一位母親帶著她 2 歲的幼兒來到兒科門診治療急性中耳炎。醫療提供者開立了抗生素耳滴劑。在給藥衛教期間，母親示範了她的技巧並說：「我會讓他側躺，把他的外耳用力『向上且向後（up and back）』拉，滴入藥水，然後讓他維持側躺五分鐘。」關於這項技術，護理師首要的糾正動作為何？
A mother brings her 2-year-old toddler to the pediatric clinic for acute otitis media. The provider prescribes an antibiotic ear drop. During medication administration education, the mother demonstrates the technique, stating, "I will have him lie on his side, pull the outer part of his ear aggressively 'up and back,' squeeze the drops in, and make him stay sideways for five minutes." What is the nurse's priority corrective action regarding this technique?
- AInform her that pulling the ear up and back is only meant for eye drops, not for administering otic (ear) medications.告知她向上且向後拉耳廓僅適用於眼藥水，而非用於給藥耳滴劑
- BConfirm her technique is totally flawless, but advise her to quickly insert a cotton ball deep into the canal to prevent any fluid from leaking out.確認她的技巧完全無瑕，但建議她快速將棉花球深塞入耳道以防止任何液體流出
- CCorrect her to pull the pinna strictly 'down and back' because the anatomical canal of a child under 3 years old is fundamentally different from an adult.✓ 正解糾正她應嚴格『向下且向後』拉耳廓，因為 3 歲以下兒童的解剖耳道與成人根本不同
- DCorrect her positioning; the toddler must be sitting completely straight up in a chair with his head tilted completely forward.糾正其姿勢；幼童必須完全坐直在椅子上並將頭部完全前傾
本題測驗基礎安全給藥技術：耳滴劑（Otic ear drops）的解剖學差異。耳道拉直技術是一道經典考題界線。對於「未滿三歲（小於 3 歲）」的嬰幼兒，其耳道呈較短且平行的狀態，必須將耳廓（Pinna）『向下且向後（Down and back）』輕拉，才能使耳道拉直呈現垂直漏斗狀，讓藥水深入。對於「三歲以上及成年人」，耳道已發育完成呈Ｓ型，才需將耳廓『向上且向後（Up and back）』拉（這就是母親犯的錯誤）。如果對 2 歲幼童使用成人的提拉法，只會使耳道更彎折封閉，導致藥水滯留外耳失敗（選項C是正確的糾正）。選項B錯誤，塞棉花球會吸收藥水且如果塞太深會損害耳膜，通常不建議或只輕輕放置於外側。選項D錯誤，側躺（Side-lying）是正確的滴入姿勢。選項A是荒謬的混淆，眼藥水不用拉耳朵。
This question tests basic safe medication administration: anatomic differences in administering otic ear drops. Pulling the ear canal straight is a classic exam point. For infants and toddlers under 3 years old, the ear canal is shorter and more horizontal; the pinna must be gently pulled 'down and back' so the canal is straightened into a vertical funnel, allowing the medication to flow inward. For those age 3 and older and adults, the ear canal has developed an S-shape, so the pinna must be pulled 'up and back' (this is the mother's mistake). If the adult technique is applied to a 2-year-old, the canal becomes more curved and obstructed, and the drops are retained in the outer ear (Option C is the correct correction). Option B is incorrect: inserting a cotton ball absorbs medication and may damage the tympanic membrane if pushed too deep; only loose, outer placement is typically used. Option D is incorrect: side-lying is the correct position for instillation. Option A is absurd and confusing: ear drops do not require pulling the ear similarly to eye drops.
世界通用的大經典考題。「小於3歲往下往後拉 (Down & back)」與「大於3歲往上往後拉 (Up & back)」這個死背法則，幾乎是世界各國護理學生考國考前最後一晚必背的數字。