{"name":"中药调剂员职业技能等级证书题库","level":"五级 / 四级 / 三级 / 二级 / 一级","org":"人力资源和社会保障部门","count":300,"questions":[{"id":1,"type":"single","stem":"中药调剂员在审核处方时发现处方中写有“十八反”配伍，正确的处理方式是","options":["拒绝调配并请处方医师确认或重新开具处方","按处方原样调配后向患者说明煎服注意事项","将相反药物减量后调配并记录在处方上","先调配后再请医师补签确认以避免患者往返"],"answer":[0],"explanation":"知识点为处方审核中的配伍禁忌把关。含十八反配伍的处方属于审核不合格处方，调剂员无权自行修改或减量，应拒绝调配并联系处方医师确认或重新开具，故选项0正确；选项1调配存在用药风险且调剂员越权；选项2擅自减量改变处方内容不合规；选项3先调配再补签颠倒了审方与调配的先后顺序，不能消除风险。","tier":"挑战"},{"id":2,"type":"single","stem":"处方中写“炒白术”而药斗内只有生白术时，调剂员正确的做法是","options":["用生白术替代并在处方上注明替代原因","拒绝调配并告知患者需医师改方或药房补货","将生白术临时炒制后按炒白术付给患者","按生白术调配但剂量加倍以补足药效"],"answer":[1],"explanation":"知识点为中药处方应付与炮制品规格。处方写炮制品名必须付相应炮制品，不得以生品替代或自行炮制，故应告知需医师改方或药房补货，选项1正确；选项0擅自替代且自行注明不能代替医师同意；选项2调剂员临时炒制无法保证炮制规范与质量；选项3加倍剂量属于擅自改方且不能改变药性差异。","tier":"进阶"},{"id":3,"type":"single","stem":"中药调剂称量时，关于戥秤的使用，下列操作符合规范的是","options":["每次称量前先校零，称完一味即归零再称下一味","为提高速度可连续称量多味药后再统一核对戥星","称量时用手直接抓取饮片放入戥盘以减少洒落","称完毒性饮片后继续用同一戥秤称普通饮片"],"answer":[0],"explanation":"知识点为戥秤称量的规范操作。称量前校零、每味称完归零可保证剂量准确，故选项0正确；选项1连续称量易导致串味和剂量误差；选项2手抓饮片不卫生且影响剂量准确；选项3毒性饮片应单独称量并清洁器具，直接续称会造成交叉污染。","tier":"进阶"},{"id":4,"type":"single","stem":"某处方中有“先煎”标记的饮片，调剂员在向患者交代煎药方法时应说明","options":["该药先单独煎煮一段时间后再放入其他饮片同煎","该药在其余药煎好前五分钟放入即可","该药与其他饮片同时下锅但需延长总煎煮时间","该药煎好后单独服用不与其他药液混合"],"answer":[0],"explanation":"知识点为特殊煎法中的先煎。先煎药需先单独煎煮一定时间再纳入群药同煎，故选项0正确；选项1是后下的做法；选项2混淆了先煎与延长煎煮时间；选项3把先煎误解为另煎兑服。","tier":"进阶"},{"id":5,"type":"single","stem":"处方中附子与半夏同用，调剂员审核时首先应判断的是","options":["处方是否属于十八反配伍禁忌并按规定处理","两药剂量是否超过药典规定的常用量","患者是否已自行煎服过同类药物","药房是否同时备有两种饮片的炮制品"],"answer":[0],"explanation":"知识点为十八反配伍审核。附子属乌头类，与半夏属十八反范畴，审方首要判断是否为配伍禁忌并按规定处理，故选项0正确；选项1剂量审核虽重要但非首要问题；选项2属于问诊内容不是审方第一判断；选项3涉及库存不影响审方结论。","tier":"进阶"},{"id":6,"type":"single","stem":"关于中药处方中“脚注”的识别，下列理解正确的是","options":["脚注是医师在药名旁标注的煎法或用法要求","脚注是处方右下角的医师签名与日期","脚注是药房内部标注的饮片斗谱位置","脚注是医保系统生成的处方编号信息"],"answer":[0],"explanation":"知识点为中药处方脚注的含义。脚注是医师对某味药的煎法、用法等特殊要求，如先煎、后下、包煎等，故选项0正确；选项1混淆了处方签名区；选项2斗谱位置属于药房管理信息；选项3编号信息与脚注无关。","tier":"进阶"},{"id":7,"type":"single","stem":"调剂完成后进行复核时，发现一方中“甘草”与“甘遂”同方出现，正确的处理环节是","options":["复核环节拦截并退回审方处按禁忌处理","复核通过后由调配人自行减量处理","复核通过后向患者口头说明即可发出","复核时将该两味药改为同名异炮制品"],"answer":[0],"explanation":"知识点为处方复核与十八反禁忌把关。甘草与甘遂属十八反，复核发现后应拦截退回按禁忌处理，故选项0正确；选项1复核不应放行更不得自行减量；选项2口头说明不能替代合规处置；选项3擅自更换炮制品属于改方行为。","tier":"挑战"},{"id":8,"type":"single","stem":"患者取药时询问“包煎”饮片如何操作，调剂员正确的指导是","options":["用纱布袋装好扎紧后与其他饮片一同煎煮","将该饮片单独煎煮后把药液兑入其他药液","将该饮片研成细粉后冲服不再入煎","将该饮片放在锅底再压上其他饮片同煎"],"answer":[0],"explanation":"知识点为包煎的操作方法。包煎药需装入纱布袋扎紧后与群药同煎，以防刺激咽喉或糊锅，故选项0正确；选项1混淆了另煎兑服；选项2改变了煎服方式；选项3不包煎起不到包煎作用。","tier":"进阶"},{"id":9,"type":"single","stem":"中药房接到一张急诊处方，处方中有“后下”的薄荷，调剂员在交代煎法时应说明","options":["其他饮片煎好前五至十分钟再放入薄荷同煎","薄荷与其余饮片同时下锅煎煮即可","薄荷需先煎二十分钟再放其他饮片","薄荷单独煎好后弃渣只取香气即可"],"answer":[0],"explanation":"知识点为后下药的煎法。薄荷含挥发油，宜在其他药煎好前短时间放入，故选项0正确；选项1同煎会致挥发性成分散失；选项2先煎与后下相反；选项3弃渣做法不符合后下要求。","tier":"进阶"},{"id":10,"type":"single","stem":"调剂员在称量一方中“细辛”时发现处方剂量明显超出常用量，正确的处置是","options":["暂停调配并请处方医师确认或重新签字","按处方剂量调配并向患者说明超量原因","自行将细辛减至常用量后继续调配","先调配其他药，细辛待患者取药时再补"],"answer":[0],"explanation":"知识点为超量处方的审核处理。细辛用量超出常用量属需医师确认的情形，调剂员应暂停调配并请医师确认或重签，故选项0正确；选项1擅自调配超量药存在风险；选项2自行减量属于改方；选项3遗漏药物更不符合调配规范。","tier":"挑战"},{"id":11,"type":"single","stem":"中药调剂员在审核处方时发现处方中写有“川乌9g”，按照毒性中药管理要求，该剂量已超过常用量上限，正确的处置方式是","options":["拒绝调配并联系处方医师确认签字","按处方原量调配后单独包装并注明先煎","将川乌减至常用量上限后调配","请患者自行找医师修改处方后再来调配"],"answer":[0],"explanation":"知识点：毒性中药处方审核。