[{"data":1,"prerenderedAt":48},["ShallowReactive",2],{"q-nurse-108-2-fundamental-nursing-023":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-108-2-基本護理學與護理行政-023","nurse-108-2-fundamental-nursing-023",108,2,23,"王先生為脊髓損傷病人，臀部有一久未癒合 10×8×4 cm 3 的傷口，入院時抱怨：「傷口都好幾個月了，怎麼都不會好？」。下列何者為護理師應最優先執行之護理措施？",{"A":15,"B":16,"C":17,"D":18},"給予傷口換藥，以保濕性敷料覆蓋","以住院期間能改善傷口大小為照顧目標","評估影響王先生傷口癒合的因素","住院飲食採高蛋白、富維生素 C 食物","C",null,[],"本題考點為護理過程的步驟順序:評估—診斷—計畫—執行—評值,任何處置前須先完整評估。傷口數月未癒暗示背後有未解決的影響因素(如營養不良、組織灌流不足、感染、持續受壓、血糖失控),護理師應最優先評估影響王先生傷口癒合的因素,據此擬定後續照護,選C。A傷口換藥、D高蛋白高維生素C飲食屬執行層面的措施,B以改善傷口大小為目標屬設定目標,三者都應建立在評估結果之上。未評估即處置可能治標不治本,故評估先行。",1,[25,29,32,36,40,44],{"webId":26,"stem":27,"number":23,"year":28,"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？",106,{"webId":30,"stem":31,"number":11,"year":28,"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":33,"stem":34,"number":35,"year":28,"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":37,"stem":38,"number":39,"year":28,"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":41,"stem":42,"number":43,"year":28,"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":45,"stem":46,"number":47,"year":28,"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？",6,1783840758054]