[{"data":1,"prerenderedAt":63},["ShallowReactive",2],{"q-nurse-115-2-maternal-pediatric-012":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":33,"lastmod":62},"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-115-2-產兒科護理學-012","nurse-115-2-maternal-pediatric-012",115,2,12,"自然產後 4 小時，協助個案下床解尿後，觸診子宮為堅硬狀，子宮底與肚臍平並且置中。觀察產後棉片每 20 分鐘就濕透一片，並不斷流出鮮紅色物，當時血壓 90\u002F56 mmHg。下列敘述何者最適當？",{"A":14,"B":15,"C":16,"D":17},"懷疑是早期產後出血，需評估是否有產道撕裂傷問題","子宮收縮不足，應儘快使用子宮收縮劑，避免出血增加","懷疑是子宮高張力收縮影響，應提供熱敷以降低子宮收縮的張力","請個案採辛式臥位，讓會陰及肛門清楚露出進行檢查出血部位","A",null,[],"本題考點是早期產後出血的原因鑑別。早期產後出血的成因可用 4T 分類：子宮收縮不良（Tone）、產道創傷（Trauma）、胎盤組織殘留（Tissue）、凝血功能異常（Thrombin）。本情境子宮觸診堅硬、子宮底與肚臍平且位置置中，代表子宮收縮良好、也沒有膀胱膨脹造成的移位；但棉墊每 20 分鐘濕透一片、持續流出鮮紅色血液並伴血壓偏低，鮮紅色與源源不止的特徵指向產道裂傷造成的活動性出血，故 A 最適當。B 錯在依據不符，子宮已堅硬即非收縮不足，再給子宮收縮劑無法處理出血來源。C 錯在情境沒有子宮高張力收縮的證據，熱敷降張力也不是產後出血的判讀邏輯。D 錯在辛式臥位主要用於觀察會陰傷口、肛門與痔瘡，深部陰道或子宮頸裂傷需以截石位配合照明與器械檢視，此刻的判讀重點在釐清出血來源與生命徵象變化。","惡露性狀與子宮觸診結果的組合，是產後出血床邊鑑別最快的兩把尺：子宮軟、輪廓不清、暗紅色血並帶凝塊 → 指向子宮收縮不良；子宮堅硬置中卻持續鮮紅色滲流 → 指向裂傷或血管性出血；子宮收縮忽好忽壞、惡露反覆增多 → 需考慮胎盤碎片殘留；出血不凝、注射部位或牙齦滲血 → 考慮凝血功能異常。產道創傷的部位由淺而深包含會陰、陰道、子宮頸與外陰陰道血腫，後者可能外顯血量不多而以劇痛、壓迫感與血壓下降為主要表現。低血容的早期代償徵象是心搏加快、脈搏壓變窄、末梢冰冷與尿量減少，血壓下降往往已是較後期的變化，這是本題把血壓 90\u002F56 mmHg 放進情境的用意。產後出血的量化界值在教科書中以自然產失血量達 500 毫升以上為常用門檻，可與四小時內的持續觀察頻次一起複習。",[24,27,29,31],{"term":25,"count":26},"早期產後出血 4T 分類",1,{"term":28,"count":26},"產道裂傷",{"term":30,"count":26},"子宮收縮評估與惡露性狀",{"term":32,"count":26},"低血容代償徵象",[34,38,43,47,52,57],{"webId":35,"stem":36,"number":37,"year":9,"session":10},"nurse-115-2-maternal-pediatric-013","有關母乳與配方奶成分的比較，下列何者錯誤？",13,{"webId":39,"stem":40,"number":41,"year":42,"session":26},"nurse-106-1-maternal-pediatric-059","小華，5 歲大，疑似細菌性支氣管炎，使用脈衝式血氧分析法（Pulse Oximetry）偵測脈動血氧，下列敘述何者錯誤？",59,106,{"webId":44,"stem":45,"number":46,"year":42,"session":10},"nurse-106-2-maternal-pediatric-073","有關嬰兒吞嚥攝食的生理特性，下列敘述何者錯誤？",73,{"webId":48,"stem":49,"number":50,"year":51,"session":26},"nurse-108-1-maternal-pediatric-031","有關孕期心臟病之敘述，下列何者錯誤？",31,108,{"webId":53,"stem":54,"number":55,"year":56,"session":26},"nurse-109-1-maternal-pediatric-075","有關威廉氏腫瘤（Wilms tumor）之可能出現的臨床表徵，下列何者錯誤？",75,109,{"webId":58,"stem":59,"number":60,"year":61,"session":10},"nurse-110-2-maternal-pediatric-029","有關新生兒腸胃系統及排泄，下列敘述何者錯誤？",29,110,"2026-08-06",1787299006934]