[{"data":1,"prerenderedAt":76},["ShallowReactive",2],{"q-nurse-108-1-psychiatric-community-028":3},{"subject":4,"prev":5,"next":8,"subjectSlug":11,"subjectFullName":4,"question":12,"related":46,"lastmod":75},"精神科與社區衛生護理學",{"webId":6,"number":7},"nurse-108-1-psychiatric-community-027",27,{"webId":9,"number":10},"nurse-108-1-psychiatric-community-029",29,"psychiatric-community",{"id":13,"webId":14,"year":15,"session":16,"subject":4,"number":17,"stem":18,"scenario":19,"carryOver":19,"options":20,"answer":25,"answerNote":19,"images":26,"explanation":27,"explanationDeep":28,"topics":29,"freq":32,"concepts":42},"nurse-108-1-精神科與社區衛生護理學-028","nurse-108-1-psychiatric-community-028",108,1,28,"邊緣型人格障礙症病人有挑撥與討好的人際互動、情緒及明顯的衝動，最適宜的護理措施為下列何者？",null,{"A":21,"B":22,"C":23,"D":24},"建立良好的治療性人際關係","避免被病人操縱","與病人訂契約保證不自殺","教導認識社會心理壓力","B",[],"本題考點是邊緣型人格障礙症的操縱行為與分裂（splitting）防衛機轉的護理對策。依邊緣型人格障礙症的病理，個案以分裂機轉將人二分為全好或全壞，藉挑撥與討好在醫療團隊間製造對立以獲取控制感，若工作人員被捲入即形成反移情並破壞治療架構，故最適宜的護理措施為 B 避免被個案操縱——具體做法是團隊統一立場、明訂並執行一致的行為界線。A 建立良好治療性人際關係是所有精神科護理的通則，未針對題幹指出的「挑撥、討好、衝動」核心問題，屬過於籠統的干擾項。C 訂不自殺契約其效度有爭議且不能取代持續的自殺風險評估，題幹亦未以自殺為主要問題。D 教導認識社會心理壓力屬衛教層次，無法約束當下的操縱行為。","分裂（splitting）的辨識線索很固定：個案對 A 護理師說「只有你懂我，其他人都很糟」，轉頭對 B 護理師說反話。破解方式是「照會與一致」——所有工作人員在交班中攤開個案說了什麼，對規則採取同一口徑，讓「分裂」失去著力點。這也是為什麼答案不是 A：對邊緣型個案而言，關係要建立，但沒有界線的關係反而餵養操縱。\n\n邊緣型的九大特徵可用口訣「怕被丟、關係盪、自我糊、衝動多、自傷常、情緒飄、空虛感、易暴怒、壓力下短暫失真」記憶（對應 DSM 的害怕被遺棄、不穩定人際、認同障礙、衝動、自殺自傷行為、情感不穩、慢性空虛、不當強烈憤怒、壓力相關的短暫妄想或解離）。\n\n實證治療首選為辯證行為治療（DBT），其四大技巧模組為正念、情緒調節、人際效能、痛苦耐受，核心哲學是「接納與改變」的辯證平衡——這與本題「既要維持關係、又不能被操縱」的雙軌立場完全同源。\n\n可延伸複習：反移情的辨識與處理、行為契約的訂立原則、自殺風險評估工具與不自殺契約的實證爭議。",[30,33,36,38,40],{"term":31,"count":32},"邊緣型人格障礙症",5,{"term":34,"count":35},"操縱行為",4,{"term":37,"count":16},"分裂(splitting)防衛機轉",{"term":39,"count":16},"界線設定",{"term":41,"count":16},"辯證行為治療(DBT)",[43],{"id":44,"name":45},"personality-disorders","人格障礙症",[47,49,54,59,64,69],{"webId":9,"stem":48,"number":10,"year":15,"session":16},"有關 Methylphenidate（Ritalin）的敘述，下列何者錯誤？",{"webId":50,"stem":51,"number":52,"year":15,"session":53},"nurse-108-2-psychiatric-community-045","社區護理師評價民眾在高血壓防治宣導計畫後，對高血壓防治的知識及態度的改變，是屬於何種評值？",45,2,{"webId":55,"stem":56,"number":57,"year":58,"session":16},"nurse-109-1-psychiatric-community-059","衛生福利部國民健康署重視對民眾賦權（empowerment）的過程，透過三項策略來提升民眾的健康識能（health literacy），下列敘述何者錯誤？",59,109,{"webId":60,"stem":61,"number":62,"year":63,"session":53},"nurse-110-2-psychiatric-community-017","有關病人於住院期間憂鬱症的照護，下列敘述何者正確？",17,110,{"webId":65,"stem":66,"number":67,"year":68,"session":53},"nurse-111-2-psychiatric-community-061","有關自來水廠水質處理工程中曝氣法（aeration）的目的，下列何者最適當？①增加水中溶氧量 ②去除不良氣味 ③降低 pH 值 ④淨化水質",61,111,{"webId":70,"stem":71,"number":72,"year":73,"session":74},"nurse-112-3-psychiatric-community-015","林先生患第一型雙相情緒障礙症（Bipolar I Disorder）多年，當其在躁症發作時，很容易與人起衝突，而出現攻擊行為，下列護理措施何者正確？①將病人留在現場 ②鼓勵病人以言語表達其感受 ③必要時，帶入保護室隔離 ④以堅定口氣指示病人適當的行為",15,112,3,"2026-09-29",1790672290837]