[{"data":1,"prerenderedAt":62},["ShallowReactive",2],{"q-nurse-113-1-fundamental-nursing-006":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":32,"lastmod":61},"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":26},"nurse-113-1-基本護理學與護理行政-006","nurse-113-1-fundamental-nursing-006",113,1,6,"護理師發現病人的主訴與病歷紀載的家庭樹資料不相符，向主要照顧者進行再次確認，此為護理過程的那個步驟？",{"A":15,"B":16,"C":17,"D":18},"護理評值","護理診斷","護理評估","護理計畫","C",null,[],"本題考點在於辨識護理過程（nursing process）五步驟中「資料收集與確認」屬於哪一階段。護理過程依序為評估、診斷、計畫、執行、評值；當主訴與病歷家庭樹資料不符而向主要照顧者「再次確認」，本質是在補正、核實資料的正確性，屬於資料收集動作，即護理評估（assessment），故選 C。A 護理評值是在措施執行後檢視目標達成度；B 護理診斷是把已收集資料歸納出健康問題；D 護理計畫是訂定目標與措施。三者都發生在資料確認之後，唯有評估對應「收集與查證資料」這個動作。","評估階段包含收集（主客觀資料）、確認、分類與記錄四動作，「再次向照顧者查證」正落在確認資料效度這一步。記憶口訣 ADPIE（Assessment→Diagnosis→Planning→Implementation→Evaluation），任何「查、問、量、觀察」的資料動作都歸評估，別和最後檢核成效的評值混淆。",[25,27,30],{"term":17,"count":26},15,{"term":28,"count":29},"護理過程 ADPIE",3,{"term":31,"count":11},"資料確認",[33,37,40,45,51,56],{"webId":34,"stem":35,"number":36,"year":10,"session":11},"nurse-113-1-fundamental-nursing-007","手術後第2天，病人於8：30 AM下床活動後主訴傷口痛且臉色蒼白、盜冷汗，醫師評估後於9 AM給予止痛藥。下列何者為最適當的評值？",7,{"webId":38,"stem":39,"number":29,"year":10,"session":29},"nurse-113-3-fundamental-nursing-003","清除醫院環境中可能孳養微生物的體液、分泌物或溶液等，以降低微生物傳播機會，下列那項措施不適當？",{"webId":41,"stem":42,"number":43,"year":44,"session":11},"nurse-114-1-fundamental-nursing-047","有關資訊系統能提升護理效能的敘述，下列何者正確？①使用條碼辨識病人，可減少給藥三讀五對流程   ②減少護理紀錄重複抄寫時間     ③增進護理管理效率     ④衛教資料資訊化，不用花費時間衛教",47,114,{"webId":46,"stem":47,"number":48,"year":49,"session":50},"nurse-115-2-fundamental-nursing-045","有關醫院安全衛生管理之敘述，下列何者最適當？",45,115,2,{"webId":52,"stem":53,"number":54,"year":55,"session":11},"nurse-107-1-fundamental-nursing-039","有關測量血壓的敘述，下列何者錯誤？",39,107,{"webId":57,"stem":58,"number":59,"year":60,"session":11},"nurse-108-1-fundamental-nursing-073","在衡量護理生產力時，下列何項因素較不需列入考量？",73,108,"2026-09-04",1788510749843]