[{"data":1,"prerenderedAt":66},["ShallowReactive",2],{"q-nurse-115-1-maternal-pediatric-020":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":35,"lastmod":65},"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":26},"nurse-115-1-產兒科護理學-020","nurse-115-1-maternal-pediatric-020",115,1,20,"張女士，懷孕 32 週，突然感到下腹疼痛，陰道流出暗紅色血液，立即就診，下列何者為最有可能的問題？",{"A":14,"B":15,"C":16,"D":17},"前置胎盤（placenta previa）","胎盤早期剝離（abruptio placenta）","脅迫性流產（inevitable abortion）","子癇症（eclampsia）","B",null,[],"本題考點是妊娠中後期陰道出血的鑑別診斷。依胎盤早期剝離的病理機轉,胎盤自子宮壁剝離後血液積存於胎盤後方,造成持續性下腹疼痛與子宮壓痛、子宮張力升高,血液滯留一段時間後才流出,顏色多呈暗紅色,與本案 32 週突發下腹痛合併暗紅色出血完全相符,故 B 最有可能。A 前置胎盤的典型表現是無痛性、鮮紅色出血,因胎盤位於子宮下段隨子宮頸變薄而剝離出血,與明顯疼痛不符。C 流產的定義為妊娠 20 週前終止,32 週已不適用此診斷。D 子癇症須以妊娠高血壓合併全身性抽搐為診斷要件,題幹並未提及血壓升高或抽搐。","兩大出血原因的對照表是必背:胎盤早期剝離為「痛、暗紅、量可能不成比例、子宮硬如板、胎心易異常」,前置胎盤為「不痛、鮮紅、量與外觀相符、子宮軟、胎心多正常」。特別注意胎盤早期剝離可能是隱藏性出血,血液全積在胎盤後方而陰道流血很少,此時外觀失血量會嚴重低估實際狀況,判斷必須依生命徵象、子宮張力與胎心型態,而非只看流出的血量。其病理延伸包括:剝離面釋放組織凝血活素進入母體循環,可引發瀰漫性血管內凝血(DIC);血液浸潤子宮肌層造成子宮呈紫藍色的 Couvelaire 子宮。危險因子中最重要的是妊娠高血壓疾病與腹部外傷、抽菸、古柯鹼使用、前次剝離史。前置胎盤懷疑時的關鍵禁忌是不做陰道內診,以免加重出血。可延伸複習:妊娠早期出血的鑑別(流產、子宮外孕、葡萄胎)。",[24,27,29,31,33],{"term":25,"count":26},"胎盤早期剝離",7,{"term":28,"count":26},"前置胎盤",{"term":30,"count":10},"隱藏性出血",{"term":32,"count":10},"流產定義",{"term":34,"count":10},"瀰漫性血管內凝血",[36,40,45,50,55,60],{"webId":37,"stem":38,"number":39,"year":9,"session":10},"nurse-115-1-maternal-pediatric-021","張女士，30 歲，G1P0，妊娠 16 週產檢的血壓量測值為 118\u002F75 mmHg，尿蛋白與尿糖測試均為陰性（-）。妊娠 28 週產檢的血壓值為 140\u002F96 mmHg，間隔四小時再測之血壓值 145\u002F100 mmHg，尿蛋白與尿糖測試均為陰性（-），依據上述相關症狀的敘述，下列何者為張女士最可能之診斷？",21,{"webId":41,"stem":42,"number":43,"year":44,"session":10},"nurse-106-1-maternal-pediatric-017","林女士因破水進入產房待產，護理師協助陰道內診，摸到胎頭前囟門，胎頭高度在-3。胎頭高度在-3 意義為何？",17,106,{"webId":46,"stem":47,"number":48,"year":44,"session":49},"nurse-106-2-maternal-pediatric-031","有關糖尿病婦女於妊娠期間護理措施之敘述，下列何者正確？",31,2,{"webId":51,"stem":52,"number":53,"year":54,"session":49},"nurse-107-2-maternal-pediatric-069","有關急性細支氣管炎的敘述，下列何者正確？",69,107,{"webId":56,"stem":57,"number":58,"year":59,"session":10},"nurse-109-1-maternal-pediatric-033","丁女士在產後 10 天惡露量突然變多且呈紅色，到門診產後檢查後確立為子宮復舊不全，造成子宮復舊不全的主要原因為何？",33,109,{"webId":61,"stem":62,"number":63,"year":64,"session":10},"nurse-110-1-maternal-pediatric-067","有關血友病住院病童及其家屬之照顧，下列敘述何者較適當？",67,110,"2026-08-06",1787299089356]