[{"data":1,"prerenderedAt":66},["ShallowReactive",2],{"q-nurse-115-2-maternal-pediatric-047":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":25},"nurse-115-2-產兒科護理學-047","nurse-115-2-maternal-pediatric-047",115,2,47,"小志，6 個月，男嬰，半夜突然大哭，雙腳屈膝、臉色蒼白、嘔吐物中含膽汁，數分鐘後緩解，20 分鐘後又再次出現上述症狀。檢查尿布，發現大便中含血與黏膜。根據上述症狀，小志可能有什麼健康問題？",{"A":14,"B":15,"C":16,"D":17},"胃食道逆流","腸套疊","幽門狹窄","巨結腸症","B",null,[],"本題考點在於嬰兒陣發性腹痛合併血便的典型鑑別。腸套疊多見於三個月到兩歲,近端腸段套入遠端造成間歇性完全阻塞,表現為突發哭鬧、雙腳屈膝、臉色蒼白,間隔數十分鐘反覆發作;阻塞後嘔吐物含膽汁,腸黏膜缺血滲血則形成含血與黏液的果醬狀大便,與題中描述完全吻合,選 B。A 錯在胃食道逆流以餵食後溢奶為主,不會有血便與陣發劇痛。C 錯在幽門狹窄為噴射狀且不含膽汁的嘔吐,並可見胃蠕動波。D 錯在巨結腸症以長期便秘與腹脹為主。","延伸病生理:腸套疊以迴腸套入結腸型最常見,套入後腸壁受壓造成靜脈回流受阻、黏膜滲血與水腫,若持續便進展為腸壁缺血壞死與腹膜炎,因此屬時間敏感的兒科急症。三大典型表現是陣發性腹痛、果醬狀血便與右上腹摸到香腸狀腫塊,右下腹因腸段被拉走而觸感空虛,稱 Dance 徵。診斷首選腹部超音波,橫切面可見同心圓的靶心徵;治療以空氣或水溶性對比劑灌腸復位為首選,若復位失敗、腸穿孔或已有腹膜炎則需手術,復位後仍有復發可能,因此需持續觀察腹痛與排便。嘔吐物是否含膽汁是判斷阻塞位置的關鍵:含膽汁代表阻塞在十二指腸 Vater 氏壺腹以下,幽門狹窄阻塞在其上故不含膽汁。可連結概念:嬰兒嘔吐鑑別診斷、腸阻塞徵象、赫希普隆氏巨結腸症的直腸切片診斷。",[24,26,28,31,33],{"term":15,"count":25},4,{"term":27,"count":10},"果醬狀血便",{"term":29,"count":30},"含膽汁嘔吐與阻塞位置",1,{"term":32,"count":30},"幽門狹窄鑑別",{"term":34,"count":30},"巨結腸症鑑別",[36,40,45,50,55,60],{"webId":37,"stem":38,"number":39,"year":9,"session":10},"nurse-115-2-maternal-pediatric-048","有關小兒急性腸胃炎（acute gastroenteritis）臨床表徵之敘述，下列何者錯誤？",48,{"webId":41,"stem":42,"number":43,"year":44,"session":10},"nurse-106-2-maternal-pediatric-014","高女士第一胎，待產時子宮收縮每 5～7 分鐘一次，持續時間 30～40 秒，強度為輕微～中度，子宮頸口為 2～3 公分，少許陰道出血，尚未破水，神情顯得愉快。此時適宜的護理指導為何？",14,106,{"webId":46,"stem":47,"number":48,"year":49,"session":30},"nurse-107-1-maternal-pediatric-028","新生兒先天性代謝異常疾病中，下列何者不是屬於體染色體隱性遺傳疾病？",28,107,{"webId":51,"stem":52,"number":53,"year":54,"session":30},"nurse-108-1-maternal-pediatric-066","有關以家庭為中心的兒童緩和安寧醫療照護，下列何者錯誤？",66,108,{"webId":56,"stem":57,"number":58,"year":59,"session":10},"nurse-109-2-maternal-pediatric-030","下列何種胎產式之胎頭徑線最短，較能順利分娩？",30,109,{"webId":61,"stem":62,"number":63,"year":64,"session":10},"nurse-110-2-maternal-pediatric-064","有關兒童毛地黃（Digoxin）給藥之護理指導，下列敘述何者正確？",64,110,"2026-08-06",1787299007370]