[{"data":1,"prerenderedAt":47},["ShallowReactive",2],{"q-nurse-111-2-maternal-pediatric-080":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":23},"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,"freq":22},"nurse-111-2-產兒科護理學-080","nurse-111-2-maternal-pediatric-080",111,2,80,"張小弟，5 個月大，因不慎跌落床下，診斷為顱內出血，有顱內壓增高（increase intracranial pressure, IICP）現象，有關其護理措施，下列敘述何者較不適當？",{"A":14,"B":15,"C":16,"D":17},"觀察兒童囟門有無緊繃鼓脹現象，每天測量頭圍","鼓勵父母陪伴，並給予安撫，減少哭泣不安","給予多喝水，增加體液容積以及腦組織灌流","保持床頭抬高約 30～45 度，維持頭部於中線位置，並避免壓迫頸靜脈","C",null,[],"本題考點為顱內壓增高(IICP)嬰兒的護理措施。IICP 處置目標為降低腦水腫與促進靜脈回流,須限制水分而非增加。C 敘述「給予多喝水增加體液容積以及腦組織灌流」是錯誤的,過度補充液體會加重腦水腫與顱內壓,IICP 時應限制液體,故為答案。A 觀察囟門緊繃鼓脹並每天量頭圍,是嬰兒監測 IICP 的重要指標,正確;B 鼓勵父母陪伴安撫、減少哭鬧,因哭泣會使顱內壓上升,正確;D 床頭抬高 30～45 度、頭部維持中線、避免壓迫頸靜脈,可促進腦部靜脈回流降低顱內壓,正確。考點在於掌握 IICP「限水、抬高床頭、減少刺激、促進靜脈回流」的照護原則。",1,[24,28,31,35,39,43],{"webId":25,"stem":26,"number":22,"year":27,"session":22},"nurse-106-1-maternal-pediatric-001","王女士，產後第 2 天，孕產史為 G 1 P 1 ，為越南籍配偶，由婆婆陪伴照顧，婆婆堅持產後一定要喝生化湯，此時護理師該如何處置？",106,{"webId":29,"stem":30,"number":10,"year":27,"session":22},"nurse-106-1-maternal-pediatric-002","有關現今產科照護發展趨勢的敘述，下列何者正確？",{"webId":32,"stem":33,"number":34,"year":27,"session":22},"nurse-106-1-maternal-pediatric-003","許女士，懷孕 30 週，這兩週血壓上升，尿液檢查也有異常反應，醫師給予胎兒生理活動評估（BPP），有關此評估之敘述下列何者正確？",3,{"webId":36,"stem":37,"number":38,"year":27,"session":22},"nurse-106-1-maternal-pediatric-004","下列何者為懷孕之確實徵候？①聽診到胎心音 ②月經未現 ③觸診到胎兒四肢的活動 ④超音波掃描到妊娠囊 ⑤觸摸到胎兒的外形輪廓",4,{"webId":40,"stem":41,"number":42,"year":27,"session":22},"nurse-106-1-maternal-pediatric-005","有關妊娠期婦女胃腸系統平滑肌鬆弛所產生之生理變化，下列何者正確？",5,{"webId":44,"stem":45,"number":46,"year":27,"session":22},"nurse-106-1-maternal-pediatric-006","有關妊娠期泌尿系統的變化情形之敘述，下列何者正確？",6,1783840793685]