川乌属毒性中药，超量处方必须拒绝调配并经处方医师重新确认签字后方可调配；按原量调配违反毒性中药管理规定；调剂员无权擅自减量；让患者自行改方不符合药房与医师沟通的规范流程。","tier":"挑战"},{"id":12,"type":"single","stem":"调剂称量时需称取“三七粉3g”，三七粉已单包且药房使用电子秤，下列称量操作中正确的是","options":["先称包装纸重量再连纸称取并扣除纸重","将粉末直接倒在秤盘上称取后刮入药袋","用称量纸称取后把纸连同药粉一起倒入药袋","先估量倒入药袋再用秤复核总重"],"answer":[0],"explanation":"知识点：粉末类中药称量。正确做法是称出包装纸（称量纸）重量作为皮重扣除，避免污染和损耗；粉末直接倒秤盘会污染秤盘且损耗；称量纸连药一起倒入药袋会把纸屑混入；估量后仅复核总重无法保证单味剂量准确。","tier":"挑战"},{"id":13,"type":"single","stem":"处方中含“薄荷6g（后下）”，煎药时后下的正确操作是","options":["在其他药煎好前5～10分钟加入薄荷","在群药煎煮开始时与其他药同时下锅","在群药煎煮结束后趁热立即倒入薄荷闷泡","将薄荷单独煎煮30分钟后兑入群药药液"],"answer":[0],"explanation":"知识点：煎药特殊煎法。薄荷含挥发油，后下应在其他药即将煎好前5～10分钟加入，减少挥发性成分损失；同时下锅挥发油损失过多；煎后闷泡不能充分提取；单独煎30分钟挥发油大量散失。","tier":"进阶"},{"id":14,"type":"single","stem":"患者持处方购买“阿胶”，要求药房代为加工成冲服用的粉末，阿胶正确的预处理方法是","options":["用黄酒或水加热溶化后兑服","直接干磨成细粉冷水冲服","用沸水整块冲泡至软化后嚼服","与群药一同入锅久煎至完全溶解"],"answer":[0],"explanation":"知识点：胶类中药的烊化。阿胶属胶类，应单独用黄酒或水加热溶化（烊化）后兑入药液服用；干磨冷水冲服不易吸收且腥味重；整块沸水冲泡难以完全软化；与群药同煎会粘锅并影响其他药成分煎出。","tier":"进阶"},{"id":15,"type":"single","stem":"中药房收到一张含“生大黄9g”的处方，医师注明“用于泻下”，调剂员在用药交代时应提醒患者","options":["药液煎好后兑入大黄另煎液，不宜久煎","大黄应与群药同煎30分钟以上以增效","大黄需先煎40分钟再下其他药","大黄应研粉后用温水送服"],"answer":[0],"explanation":"知识点：大黄不同功效的煎法差异。大黄用于泻下时取其泻下成分，不宜久煎，宜后下或另煎兑服；久煎泻下作用减弱；先煎会使泻下成分破坏；研粉温水送服虽可，但不是本处方注明泻下时的标准煎法交代。","tier":"进阶"},{"id":16,"type":"single","stem":"处方中同时出现“附子9g”和“半夏9g”，调剂员审核时正确的判断是","options":["属于十八反配伍，应拒绝调配并请医师确认","属于十九畏配伍，需减量后调配","虽属相反但临床常用，可直接调配","需将两药先煎后合并药液即可调配"],"answer":[0],"explanation":"知识点：十八反与十九畏的区分。附子与半夏属十八反（乌头类反半夏），原则上禁止同方；十九畏是另一类配伍禁忌，与此不符；临床如需使用须医师双签字确认，调剂员不能直接调配；先煎合并不能消除配伍禁忌问题。","tier":"进阶"},{"id":17,"type":"single","stem":"煎药室使用自动煎药机煎煮一剂含“车前子”的处方，车前子正确的处理方式是","options":["装入纱布袋包煎以防糊锅","直接倒入煎药机与群药同煎","先煎20分钟后加入其他药","煎好后单独过滤取汁兑入"],"answer":[0],"explanation":"知识点：包煎药材。车前子细小且含黏液质，直接煎煮易糊锅、难过滤，应装纱布袋包煎；直接同煎易糊锅；先煎20分钟不能解决糊锅和过滤问题；煎后单独过滤不符合包煎操作要求。","tier":"进阶"},{"id":18,"type":"single","stem":"患者询问“人参健脾丸”与“藿香正气水”能否同时服用，调剂员回答的合理依据是","options":["两者含相反药味，应间隔2小时以上服用","两者均含甘草，同服易致水肿","藿香正气水含酒精，与补益药同服会降低疗效","两者功效相反，需先停用补益药再服藿香正气水"],"answer":[0],"explanation":"知识点：中成药联用禁忌。人参健脾丸含人参，藿香正气水含藿香等，传统认为人参恶藿香（十九畏范畴的配伍禁忌），两者不宜同服，应间隔服用；均含甘草不成立；含酒精降低补益药疗效无确切依据；功效相反不是停用补益药的理由。","tier":"进阶"},{"id":19,"type":"multi","stem":"中药调剂员在审核一张儿科处方时，发现处方中含“麻黄3g、苦杏仁6g、甘草3g”，下列审核与交代要点中正确的有","options":["核对患儿年龄体重与剂量是否相符","告知家长麻黄可能引起兴奋，睡前慎服","苦杏仁应后下以保留有效成分","交代煎药时麻黄先煎去沫","嘱家长可自行加量以增强疗效"],"answer":[0,1,3],"explanation":"知识点：儿科处方审核与用药指导。麻黄汤类方需核对儿科剂量、注意麻黄兴奋作用、麻黄先煎去沫；苦杏仁后下并非其常规要求（后下多用于含挥发油药材）；自行加量违反安全用药原则。","tier":"挑战"},{"id":20,"type":"single","stem":"处方写“焦白术”，调剂时应付的炮制品是","options":["白术片炒至表面焦褐色","白术片炒至表面黑褐色","白术片炒至表面黄棕色","白术片炒至表面焦黑色"],"answer":[0],"explanation":"本题考查炮制品规格辨识。焦白术为白术片炒至表面焦褐色、内部黄棕色，故正确项为A。B为炒炭品（黑褐色）的特征；C为清炒或麸炒偏轻的火候描述；D炭化过重，不符焦品火候。","tier":"基础"},{"id":21,"type":"single","stem":"审方时发现处方中“川乌”与“半夏”同用，调剂员首先应做的是","options":["按方称量后另包注明先煎","请处方医师双签字确认","将两味药减量后调配","拒绝调配并告知患者改方"],"answer":[1],"explanation":"本题考查十八反配伍禁忌的处置程序。川乌与半夏属十八反，原则上不宜同用，若医师确需同用应在处方处双签字，故B正确。A未处理禁忌即调配；C擅自减量属越权更改处方；D直接拒绝不符合“确认后可用”的审核流程。","tier":"进阶"},{"id":22,"type":"single","stem":"煎药时处方标注“先煎”的饮片，正确的操作是","options":["与群药同时入锅浸泡后共煎","先单独煎煮一段时间再入群药","在群药煎好前数分钟投入","包入纱布袋与群药同煎"],"answer":[1],"explanation":"本题考查特殊煎法。