[{"data":1,"prerenderedAt":64},["ShallowReactive",2],{"q-nurse-115-1-medical-surgical-022":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":34,"lastmod":63},"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":26},"nurse-115-1-內外科護理學-022","nurse-115-1-medical-surgical-022",115,1,22,"王老太太背部骨骼疼痛就醫，醫生懷疑是多發性骨髓瘤，請依序回答下列3題。下列何者為確定診斷的主要標準？",{"A":14,"B":15,"C":16,"D":17},"骨髓內漿細胞比例為40%","血清IgG 為2 gm\u002FdL","X光檢查發現有骨頭侵蝕現象","IgA＜0.1 gm\u002FdL","A",null,[],"本題考點是多發性骨髓瘤診斷標準中主要與次要標準的分辨。依 Durie-Salmon 診斷架構,主要標準包括組織切片證實漿細胞瘤、骨髓漿細胞比例超過三成,以及單株免疫球蛋白達高標(IgG 超過 3.5 gm\u002FdL 或 IgA 超過 2 gm\u002FdL);骨髓內漿細胞達 40% 已明顯超過三成門檻,屬主要標準,故選 A。B 錯:IgG 僅 2 gm\u002FdL 未達主要標準門檻,只能列為次要標準。C 錯:X 光的溶骨性侵蝕雖典型,但屬次要標準。D 錯:正常免疫球蛋白被壓抑而使 IgA 極低,同樣歸於次要標準。","疾病本質是骨髓中單株漿細胞失控增生,後果可用 CRAB 記憶:高血鈣(Calcium)、腎功能不良(Renal)、貧血(Anemia)、骨病灶(Bone)。溶骨機轉在於惡性漿細胞活化蝕骨細胞並抑制造骨細胞,故 X 光呈打洞狀病灶且鹼性磷酸酶常不升高,病理性骨折與背痛因此常是首發症狀。實驗室特徵包括血清蛋白電泳的 M 波峰、尿中 Bence-Jones 蛋白(輕鏈)、紅血球排列成串錢狀與紅血球沉降速率明顯上升。輕鏈沉積於腎小管是腎損傷主因,故水分攝取與避免腎毒性藥物是照護重點。延伸複習:與骨轉移癌、骨質疏鬆的鑑別。",[24,27,30,32],{"term":25,"count":26},"多發性骨髓瘤",4,{"term":28,"count":29},"單株免疫球蛋白",2,{"term":31,"count":10},"Durie-Salmon 主要與次要標準",{"term":33,"count":10},"骨髓漿細胞比例",[35,39,44,48,53,58],{"webId":36,"stem":37,"number":38,"year":9,"session":10},"nurse-115-1-medical-surgical-023","王老太太因便秘、意識不清，家屬送至急診求治，發現有心律不整的問題，下列何者是王老太太最有可能發生的問題？",23,{"webId":40,"stem":41,"number":42,"year":43,"session":10},"nurse-106-1-medical-surgical-019","評估膝關節內是否有少量液體積存之方法，下列何者正確？",19,106,{"webId":45,"stem":46,"number":47,"year":43,"session":29},"nurse-106-2-medical-surgical-033","有關化學治療靜脈給藥之敘述，下列何者正確？",33,{"webId":49,"stem":50,"number":51,"year":52,"session":29},"nurse-107-2-medical-surgical-071","救護車送入一位昏迷病人，心跳 120 次\u002F分，血壓 85\u002F50 mmHg，呼吸速率 35 次\u002F分，呼吸有一股很濃的腐壞水果味，血糖為 600 mg\u002FdL。下列何者為其最可能之診斷？",71,107,{"webId":54,"stem":55,"number":56,"year":57,"session":10},"nurse-109-1-medical-surgical-035","當癌症病人出現下列何種血液檢驗數據時，要考慮停止化學治療？①白血球 1,500\u002FμL ②紅血球 500 萬\u002FμL ③血小板 11 萬\u002FμL ④絕對嗜中性球 1,000\u002FμL",35,109,{"webId":59,"stem":60,"number":61,"year":62,"session":10},"nurse-110-1-medical-surgical-069","有關嗜鉻細胞瘤的敘述，下列何者錯誤？",69,110,"2026-08-06",1787299088755]