# 一位72歲個案有運動性暈厥，以及傳導至頸動脈的粗糙收縮期漸強-漸弱雜音。請點擊此雜音聽診最清晰的位置。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397524&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位72歲個案有運動性暈厥，以及傳導至頸動脈的粗糙收縮期漸強-漸弱雜音。請點擊此雜音聽診最清晰的位置。

![](https://mymerci.kr/data/nclex/hotspot/v2/v2_cardiac_landmarks.png)

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## 解析

主動脈區是最佳答案。主動脈瓣狹窄在胸骨上緣右側第二肋間處聽診最清晰。其他標記區域未能最佳符合本項目的線索。

## 深入解析

快速解答
主動脈區（Aortic area）是最佳答案。主動脈瓣狹窄（Aortic stenosis）在胸骨上緣右側第二肋間聽得最清楚。圖中標記的其他區域並非此題線索的最佳對應位置。

為何正確
瓣膜音是透過標準胸壁聽診點來辨識，在這些點上，瓣膜震動傳導得最清晰。選擇區域前，必須確認位置（左右側）、肋間及胸骨或鎖骨中線的解剖標誌是否完全吻合。

簡易類比或圖像聯想
將心前區想像成一張五站地圖：主動脈區在胸骨右緣上方，肺動脈區在胸骨左緣上方，艾伯點（Erb point）再往下一個肋間，三尖瓣區在胸骨左緣下方，而二尖瓣區則在心尖處。

記憶掛鉤
右側第二肋間加上輻射至頸動脈，指向主動脈區。

NCLEX 決策法則
當心雜音或心音線索提及特定瓣膜或輻射模式時，應將其對應到標準的聽診標誌點；點選前務必再次確認左右側及肋間位置。

為何其他選項錯誤
其他區域雖然也是有效的心臟聽診點，但每個點主要聽診的瓣膜或心音不同。未對應線索而選擇鄰近的點，是常見的熱點選取錯誤。參考資料

- [1]NCBI Bookshelf: 心血管評估與心臟聽診區

## 臨床情境

臨床情境
一位72歲個案出現勞力性暈厥（exertional syncope），且有粗糙的收縮期漸強-漸弱心雜音（harsh systolic crescendo-decrescendo murmur）輻射至頸動脈。

護理師應注意事項
主動脈區（Aortic area）是最佳答案。主動脈瓣狹窄（Aortic stenosis）在胸骨上緣右側第二肋間聽得最清楚。圖中標記的其他區域並非此題線索的最佳對應位置。

臨床應用
當心雜音或心音線索提及特定瓣膜或輻射模式時，應將其對應到標準的聽診標誌點；點選前務必再次確認左右側及肋間位置。

## 重要概念

- **Aortic area** — 右側第二肋間。
- **Aortic stenosis** — 主動脈瓣（Aortic valve）狹窄，阻礙左心室射出。
- **Carotid radiation** — 心雜音傳導至頸部。

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