先煎药需先单独煎煮约20～30分钟后再下群药，故B正确。A等同普通共煎，失去先煎意义；C属“后下”操作；D为包煎处理，与先煎目的不同。","tier":"基础"},{"id":23,"type":"single","stem":"处方开“生牡蛎”且未注明先煎，调剂员正确的处理是","options":["按方调配并提醒先煎","按方调配并注明后下","按方调配并注明包煎","按方调配并注明另煎"],"answer":[0],"explanation":"本题考查矿物类药的特殊煎法。生牡蛎质地坚硬，需先煎以利有效成分溶出，虽处方未注明，调剂员应主动提示先煎，故A正确。B后下适用于气味芳香药；C包煎适用于黏毛类药；D另煎适用于贵重药。","tier":"基础"},{"id":24,"type":"single","stem":"调剂称量时，毒性中药饮片的计量要求是","options":["按处方量称取后单独包装","按处方量称取后混入群药","按处方量加倍称取备用","按处方量称取后交患者自量"],"answer":[0],"explanation":"本题考查毒性中药管理。毒性饮片应单独称量、单独包装并注明，故A正确。B混入群药不便核对与警示；C加倍称取严重违规；D交患者自量不符合调剂规范。","tier":"基础"},{"id":25,"type":"single","stem":"患者取药时询问“阿胶”如何服用，调剂员正确的指导是","options":["与群药同煎半小时","另煎兑入药液中服用","先煎半小时后入群药","包煎后与群药共煮"],"answer":[1],"explanation":"本题考查胶类药的煎服指导。阿胶宜烊化或另煎兑服，故B正确。A同煎易粘锅糊化；C先煎不适用于胶类；D包煎不能解决胶类粘锅问题。","tier":"基础"},{"id":26,"type":"single","stem":"调剂处方时发现“黄芪”与“炙黄芪”未注明，处方仅写“黄芪”，应付","options":["生黄芪片","炙黄芪片","生炙各半","酒炙黄芪片"],"answer":[0],"explanation":"本题考查炮制品与处方应付。处方写药名未注明炮制时，一般付生品，故A正确。B炙黄芪需处方注明“炙”；C各半无依据；D酒炙黄芪非该药常规规格。","tier":"挑战"},{"id":27,"type":"single","stem":"煎药机煎煮前，饮片浸泡时间的正确范围是","options":["10～15分钟","20～30分钟","40～60分钟","90～120分钟"],"answer":[1],"explanation":"本题考查煎药前处理。饮片煎前宜浸泡20～30分钟，故B正确。A时间过短，有效成分不易溶出；C、D浸泡过久易致部分成分水解或变质。","tier":"基础"},{"id":28,"type":"single","stem":"处方中“薄荷”标注“后下”，其正确操作是","options":["群药煎沸后5～10分钟投入","群药煎沸前30分钟投入","与群药同时投入共煎","群药煎好后趁热投入"],"answer":[0],"explanation":"本题考查后下药操作。薄荷含挥发油，宜在群药煎沸后5～10分钟投入，故A正确。B属先煎操作；C同煎挥发油损失大；D煎好后再投无法煎出成分。","tier":"基础"},{"id":29,"type":"single","stem":"患者反映煎好的药液有大量沉淀，调剂员正确的解释是","options":["沉淀均为杂质，必须弃去","部分沉淀为有效成分，服前摇匀","沉淀说明药物变质，应停用","沉淀需过滤后再加热服用"],"answer":[1],"explanation":"本题考查煎药后药液处理。部分沉淀为有效成分析出，服前摇匀即可，故B正确。A弃去可能损失药效；C沉淀不等于变质；D过滤后加热并不能解决沉淀问题。","tier":"基础"},{"id":30,"type":"single","stem":"药师审核处方时发现“妊娠三个月妇女”处方中含“桃仁”，正确的处置是","options":["按方调配并注明饭后服","按方调配并注明减半服","联系医师确认是否必要","按方调配并嘱多饮水"],"answer":[2],"explanation":"本题考查妊娠用药审核。桃仁为活血药，孕妇慎用，应联系医师确认，故C正确。A、B、D均未处理妊娠禁忌风险，直接调配存在安全隐患。","tier":"挑战"},{"id":31,"type":"single","stem":"调剂处方时发现医师写“川乌9g”，中药房常规给付的是制川乌，此时正确的审核处置是","options":["按制川乌9g直接调配并注明","拒绝调配并要求医师重新签名","改为生川乌9g后调配并记录","按制川乌6g减量调配并告知"],"answer":[0],"explanation":"知识点：毒性中药炮制品与处方应付。处方写川乌，药房应付制川乌，按炮制品调配并注明是规范做法；拒绝调配并非因签名问题；改生川乌违反毒性中药管理；自行减量属擅自改方。","tier":"挑战"},{"id":32,"type":"single","stem":"某处方同时含“附子6g”与“半夏9g”，审核时最应关注的调配要点是","options":["两药需分别单包并标注先煎","附子先煎半小时后再入半夏","两药同煎以增强温化痰饮","半夏需研粉冲服后再煎附子"],"answer":[0],"explanation":"知识点：十八反与先煎药处理。附子需先煎，半夏属相反配伍但医师双签名可用，规范做法是分别单包标注煎法；先煎后入半夏不是调配环节要求；同煎忽略先煎；研粉冲服无依据。","tier":"进阶"},{"id":33,"type":"single","stem":"使用戥子称量3g细料药时，正确的操作是","options":["放在戥盘一角快速称取","用戥盘中央并轻放轻提","用手抓药估量后上戥复核","先称5g再取出2g作余量"],"answer":[1],"explanation":"知识点：戥子称量规范。细料药应放戥盘中央、轻放轻提，避免洒落和误差；放一角易偏载；手估后再复核不符合定量要求；先多称再取走属反复操作易损耗。","tier":"基础"},{"id":34,"type":"single","stem":"处方中“阿胶9g”与群药同方，调剂时正确的处理方式是","options":["与群药同包后嘱患者同煎","单包并注明烊化兑服","单包并注明先煎半小时","与群药同包并注明后下"],"answer":[1],"explanation":"知识点：胶类药特殊煎法。阿胶需烊化兑服，应单包注明；同煎会粘锅糊化；先煎不适用于胶类；后下亦非胶类处理方式。","tier":"基础"},{"id":35,"type":"single","stem":"煎药室收到一剂含“薄荷6g”的处方，贴签上应提示的煎法是","options":["先煎20分钟","后下5分钟","包煎另包","烊化兑服"],"answer":[1],"explanation":"知识点：含挥发油药物的煎煮。