[{"data":1,"prerenderedAt":63},["ShallowReactive",2],{"q-nurse-115-2-psychiatric-community-004":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":33,"lastmod":62},"精神科與社區衛生護理學","psychiatric-community",{"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-精神科與社區衛生護理學-004","nurse-115-2-psychiatric-community-004",115,2,4,"一位 42 歲女性，診斷憂鬱症，經醫師處方千憂解 duloxetine（Cymbalta ® ）治療。用藥第 7 天返診時，她抱怨最近常感焦慮、緊張、容易出汗、手抖。下列評估或處置，何者最適當？",{"A":14,"B":15,"C":16,"D":17},"評估為藥物耐受性不佳，建議立即改用抗精神病藥物","評估為高血壓危象，需立即停藥並補充酪胺酸的攝取","此為藥物初期常見的中樞神經症狀，應加強衛教與觀察","此藥主要作用在多巴胺 D 2 接受器，需改為血清素類抗憂鬱藥","C",null,[],"本題考點為SNRI類抗憂鬱劑duloxetine的初期副作用辨識。duloxetine為血清素與正腎上腺素再回收抑制劑(SNRI),用藥初期常見焦慮、緊張、出汗、手抖等中樞神經與自律神經症狀,多為暫時性,隨用藥時間可漸緩解,處置以加強衛教與持續觀察為宜,故C正確。A錯在此為初期常見反應而非耐受性不佳,更無改用抗精神病藥物的適應症。B錯在高血壓危象是MAOI併用含酪胺酸食物的風險,且處置是避免攝取酪胺酸而非補充。D錯在duloxetine作用於血清素與正腎上腺素系統,並非多巴胺D2接受器。","抗憂鬱藥的作用機轉是常考對照:SSRI(如fluoxetine)只抑制血清素回收;SNRI(venlafaxine、duloxetine)同時抑制血清素與正腎上腺素回收,故初期交感樣症狀(出汗、手抖、心悸)較明顯;MAOI(如phenelzine)抑制單胺氧化酶,併用起司、紅酒等含酪胺酸食物會引發高血壓危象;而作用於多巴胺D2接受器的是抗精神病藥物,不是抗憂鬱藥。另需記得抗憂鬱藥療效通常需2至4週才顯現,初期副作用先於療效出現,是病人自行停藥的高峰期,因此衛教與觀察是此階段照護核心。",[24,27,29,31],{"term":25,"count":26},"SNRI",1,{"term":28,"count":26},"duloxetine副作用",{"term":30,"count":26},"MAOI高血壓危象",{"term":32,"count":26},"酪胺酸",[34,38,43,47,52,57],{"webId":35,"stem":36,"number":37,"year":9,"session":10},"nurse-115-2-psychiatric-community-005","張先生，78 歲，因迷路警察通知家人領回，張先生大聲表示：「我只是想拜訪老王，一時想不起他住那裡，所以才在附近逛逛。」家人感錯愕，因為 1 個月前才陪爸爸參加王先生的葬禮。下列何項最可能是張先生的診斷？",5,{"webId":39,"stem":40,"number":41,"year":42,"session":26},"nurse-106-1-psychiatric-community-051","社區有形的資源中，最容易取得但最難掌控者，下列何者正確？",51,106,{"webId":44,"stem":45,"number":46,"year":42,"session":10},"nurse-106-2-psychiatric-community-065","有關 Anderson 和 McFarlane（2008）以社區為夥伴的健康評估模式，下列何者正確？",65,{"webId":48,"stem":49,"number":50,"year":51,"session":10},"nurse-108-2-psychiatric-community-023","有關思覺失調症生物的成因，主要為下列何者？",23,108,{"webId":53,"stem":54,"number":55,"year":56,"session":10},"nurse-109-2-psychiatric-community-067","依據勞工健康保護規則，規定未滿 40 歲一般作業員至少多久做 1 次健康檢查？",67,109,{"webId":58,"stem":59,"number":60,"year":61,"session":26},"nurse-111-1-psychiatric-community-021","李小姐因強迫症住院，今日母親探視時又因李小姐的強迫症狀而有爭執，母親離去後李小姐顯得焦躁不安。下列何種說法最有助於協助病人覺察自己的焦慮與行為間的關聯性？",21,111,"2026-08-06",1787299016814]