[{"data":1,"prerenderedAt":47},["ShallowReactive",2],{"q-nurse-106-2-fundamental-nursing-036":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":24},"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,"freq":23},"nurse-106-2-基本護理學與護理行政-036","nurse-106-2-fundamental-nursing-036",106,2,36,"蔣奶奶 16 小時未解尿，膀胱脹，經誘尿無效需導尿。下列護理措施何者較不適當？",{"A":15,"B":16,"C":17,"D":18},"可採用單次導尿","選擇 14 Fr.導尿管","導尿管插入 5 公分","一次導出所有尿液","D",null,[],"本題考點是急性尿滯留導尿的安全原則。依膀胱減壓生理,長時間脹滿的膀胱若一次快速排空大量尿液,腔內壓驟降會使黏膜血管充血破裂而血尿,並可能引發迷走神經反射性低血壓,故應分段緩慢導出,「一次導出所有尿液」為較不適當,選 D。A 蔣奶奶為暫時性尿滯留,採單次(直入式)導尿即可,適當;B 成人一般選 14 Fr. 導尿管口徑適中,適當;C 女性尿道短,導尿管插入約 5～7.5 公分見尿即可,插入 5 公分適當。唯 D 忽略減壓安全。",1,[25,28,31,35,39,43],{"webId":26,"stem":27,"number":23,"year":10,"session":23},"nurse-106-1-fundamental-nursing-001","下列何者為預防院內感染最經濟有效的方法？",{"webId":29,"stem":30,"number":11,"year":10,"session":23},"nurse-106-1-fundamental-nursing-002","下列那一種健康問題會導致體溫過高？",{"webId":32,"stem":33,"number":34,"year":10,"session":23},"nurse-106-1-fundamental-nursing-003","王先生因腦血管損傷住院中，下列何種灌注溶液不適合王先生使用？",3,{"webId":36,"stem":37,"number":38,"year":10,"session":23},"nurse-106-1-fundamental-nursing-004","醫囑為 Acetaminophen 1 tab q6h p.r.n. if BT≧39℃之含義，下列敘述何者正確？",4,{"webId":40,"stem":41,"number":42,"year":10,"session":23},"nurse-106-1-fundamental-nursing-005","測量 H5N1 流感病毒感染病人生命徵象時，下列何項防護設備較不必要？",5,{"webId":44,"stem":45,"number":46,"year":10,"session":23},"nurse-106-1-fundamental-nursing-006","林小姐因中風導致右側肢體偏癱，住院期間有關病人之安全，下列敘述何者錯誤？",6,1783840736495]