薄荷含挥发油，应后下短煎；先煎会散失有效成分；包煎用于细小或带绒毛药；烊化用于胶类。","tier":"基础"},{"id":36,"type":"single","stem":"患者取药时询问汤剂为何要“温服”，调剂员最恰当的指导是","options":["所有汤剂放凉后服用效果更好","解表剂温服有助发汗祛邪","温服可避免所有胃肠道反应","温服是煎药后唯一的服用温度"],"answer":[1],"explanation":"知识点：服药温度指导。解表剂温服助发汗是正确解释；放凉更好不成立；温服不能避免所有胃肠反应；服用温度并非唯一。","tier":"进阶"},{"id":37,"type":"single","stem":"某处方写“生大黄9g（后下）”，调剂员调配时应特别注意","options":["生大黄需先煎以减毒","后下药应在群药煎好前5分钟入锅","后下药需另煎后兑入药液","后下药应研粉冲服不入煎"],"answer":[1],"explanation":"知识点：后下药操作。后下药一般在群药煎好前5分钟入锅；生大黄先煎会减弱泻下力；另煎兑入不是后下；研粉冲服非本方要求。","tier":"基础"},{"id":38,"type":"single","stem":"处方中含“车前子12g”，调剂时正确的处理是","options":["单包并注明包煎","与群药同煎并搅拌","单包并注明先煎","研粉后冲服"],"answer":[0],"explanation":"知识点：包煎药范围。车前子细小易糊锅，需包煎；同煎搅拌仍易糊；先煎不解决细小问题；研粉冲服改变用法。","tier":"基础"},{"id":39,"type":"single","stem":"患者反映煎药时药液溢出，追问发现其将“旋覆花”直接倒入锅中，正确的指导是","options":["旋覆花应包煎以防绒毛刺激咽喉","旋覆花应先煎以减毒","旋覆花应后下以保挥发油","旋覆花应烊化后兑入"],"answer":[0],"explanation":"知识点：包煎药的特殊品种。旋覆花带绒毛需包煎；先煎、后下、烊化均不适用于旋覆花。","tier":"挑战"},{"id":40,"type":"single","stem":"调剂完成后发现一方中“甘草”与“海藻”同用且无医师双签名，正确的处置是","options":["照方调配并口头提醒患者","暂停调配并联系医师确认","将海藻减量后调配","将甘草改为炙甘草后调配"],"answer":[1],"explanation":"知识点：十八反配伍审核。甘草反海藻，无医师双签名应暂停并联系医师；照方调配违规；减量或改炮制品不能规避相反配伍。","tier":"挑战"},{"id":41,"type":"single","stem":"某处方要求“三七粉3g”，中药房给付的三七粉应如何调配","options":["与群药同包同煎","单包并注明冲服","单包并注明先煎","与群药同包后下"],"answer":[1],"explanation":"知识点：贵重细料药调配。三七粉应单包注明冲服；同煎浪费且影响用量；先煎、后下均不适用于粉末冲服。","tier":"基础"},{"id":42,"type":"single","stem":"审核中药处方时发现处方写有“十八反”中甘草与海藻同用，调剂员首先应做的是","options":["拒绝调剂并报告处方医师确认","按处方剂量正常调配后发药","将海藻减量一半后调配","把甘草改为炙甘草后调配"],"answer":[0],"explanation":"知识点：处方审核中十八反配伍禁忌。甘草反海藻属十八反内容，审核发现禁忌配伍应拒绝调配并联系医师确认。按方调配会使患者承受配伍风险；减量不能消除禁忌；改炮制规格不改变配伍禁忌性质。","tier":"挑战"},{"id":43,"type":"single","stem":"某医师处方中写“川乌6g”，中药房调剂时对该饮片正确的处理是","options":["先煎并单独注明用法用量","与群药同煎以节省时间","研粉后随汤药冲服","用酒送服以增强药效"],"answer":[0],"explanation":"知识点：毒性饮片川乌的煎法。川乌含乌头类生物碱，需先煎久煎以减毒，并单独注明。同煎减毒不充分；研粉冲服毒性更大；酒能促进乌头碱吸收，更易中毒。","tier":"进阶"},{"id":44,"type":"single","stem":"调剂一方剂时处方写“生大黄6g，后下”，调剂员在发药交代中应说明后下的正确时机是","options":["群药煎沸10至15分钟后再入","群药煎沸前与冷水同时入锅","群药煎好后趁热投入闷泡","群药第二煎时才投入同煎"],"answer":[0],"explanation":"知识点：后下药的煎煮时机。后下药一般在群药煎沸10至15分钟后投入，以保留挥发成分或避免久煎减效。与冷水同煎等于久煎；煎好后投入不出有效成分；只在第二煎投入不符合后下要求。","tier":"进阶"},{"id":45,"type":"single","stem":"煎药室使用自动煎药机煎煮含阿胶的处方时，阿胶的正确处理是","options":["另用开水或黄酒溶化后兑入药液","与群药一起装入布袋同煎","先煎半小时后再下群药","打碎后与群药同煎并延长煎煮时间"],"answer":[0],"explanation":"知识点：烊化药的处理。阿胶属胶类，需单独溶化后兑入煎好的药液中。与群药同煎会粘锅、糊化并吸附其他药成分；先煎会粘底；打碎同煎同样造成粘锅和药液浑浊。","tier":"基础"},{"id":46,"type":"single","stem":"某患者持方来调配，处方写“旋覆花9g，包煎”，调剂员对包煎意义的正确解释是","options":["防止其绒毛刺激咽喉及药液浑浊","减少其挥发油成分在煎煮中散失","避免其与群药发生化学配伍变化","使其有效成分在煎煮中缓慢释放"],"answer":[0],"explanation":"知识点：包煎的目的。旋覆花等带绒毛或细小种子类药物包煎，主要为防止绒毛刺激咽喉、避免药液浑浊。减少挥发油散失是后下的目的；避免配伍变化是相恶相反的处理；缓慢释放不是包煎的主要意义。","tier":"挑战"},{"id":47,"type":"single","stem":"处方中同时写有“人参10g”与“莱菔子15g”，审核该处方时应重点关注的是","options":["两者同用可能削弱人参补气功效","两者同用会产生十八反配伍禁忌","两者同用需将莱菔子先煎减毒","两者同用须把莱菔子炒制后入药"],"answer":[0],"explanation":"知识点：中药配伍禁忌与相恶概念。人参恶莱菔子，莱菔子耗气可削弱人参补益作用，审核时应关注并联系医师。二者不属十八反；莱菔子无毒不需先煎减毒；炒制是炮制规格问题，不解决相恶。","tier":"进阶"},{"id":48,"type":"single","stem":"调剂员在称量一方中“细辛3g”时，正确的调剂操作是","options":["按处方剂量准确称取，不得随意加量","因细辛常用量偏小可目测抓取","按“细辛不过钱”折算减为1g","将细辛与其他饮片合并估量"],"answer":[0],"explanation":"知识点：毒性及小剂量饮片的称量。细辛等需按处方剂量准确称量，不得凭经验目测或估量。