# 兩位護理師同時評估一位心律不整心悸個案的心尖脈與橈動脈脈搏。點選心跳與周邊脈搏差異最大的 15 秒區間。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=581205&lang=zh-tw  
> language: zh-TW  
> subject: Reduction of Risk Potential  
> category: ROR

## 題目

兩位護理師同時評估一位心律不整心悸個案的心尖脈與橈動脈脈搏。點選心跳與周邊脈搏差異最大的 15 秒區間。

![](https://mymerci.kr/data/nclex/hotspot/regen_20260908_2350/HSR542.svg)

## 解析

C 有 20 次心尖搏動但僅 16 次橈動脈脈搏，差異為四。

## 深入解析

快速解答
C. C 有 20 次心尖搏動但僅 16 次橈動脈脈搏，差異為四。
為何這是最佳選擇
在每個共同區間內計算對應事件。心尖搏動與其橈動脈脈搏之間的小延遲是預期的，並非脈搏缺失。C 的實際計數差異最大；應報告完整評估，而非僅憑計數推斷心律診斷。
臨床情境
這些觀察為虛構的教學資料。請應用所述情境；所選特徵本身不能取代完整的床邊評估。
記憶口訣
區分周邊脈搏延遲到達與周邊脈搏缺失。
決策規則
區分周邊脈搏延遲到達與周邊脈搏缺失。
為何其他區域不合適
A 的計數相符為 18。B 為 21 對 20，差異為一。D 為 17 對 15，差異為二。其較低或較高的絕對速率並未超過 C 的差異四。
**來源**
- 同時評估心尖與橈動脈可識別脈搏短絀。

## 重要概念

- **Apical-radial comparison with physiologic pulse delay** — 區分周邊脈搏延遲到達與周邊脈搏缺失。
- **Comparison with context** — B 的心臟計數最快，D 的周邊脈搏最少，但兩者的配對差異均非最大。

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