度過高（如超過 4 mEq\u002FL）屬嚴重中毒，血液透析是清除鋰鹽的重要處置，並非不建議透析。","鋰鹽是精神科用藥中監測最嚴的藥物之一，核心就在「治療指數狹窄」：治療濃度與中毒濃度僅一線之隔，這是理解本題所有選項的主軸。因為安全範圍窄，才需要分次服用以避免單次吸收造成的尖峰濃度過高，也才需要定期抽血監測濃度。要特別澄清一個常見錯誤說法：分次給藥並不是因為鋰鹽半衰期短——鋰鹽半衰期其實約 18～24 小時並不算短，真正原因是治療指數狹窄需要削平尖峰。藥物動力學上，鋰鹽為離子、不經肝臟代謝，主要由腎臟排除，且在腎小管與鈉競爭再吸收，所以脫水、限鈉、併用利尿劑（尤其 thiazide）都會使鋰鹽滯留、濃度升高而中毒，這也解釋了為何監測腎功能與體液狀態如此重要（對應 B 的錯處）。濃度分層記憶：維持期約 0.6～1.2 mEq\u002FL、急性躁期約 1.0～1.5 mEq\u002FL；出現中毒徵象（腸胃不適、粗大顫抖、意識改變）並隨濃度升高而加重，濃度極高時透析是有效的清除方式（對應 C、D 的錯處）。",[24,27,29,31,33],{"term":25,"count":26},"鋰鹽治療指數狹窄",1,{"term":28,"count":26},"分次給藥削平尖峰濃度",{"term":30,"count":26},"鋰鹽經腎臟排除非肝代謝",{"term":32,"count":26},"急性躁期血中濃度 1.0~1.5 mEq\u002FL",{"term":34,"count":26},"鋰鹽中毒與血液透析",[36,40,45,50,55,60],{"webId":37,"stem":38,"number":39,"year":9,"session":10},"nurse-112-2-psychiatric-community-005","有關抗精神病藥物的敘述，下列何者正確？",5,{"webId":41,"stem":42,"number":43,"year":9,"session":44},"nurse-112-3-psychiatric-community-021","邵女士，67 歲，因車禍接受手術，在加護病房第二天出現混亂、慌張、不安、定向障礙之症狀，小夜班時不斷拉鈴要求出去，大夜班時跟護理師反映牆壁上有許多蟑螂。針對此譫妄（delirium）狀態，下列何項護理措施最適宜？",21,3,{"webId":46,"stem":47,"number":48,"year":49,"session":10},"nurse-113-2-psychiatric-community-015","有關心理防衛機轉，下列敘述何者正確？",15,113,{"webId":51,"stem":52,"number":53,"year":54,"session":44},"nurse-114-3-psychiatric-community-013","有關抗鬱劑的衛教，下列敘述何者最適當？",13,114,{"webId":56,"stem":57,"number":58,"year":59,"session":26},"nurse-106-1-psychiatric-community-067","有關外籍及大陸配偶婦女之生育健康管理，下列何者錯誤？",67,106,{"webId":61,"stem":62,"number":43,"year":63,"session":10},"nurse-107-2-psychiatric-community-021","蔡女士，60 歲，罹患思覺失調症（昔稱精神分裂症）已 30 年，自我照顧能力明顯退化，日間常因來不及如廁而尿濕褲子，下列護理措施何者最適當？",107,"2026-09-04",1788510748715]