目测、合并估量都不符合称量要求；自行折算减量属擅自改方，调剂员无权更改处方剂量。","tier":"基础"},{"id":49,"type":"single","stem":"患者取回汤剂后询问服药时间，处方为补益类方剂且无特殊医嘱，调剂员恰当的用药指导是","options":["宜饭前空腹服用以利吸收","宜饭后立即服用减少刺激","宜睡前一次性顿服全部药液","宜与浓茶同服以助药力上行"],"answer":[0],"explanation":"知识点：补益药的服药时间指导。补益类方剂一般宜饭前空腹服，利于吸收。饭后立即服多用于对胃肠刺激大的方药；睡前顿服不是补益剂常规；浓茶含鞣质会与药中成分结合，不宜同服。","tier":"进阶"},{"id":50,"type":"multi","stem":"某医疗机构中药房收到一张含“制川乌9g”的处方，调剂员在审核与调剂该处方时，下列哪些做法符合中药调剂操作规范","options":["先核对处方医师签章与毒性药品处方权限，再按调剂规程单独称量并双人复核","将制川乌与处方中其他饮片同法称量后直接混入群药包，以节省分戥时间","调剂完毕后在外包装标注“先煎”并口头告知患者制川乌需先煎60分钟以上","因制川乌属毒性中药，调剂时按普通饮片剂量称准后即可，无需在处方上签名"],"answer":[0,2],"explanation":"知识点：含毒性中药饮片处方的审核、调剂与用药指导。制川乌为毒性中药饮片，须审核处方权限、单独称量与复核，并指导先煎以减毒，故第1、3项正确。第2项错误在于毒性饮片不得随意混入群药同包，应单独处理并复核；第4项错误在于毒性中药调剂后调剂人须签名，且不能仅按普通饮片流程处理。","tier":"进阶"},{"id":51,"type":"single","stem":"中药调剂员在审核处方时发现医师书写“川乌9g”，应重点核对该药与下列哪类药物的配伍禁忌","options":["甘草、蜂蜜等解毒类","半夏、瓜蒌等化痰类","黄芪、党参等补气类","陈皮、砂仁等理气类"],"answer":[1],"explanation":"知识点为十八反中乌头类与半夏、瓜蒌、贝母、白蔹、白及相反，川乌属乌头类。半夏、瓜蒌属相反药，正确。甘草蜂蜜可解乌头毒，不是反药。黄芪党参为补气药，与川乌无相反关系。陈皮砂仁为理气药，与川乌亦无相反关系。","tier":"挑战"},{"id":52,"type":"single","stem":"调剂含有“先煎”药物的处方时，正确的操作是","options":["将先煎药与群药同时入锅共煎","将先煎药单独煮沸一段时间后再入群药","将先煎药包成小包与群药同煎后取出","将先煎药研成细粉在群药将煎好时投入"],"answer":[1],"explanation":"先煎目的是延长煎煮时间，如矿石类、贝壳类、毒性药需先煎。正确做法是先单独煮沸一段时间再加入其余药物。与群药同时入锅失去先煎意义。包成小包同煎仍不能延长其煎出时间。研粉在将煎好时投入属后下类思路，不适用于先煎药。","tier":"基础"},{"id":53,"type":"single","stem":"患者处方中有“阿胶”，调剂员应采用的正确调配方式是","options":["与群药一同入锅煎煮","单独烊化后兑入煎好的药液中","研成粗粉与群药包在一起同煎","用冷水浸泡后先煎半小时再兑入"],"answer":[1],"explanation":"阿胶为胶类药物，需烊化即单独用开水或黄酒溶化后兑入药液。与群药同煎会粘锅并影响其他药煎出。研粗粉同煎同样会粘锅糊化。冷水浸泡先煎会使胶质糊锅，均不正确。","tier":"基础"},{"id":54,"type":"single","stem":"处方中“人参”与“五灵脂”同方出现时，调剂员正确的处置是","options":["按方调配并在发药时提醒患者饭后服","拒绝调配并请医师重新开具处方","将五灵脂减量后正常调配","将人参另煎后与其他药液混合服用"],"answer":[1],"explanation":"人参畏五灵脂属十九畏配伍禁忌，同方出现应拒绝调配并联系医师。饭后服不能解决配伍禁忌。减量调配仍属同方使用禁忌药对。另煎混合只是改变煎法，不能消除配伍禁忌。","tier":"进阶"},{"id":55,"type":"single","stem":"药师在发药指导时告诉患者“车前子需包煎”，其主要原因是","options":["车前子气味芳香易挥发","车前子细小易漂浮或糊锅","车前子质地坚硬需久煎","车前子有毒需控制煎出量"],"answer":[1],"explanation":"包煎适用于细小、带绒毛或易使药液浑浊的药物，车前子细小易漂浮糊锅。气味芳香易挥发是后下药的特点。质地坚硬需久煎是矿石类先煎的理由。车前子并非有毒需控制煎出量的药物。","tier":"基础"},{"id":56,"type":"single","stem":"某患者处方开具“薄荷6g”，调剂员在交代煎法时应告知","options":["薄荷需先煎二十分钟","薄荷应在其他药煎好前五分钟加入","薄荷需与群药同煎四十分钟","薄荷需单独煎煮后弃渣取汁"],"answer":[1],"explanation":"薄荷含挥发油，属后下药，应在煎好前短时间加入。先煎会使挥发油散失。与群药同煎四十分钟同样使有效成分挥发。单独煎煮弃渣取汁不符合后下操作，也浪费药效。","tier":"进阶"},{"id":57,"type":"single","stem":"中药调剂称量时，关于“等量递减”分戥法的正确理解是","options":["每味药单独称量后分别包装","按处方总量一次称出后平均分配","将各味药按剂量由多到少依次称取","每味药称量时都从零位重新起称"],"answer":[2],"explanation":"分戥法常用于多剂处方，按每味药剂量由多到少依次称取可减少误差累积。每味单独称量分别包装不是分戥法的含义。总量一次称出平均分配无法保证每味药剂量准确。每味都从零位起称是普通单剂称法，不属于等量递减分戥。","tier":"基础"},{"id":58,"type":"single","stem":"调剂过程中发现处方中“生大黄”与“制大黄”书写不清，调剂员应","options":["按生大黄调配并注明","按制大黄调配并注明","联系开方医师确认后再调配","任选一种调配后请患者自行选择"],"answer":[2],"explanation":"生大黄与制大黄功效不同，书写不清应联系医师确认。擅自按生大黄调配可能改变泻下作用。擅自按制大黄调配同样可能不符合医师意图。让患者自行选择不符合调剂员职责。","tier":"挑战"},{"id":59,"type":"single","stem":"某中药房收到一张处方，其中“罂粟壳”用量为9g，调剂员正确的处置是","options":["按处方量正常调配并登记","拒绝调配并报告上级药师","将用量减为3g后调配","请患者签字后按原量调配"],"answer":[1],"explanation":"罂粟壳属麻醉药品管理品种，处方用量有严格限制，超量应拒绝调配并报告。按原量调配违反管理规定。擅自减量调配仍属超量处方的不当处理。请患者签字不能替代医师处方合规性审核。","tier":"进阶"},{"id":60,"type":"single","stem":"患者取药时询问“服药期间能否饮茶”，调剂员针对含铁类补血药处方的正确回答是","options":["可以饮浓茶以助吸收","不宜饮茶以免影响吸收","必须用茶水送服","饮茶与服药无任何关系"],"answer":[1],"explanation":"茶叶中鞣质可与铁类等成分结合影响吸收，服补血药期间不宜饮茶。