[{"data":1,"prerenderedAt":65},["ShallowReactive",2],{"q-nurse-113-2-fundamental-nursing-024":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":34,"lastmod":64},"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":27},"nurse-113-2-基本護理學與護理行政-024","nurse-113-2-fundamental-nursing-024",113,2,24,"長期服用毛地黃的病人，胸悶覺得全身無力到急診求治，護理師進行心跳評估，下列敘述何者錯誤？",{"A":15,"B":16,"C":17,"D":18},"協助病人平躺休息 15 分鐘之後再測量","手掌溫熱聽診器後使用鐘面進行評估","將聽診器置於左鎖骨中線和第五肋間交會處","評估完整 1 分鐘需要注意心率的規則與強度","B",null,[],"本題考點在於心尖脈（心音）聽診的正確技巧,屬反向題（問「何者錯誤」）。A 平躺休息 15 分鐘後測量可排除活動影響（對）、C 聽診器置於左鎖骨中線與第五肋間交會處即心尖搏動處（對）、D 心律不規則者須評估完整 1 分鐘並注意規則性與強度（對）。錯誤敘述為 B,聽診心音應使用聽診器的「膜面」（diaphragm）聽取較高頻的正常心音（S1、S2），而非「鐘面」（bell，用於聽低頻雜音如 S3、S4），故選 B。","聽診器兩面用途:膜面（diaphragm）聽高頻音——正常心音 S1S2、呼吸音、腸蠕動音;鐘面（bell）輕觸皮膚聽低頻音——S3、S4 奔馬律、血管雜音與二尖瓣狹窄的舒張期隆隆音。測心尖脈評估心率規則性時用膜面於心尖區（左鎖骨中線第五肋間）。長期服毛地黃者須警覺毒性引起的心搏過緩與心律不整,心跳低於 60 次\u002F分應依醫囑暫緩給藥並通報。",[25,28,30,32],{"term":26,"count":27},"心尖脈聽診",1,{"term":29,"count":27},"聽診器膜面聽高頻",{"term":31,"count":27},"鐘面聽低頻",{"term":33,"count":27},"心尖搏動位置",[35,39,44,49,54,59],{"webId":36,"stem":37,"number":38,"year":10,"session":11},"nurse-113-2-fundamental-nursing-025","病人頭部受傷，腦壓過高，最有可能出現下列何種呼吸型態？",25,{"webId":40,"stem":41,"number":42,"year":43,"session":27},"nurse-114-1-fundamental-nursing-021","有關尿液性質的敘述，下列何者錯誤？",21,114,{"webId":45,"stem":46,"number":47,"year":43,"session":48},"nurse-114-3-fundamental-nursing-015","有關輸血的注意事項，下列何者最適當？",15,3,{"webId":50,"stem":51,"number":52,"year":53,"session":27},"nurse-106-1-fundamental-nursing-063","下列何者不屬於專科護理師之角色與功能？",63,106,{"webId":55,"stem":56,"number":57,"year":58,"session":11},"nurse-107-2-fundamental-nursing-027","下列何者為靜脈注射部位產生浸潤的可能原因？",27,107,{"webId":60,"stem":61,"number":62,"year":63,"session":11},"nurse-108-2-fundamental-nursing-061","單位主管利用減薪、降級或解僱的方式達到行政管理的績效，是採用下列那一種影響力？",61,108,"2026-09-04",1788510754585]