[{"data":1,"prerenderedAt":64},["ShallowReactive",2],{"q-nurse-114-3-maternal-pediatric-045":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":34,"lastmod":63},"產兒科護理學","maternal-pediatric",{"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":10},"nurse-114-3-產兒科護理學-045","nurse-114-3-maternal-pediatric-045",114,3,45,"當 3 歲的腦瘤女童出現下列何種徵象時，護理師應進一步評估是否為顱內壓上升？",{"A":14,"B":15,"C":16,"D":17},"心跳過快、血壓下降","頻尿、尿量多","頭痛、噴射狀嘔吐","活動量大、貓哭聲","C",null,[],"本題考點在於辨識兒童顱內壓上升的徵象。依顱內壓上升的表現,頭痛與不伴噁心先兆的「噴射狀嘔吐」是典型警訊,故 C 正確。A 錯,顱內壓上升晚期為庫欣三徵——血壓上升、脈搏變慢、呼吸不規則,而非心跳過快、血壓下降;B 錯,頻尿多尿與尿崩或血糖相關,非顱內壓上升特徵;D 錯,活動量大不符,且貓哭聲屬貓哭症(染色體疾病)之表現,與顱內壓無關。","顱內壓上升遵循 Monro-Kellie 學說:顱腔容積固定,血液、腦脊髓液、腦組織任一增加即互相壓迫。嬰兒因囟門未閉、顱縫可裂開,早期可見前囟膨出、頭圍增大、落日眼;較大兒童則以頭痛、噴射性嘔吐、意識改變為主,庫欣三徵是晚期危象。",[24,26,29,32],{"term":25,"count":10},"庫欣三徵",{"term":27,"count":28},"噴射狀嘔吐",2,{"term":30,"count":31},"顱內壓上升",1,{"term":33,"count":31},"Monro-Kellie 學說",[35,39,44,49,54,59],{"webId":36,"stem":37,"number":38,"year":9,"session":10},"nurse-114-3-maternal-pediatric-046","高小弟，8 個月，診斷泌尿道感染（urinary tract infection），下列護理指導何者最適當？",46,{"webId":40,"stem":41,"number":42,"year":43,"session":28},"nurse-115-2-maternal-pediatric-042","小力，4 歲，診斷為重度 β 型海洋性貧血，居家使用注射型排鐵劑（desferal），下列敘述何者不適當？",42,115,{"webId":45,"stem":46,"number":47,"year":48,"session":28},"nurse-106-2-maternal-pediatric-006","有關胚胎與胎兒的發育，下列敘述何者正確？",6,106,{"webId":50,"stem":51,"number":52,"year":53,"session":28},"nurse-107-2-maternal-pediatric-044","琳琳，9 個月大，因細支氣管合併肺炎再度住院，醫囑需要胸腔物理治療，有關協助家屬進行出院準備，下列護理指導何者正確？",44,107,{"webId":55,"stem":56,"number":57,"year":58,"session":31},"nurse-109-1-maternal-pediatric-008","懷孕 28 週婦女，羊水指數（AFI）小於 5 公分，表示胎兒可能出現下列何種情況？",8,109,{"webId":60,"stem":61,"number":42,"year":62,"session":31},"nurse-110-1-maternal-pediatric-042","小方，3 歲，因急性腸胃炎住院，下列何種行為反應顯示小方處於分離焦慮的抗議期？",110,"2026-09-04",1788510762629]