浓茶更会加重影响，不能助吸收。茶水送服同样不合适。饮茶与服药存在相互影响，并非无关。","tier":"进阶"},{"id":61,"type":"single","stem":"煎药室接到一张处方，其中“附子”未注明先煎，调剂员发现后应","options":["按常规与群药同煎","先煎附子后再入群药并记录","将附子减量后同煎","将附子后下以保留药效"],"answer":[1],"explanation":"附子含毒性成分，需先煎以降低毒性，处方未注明时调剂员应主动先煎并记录。与群药同煎不能充分减毒。减量同煎不能解决毒性问题。后下会使毒性成分煎出更多，更不安全。","tier":"进阶"},{"id":62,"type":"multi","stem":"中药调剂员在发药指导时，针对含有“后下药”的处方，应向患者交代的正确做法包括","options":["后下药应在其他药煎好前五至十分钟加入","后下药可提前用冷水浸泡一夜再入煎","后下药加入后应继续煎煮五至十分钟","后下药煎煮时间过长会损失有效成分","后下药需与群药同时入锅以节省时间"],"answer":[0,2,3],"explanation":"后下药含挥发油或不宜久煎，应在煎好前短时间加入并继续煎五至十分钟，久煎会损失有效成分。提前浸泡一夜可能使部分成分变化，不是后下药的标准操作。与群药同时入锅失去后下意义，不能节省时间而牺牲药效。","tier":"挑战"},{"id":63,"type":"single","stem":"处方中写“炒白术”，药房应给付的饮片是","options":["白术片","麸炒白术","土炒白术","焦白术"],"answer":[1],"explanation":"知识点：常见炮制品与处方应付。炒白术在现行调剂中一般指麸炒白术，麸炒可缓和燥性、增强健脾作用。白术片是生品，偏于燥湿利水；土炒白术多用于健脾止泻；焦白术多用于收敛止泻，与处方“炒白术”的常规应付不同。","tier":"基础"},{"id":64,"type":"single","stem":"处方中“川乌”与“半夏”同方出现时，调剂员首先应做的处置是","options":["按方分别称量后分包","请处方医师双签字确认","将两味药另包并注明先煎","拒绝调配并报告主管药师"],"answer":[1],"explanation":"知识点：十八反与调配审核。川乌与半夏属于“十八反”相反配伍，调剂员不能自行调配，也不能只做分包标注，应先请处方医师双签字确认后方可调配。按方分别称量、另包先煎、直接拒绝调配并报告都不是规范的首选处置。","tier":"基础"},{"id":65,"type":"single","stem":"中药调剂称量时，戥秤使用前应首先检查的是","options":["戥星是否与秤杆垂直","戥砣与戥盘的配套性","戥纽是否在秤杆中点","秤杆是否保持水平平衡"],"answer":[3],"explanation":"知识点：戥秤使用前检查。使用戥秤前应先检查空秤是否平衡，即秤杆保持水平平衡，这是称量准确的前提。戥星与秤杆垂直、戥砣与戥盘配套、戥纽位置都是戥秤本身结构要求，不是每次使用前首先检查的动作。","tier":"基础"},{"id":66,"type":"single","stem":"煎药时，处方中标注“后下”的薄荷，正确操作是","options":["与其他药同时浸泡后同煎","在群药煎好前5～10分钟加入","在群药煎沸后立即加入并久煎","单煎取汁后兑入群药药液中"],"answer":[1],"explanation":"知识点：特殊煎法之后下。薄荷含挥发油，久煎易失效，应在群药煎好前5～10分钟加入。同时浸泡同煎、沸后立即加入并久煎、单煎取汁兑入都不是“后下”的规范操作。","tier":"基础"},{"id":67,"type":"single","stem":"处方中“阿胶”的正确调剂处理是","options":["打碎后与其他药同煎","用开水溶化后兑入药液","先煎半小时再入群药","包煎以避免糊锅"],"answer":[1],"explanation":"知识点：胶类药的烊化。阿胶属胶类，应单独用开水或黄酒溶化后兑入煎好的药液中。打碎同煎、先煎、包煎都不能解决胶类易粘锅、易糊化的问题，也不是规范用法。","tier":"基础"},{"id":68,"type":"single","stem":"处方中写“生大黄”，调剂员给付的应是","options":["熟大黄","酒大黄","生大黄片","大黄炭"],"answer":[2],"explanation":"知识点：大黄炮制品的处方应付。处方写“生大黄”应给付生大黄片，取其泻下力强。熟大黄泻下力缓，酒大黄偏于活血，大黄炭偏于凉血止血，均与生大黄不同。","tier":"基础"},{"id":69,"type":"single","stem":"中药饮片调剂时，发现处方中“附子”未标注先煎，调剂员应","options":["按常规群药同煎","先煎30分钟后入群药","减量后群药同煎","改用制附子后群药同煎"],"answer":[1],"explanation":"知识点：毒性药先煎。附子含乌头碱类成分，需先煎30分钟以上以减毒，即使处方未标注，调剂员也应提示并先煎。群药同煎、减量同煎、改用制附子后群药同煎都不能保证减毒充分。","tier":"进阶"},{"id":70,"type":"single","stem":"患者取药时询问“补益药饭前还是饭后服”，调剂员回答正确的是","options":["补益药宜饭前服","补益药宜饭后服","补益药宜睡前服","补益药宜空腹服"],"answer":[0],"explanation":"知识点：服药时间指导。补益药一般宜饭前服，有利于吸收。饭后服多用于对胃肠有刺激的药，睡前服多用于安神药，空腹服多用于驱虫药或泻下药，与补益药的常规服法不同。","tier":"基础"},{"id":71,"type":"single","stem":"中药房调剂时，发现处方中“甘草”与“甘遂”同方，调剂员正确的处置是","options":["按方分别称量后分包","请处方医师双签字确认","将两味药另包并注明先煎","拒绝调配并报告主管药师"],"answer":[1],"explanation":"知识点：十八反的调配审核。甘草与甘遂属“十八反”相反配伍，调剂员不能自行调配，应先请处方医师双签字确认。分别称量分包、另包先煎、直接拒绝调配并报告都不是规范首选。","tier":"挑战"},{"id":72,"type":"multi","stem":"中药调剂员在审核处方时，遇到下列哪些情况应当请处方医师确认或双签字后方可调配","options":["处方中川乌与半夏同用","处方中甘草与甘遂同用","处方中附子未标注先煎","处方中人参未标注另煎"],"answer":[0,1],"explanation":"知识点：处方审核中需医师确认的情形。川乌与半夏、甘草与甘遂均属十八反相反配伍，必须请医师双签字确认。