[{"data":1,"prerenderedAt":63},["ShallowReactive",2],{"q-nurse-115-1-medical-surgical-009":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":33,"lastmod":62},"內外科護理學","medical-surgical",{"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":11},"nurse-115-1-內外科護理學-009","nurse-115-1-medical-surgical-009",115,1,9,"肝性腦病變可能出現的臨床表徵，下列何者錯誤？",{"A":14,"B":15,"C":16,"D":17},"深腱反射消失","肌肉僵直、抽搐發作","巴賓斯基反射（Babinski’s sign）陽性","非昏迷期會出現手掌撲翼樣震顫（asterixis）","A",null,[],"本題考點是肝性腦病變的神經學表徵。依其病生理,肝功能衰竭與門脈系統分流使腸道產生的氨無法轉為尿素排除,血氨與假性神經傳導物質作用於中樞神經,造成意識改變與運動皮質抑制解除的上運動神經元徵象,因此深腱反射通常是增強而非消失,A 為錯誤敘述。B 正確:病程進展可出現肌肉僵直、去大腦姿勢與抽搐。C 正確:巴賓斯基反射陽性反映錐體徑路受影響,屬上運動神經元病徵。D 正確:手掌撲翼樣震顫是非昏迷期的典型指標,請病人手腕背屈時出現不規則拍動。","分期記法:第一期輕微人格與睡眠日夜顛倒、第二期嗜睡與撲翼樣震顫明顯、第三期意識混亂但可喚醒、第四期昏迷伴反射改變。撲翼樣震顫與書寫變形、建構性失用(畫五角星困難)可當床邊追蹤指標。治療策略全部指向降血氨:lactulose 酸化腸道使氨變成不易吸收的銨並促排便、抗生素抑制產氨菌、限制過量蛋白質並避免便秘、低血鉀與腸胃道出血等誘因。反射由增強走向消失通常代表病情惡化至深度昏迷,故本題把「消失」列為錯誤敘述。延伸複習:門脈高壓的側枝循環、食道靜脈瘤出血與腦病變的誘發關係。",[24,26,29,31],{"term":25,"count":11},"肝性腦病變",{"term":27,"count":28},"血氨代謝",2,{"term":30,"count":10},"撲翼樣震顫",{"term":32,"count":10},"巴賓斯基反射",[34,38,43,47,52,57],{"webId":35,"stem":36,"number":37,"year":9,"session":10},"nurse-115-1-medical-surgical-010","因闌尾炎破裂而懷疑有腹膜炎病人之臨床表徵，下列何者正確？①觸診腹部僵硬           ②強烈的反彈痛 ③腸蠕動音增加    ④腹部叩診為實音",10,{"webId":39,"stem":40,"number":41,"year":42,"session":10},"nurse-106-1-medical-surgical-006","顱底骨折常出現的徵象，下列何者錯誤？",6,106,{"webId":44,"stem":45,"number":46,"year":42,"session":28},"nurse-106-2-medical-surgical-020","有關全髖關節置換術病人出院之護理指導，下列何者正確？",20,{"webId":48,"stem":49,"number":50,"year":51,"session":28},"nurse-107-2-medical-surgical-058","執行動脈血液氣體分析時，未將抽取之血液樣本放置冰水中會導致檢查值發生之改變，下列何者正確？",58,107,{"webId":53,"stem":54,"number":55,"year":56,"session":10},"nurse-109-1-medical-surgical-022","有關鼻咽癌病理學的敘述，下列何者錯誤？",22,109,{"webId":58,"stem":59,"number":60,"year":61,"session":10},"nurse-110-1-medical-surgical-056","有關抗凝劑 Warfarin 使用的注意事項，下列何者錯誤？",56,110,"2026-08-06",1787299088604]