附子未标注先煎、人参未标注另煎属于调剂员应提示或按规范处理的问题，不涉及相反配伍，不需要医师双签字。","tier":"挑战"},{"id":73,"type":"single","stem":"处方写“焦白术”，药房当前只有生白术和土炒白术，调剂员正确的处置是","options":["直接付生白术并在药袋标注代用","直接付土炒白术并在药袋标注代用","请处方医师确认改用哪种白术并签字","将生白术与土炒白术各半混合付给"],"answer":[2],"explanation":"考查中药临方炮制品与处方应付。焦白术需炒至表面焦褐色，药房无此炮制品时应请医师确认替代品，故C对；A、B擅自以生品或土炒品代用改变了炮制规格；D混合两种炮制品既非焦白术也改变了药性。","tier":"进阶"},{"id":74,"type":"single","stem":"审方时发现处方中“川乌6g”与“法半夏9g”同方配伍且无医师签章，调剂员应当","options":["照方调配并在发药时口头提示先煎","将两药减量后调配并另包标注","拒绝调配并请处方医师重新签字确认","把川乌改为制川乌后继续调配"],"answer":[2],"explanation":"考查十八反配伍禁忌与审方职责。川乌与半夏属十八反配伍，须医师双签字确认方可调配，故C对；A照方调配未处理禁忌风险；B自行减量调剂员无权更改处方；D擅自改炮制规格仍属无签字确认的禁忌配伍。","tier":"挑战"},{"id":75,"type":"single","stem":"调剂含“薄荷”的处方时，为减少挥发油损失，薄荷的正确处理方式是","options":["与群药同煎30分钟","另包后于其他药煎好前5分钟下","先煎20分钟再入群药","用温水浸泡1小时后与群药同煎"],"answer":[1],"explanation":"考查后下药的煎法。薄荷含挥发油，宜后下，故B对；A久煎使挥发油大量散失；C先煎同样导致有效成分损失；D浸泡后同煎仍不能避免挥发油受热损失。","tier":"进阶"},{"id":76,"type":"single","stem":"处方开“三七粉3g冲服”，调剂员正确的给付与交代方式是","options":["三七粉与群药同包，嘱患者一起煎煮","三七粉单包，嘱用煎好药液冲服","三七粉单包，嘱加冷水调匀后与群药同煎","三七粉混入群药包，嘱煎时后下"],"answer":[1],"explanation":"考查贵重细料药冲服法。三七粉宜单包，用煎好药液冲服，故B对；A同煎使有效成分受热破坏且浪费；C调匀同煎同样损失成分；D混包后下不能保证冲服要求。","tier":"基础"},{"id":77,"type":"single","stem":"煎药机煎煮解表类处方时，较适宜的煎煮时间是","options":["武火煮沸后文火煎40分钟","武火煮沸后文火煎20分钟","武火煮沸后文火煎60分钟","武火煮沸后文火煎90分钟"],"answer":[1],"explanation":"考查解表剂煎煮时间。解表药多含挥发油，宜武火煮沸后文火煎20分钟左右，故B对；A、C、D时间过长导致挥发油散失、药性改变。","tier":"基础"},{"id":78,"type":"single","stem":"某患者持处方配药，方中“附子”未注明先煎，调剂员最恰当的处置是","options":["按常规与群药同煎并口头告知","将附子另包并嘱先煎30至60分钟","将附子减量后与群药同煎","将附子改为同方中其他温阳药替代"],"answer":[1],"explanation":"考查毒性中药附子的煎法。附子需先煎以减毒，方中未注明时调剂员应另包并交代先煎，故B对；A同煎毒性成分煎出不完全；C自行减量改变处方；D擅自替换药物违反处方原则。","tier":"挑战"},{"id":79,"type":"single","stem":"处方中同时出现“生大黄”与“芒硝”，调剂员对芒硝的正确处理是","options":["与生大黄同煎20分钟","另包，待药液煎好后溶入搅匀","先煎30分钟再入群药","与群药同包同煎并后下"],"answer":[1],"explanation":"考查芒硝的溶化法。芒硝宜溶化兑入煎好药液中，故B对；A同煎影响泻下成分；C先煎造成成分分解；D同煎后下仍不符合溶化要求。","tier":"进阶"},{"id":80,"type":"multi","stem":"以下关于中药调剂称量操作的描述，正确的有","options":["称量前应检查戥子零点是否平衡","毒性中药应逐味单独称量并复核","一方多剂时可按总剂量称取后目测分堆","称量完毕应将戥盘擦拭干净","鲜药可与干药按同一比例折算后称取"],"answer":[0,1,3],"explanation":"考查调剂称量规范。A称前校零保证准确；B毒性药单独称量复核防差错；D清洁戥盘防串味交叉污染；C目测分堆不能保证每剂剂量均匀；E鲜药与干药含水量不同，不能简单按同一比例折算。","tier":"进阶"},{"id":81,"type":"single","stem":"某患者取回含“荆芥”的汤剂，反映药液气味很淡、效果不佳，调剂员核查发现煎药时荆芥与群药同煎40分钟，正确的分析是","options":["荆芥应包煎，同煎导致绒毛混入","荆芥应后下，久煎使挥发油散失","荆芥应先煎，同煎使有效成分未煎出","荆芥应烊化，同煎导致成分破坏"],"answer":[1],"explanation":"考查情境案例中后下药判断。荆芥含挥发油，宜后下，久煎致气味淡、疗效降低，故B对；A包煎针对绒毛类药；C先煎针对矿石类；D烊化针对胶类药，均不适用于荆芥。","tier":"挑战"},{"id":82,"type":"single","stem":"中药调剂员在审核处方时发现处方中写有“十八反”中甘草与甘遂同用，正确的处置方式是","options":["拒绝调配并请处方医师重新开具","将甘遂减量后照方调配","将甘草减量后照方调配","两药分别包装并注明间隔服用"],"answer":[0],"explanation":"知识点：处方审核中的配伍禁忌。十八反属绝对禁忌，甘草反甘遂，调剂员应拒绝调配并联系医师。减量调配仍属违反禁忌，故B、C错；分别包装间隔服用不能消除配伍禁忌，故D错。","tier":"挑战"},{"id":83,"type":"single","stem":"调剂处方时需将饮片称量误差控制在合理范围，一般每剂总量的重量误差应不超过","options":["±1%","±5%","±10%","±20%"],"answer":[1],"explanation":"知识点：中药调剂称量误差要求。常规调剂每剂总量误差控制在±5%以内。±1%过于苛刻不现实；±10%、±20%超出允许范围，会影响疗效，故A、C、D错。","tier":"进阶"},{"id":84,"type":"single","stem":"处方中写“炒白术”而未注明具体炮制程度，调剂员应给付的饮片是","options":["生白术片","麸炒白术","土炒白术","焦白术"],"answer":[1],"explanation":"知识点：中药炮制品的处方应付。处方写“炒白术”通常指麸炒白术。生白术片未炒，故A错；土炒、焦炒另有专用处方名，故C、D错。","tier":"进阶"},{"id":85,"type":"single","stem":"某患者处方中含阿胶，调剂员在煎药环节应做的处理是","options":["与群药同煎","先煎30分钟","烊化后兑入药液","包煎后入锅"],"answer":[2],"explanation":"知识点：特殊煎法中的烊化。阿胶为胶类，需单独烊化后兑入煎好的药液中。与群药同煎会粘锅并影响其他药，故A错；先煎不适用于胶类，故B错；包煎适用于细小或带绒毛药，故D错。","tier":"进阶"},{"id":86,"type":"single","stem":"处方中同时开具“生大黄”与“制大黄”时，调剂员对两者的功效差异理解正确的是","options":["生大黄泻下力强，制大黄泻下力缓","生大黄偏于活血，制大黄偏于止血","生大黄偏于清热，制大黄偏于攻积","两者功效相同仅炮制工艺不同"],"answer":[0],"explanation":"知识点：大黄不同炮制品的功效差异。生大黄泻下力强，酒制或熟制后泻下力减弱。B、C所述功效对应关系颠倒或错配；D忽视了炮制对药效的影响，故错。","tier":"进阶"},{"id":87,"type":"single","stem":"患者取药时询问服药期间能否饮茶，调剂员针对含生物碱类中药处方的正确答复是","options":["可以饮浓茶助消化","不宜饮茶以免影响吸收","用茶水送服效果更好","仅忌绿茶不忌红茶"],"answer":[1],"explanation":"知识点：服药期间的饮食禁忌。茶叶含鞣质，可与生物碱结合影响吸收，故不宜饮茶。浓茶助消化与该禁忌无关，故A错；茶水送服会降低药效，故C错；红茶绿茶均含鞣质，故D错。","tier":"进阶"},{"id":88,"type":"single","stem":"调剂员在称量三七粉时发现戥秤零点偏移，正确的做法是","options":["直接按经验估计称量","调零后再行称量","将偏移量计入总重","改用目测分装"],"answer":[1],"explanation":"知识点：称量器具的校准。戥秤零点偏移应先调零再称量，保证剂量准确。凭经验估计、把偏移量计入总重、目测分装都会造成剂量误差，故A、C、D错。","tier":"挑战"},{"id":89,"type":"single","stem":"某医疗机构中药房调剂员在收到一张字迹模糊、剂量单位不清的处方时，正确的处置是","options":["按常见剂量猜测后调配","联系处方医师确认后再调配","先调配再请医师补签","让患者自行确认剂量"],"answer":[1],"explanation":"知识点：处方审核中存疑处方的处置。字迹模糊、单位不清属存疑处方，应联系医师确认。猜测剂量、先调配后补签、让患者确认均不符合处方审核要求，故A、C、D错。","tier":"进阶"},{"id":90,"type":"multi","stem":"调剂员在向患者交代含挥发性成分中药的煎服要点时，正确的做法包括","options":["薄荷、砂仁等应后下","煎药宜用武火久煎","煎好后应趁热过滤","药液宜密闭保存","可提前一夜浸泡再煎"],"answer":[0,2,3],"explanation":"知识点：含挥发性成分中药的煎服指导。后下、趁热过滤、密闭保存可减少挥发油损失。武火久煎会加速挥发油散失，故B错；提前一夜浸泡易致成分变化及变质，故E错。","tier":"挑战"},{"id":91,"type":"single","stem":"医师处方写“焦白术”，调剂时应付的饮片是","options":["白术片炒至表面焦褐色、内部焦黄色","白术片炒至表面黄白色、有焦香气","白术片用武火炒至全部黑褐色","白术片蒸透后切厚片干燥"],"answer":[0],"explanation":"知识点为中药饮片炮制规格与处方应付。焦白术要求炒至表面焦褐色、内部焦黄色并具焦香气，故第一项正确；第二项是清炒白术（炒白术）的程度，非焦品；第三项炒成全部黑褐色属焦枯，不符合焦白术火候；第四项是蒸制加工，与焦品无关。","tier":"基础"},{"id":92,"type":"single","stem":"处方中写“二冬”时，中药调剂员应付的饮片是","options":["天冬、麦冬","天冬、款冬花","麦冬、忍冬藤","天冬、冬瓜子"],"answer":[0],"explanation":"知识点为处方并开药名的应付。二冬指天冬与麦冬，故第一项正确；款冬花虽名含冬但不属二冬；忍冬藤为清热解毒药，非二冬组成；冬瓜子为化痰排脓药，与二冬无关。","tier":"基础"},{"id":93,"type":"single","stem":"调剂处方中写“炒三仙”，应付的饮片组合是","options":["山楂、神曲、麦芽","山楂、槟榔、麦芽","神曲、谷芽、麦芽","山楂、神曲、谷芽"],"answer":[0],"explanation":"知识点为并开药名“焦三仙/炒三仙”的组成。炒三仙指山楂、神曲、麦芽三味消食药，故第一项正确；槟榔不是三仙组成；谷芽可替代麦芽但非三仙固定组成；少山楂也不符合固定并开。","tier":"基础"},{"id":94,"type":"single","stem":"中药房调剂时，处方中写“薄荷”，其常用应付规格和煎法提示是","options":["生品，注明后下","生品，注明先煎","蜜炙品，注明包煎","生品，注明烊化"],"answer":[0],"explanation":"知识点为含挥发油药物的煎法。薄荷含挥发油，宜生用并后下，故第一项正确；先煎用于质地坚硬或需减毒药，不适用于薄荷；蜜炙与包煎不是薄荷常规规格；烊化用于胶类药，与薄荷无关。","tier":"基础"},{"id":95,"type":"single","stem":"处方中写“阿胶”，调剂员在发药交代时应提示的煎服方法是","options":["单独烊化后兑入药液","与他药同煎并先煎半小时","装纱布袋后与他药同煎","研粉后直接冲入沸水服用"],"answer":[0],"explanation":"知识点为胶类药的煎服处理。阿胶应单独烊化（溶化）后兑入煎好的药液，故第一项正确；与他药同煎会粘锅并影响其他药；装袋同煎仍会黏附药渣；研粉冲沸水虽可溶但非规范烊化兑服法，且易成块。","tier":"基础"},{"id":96,"type":"single","stem":"某处方含“附子9g”，调剂员审核时应特别关注的是","options":["是否注明先煎及用药剂量是否在常规范围","是否注明后下及是否需另包","是否注明包煎及是否需去毛","是否注明另煎及是否需研粉冲服"],"answer":[0],"explanation":"知识点为毒性中药的处方审核要点。附子有毒，需先煎以减毒，且剂量须符合规定，故第一项正确；后下针对含挥发油药，与附子减毒目的不符；包煎针对黏性或带绒毛药；另煎针对贵重药，均非附子审核重点。","tier":"基础"},{"id":97,"type":"single","stem":"调剂处方时发现医师写“川贝母3g”，而药房只有“浙贝母”，正确的处置是","options":["联系处方医师确认是否可替代后再调剂","直接用浙贝母按同剂量替代川贝母","将浙贝母加量至川贝母的两倍替代","暂不调剂并让患者自行去外院购买"],"answer":[0],"explanation":"知识点为处方用药与饮片替代的审核程序。川贝母与浙贝母功效、价格不同，不得擅自替代，应联系医师确认，故第一项正确；直接同剂量替代属擅自更改处方；加量替代更无依据；让患者自行外购不属于调剂员规范处置。","tier":"挑战"},{"id":98,"type":"single","stem":"某患者持含“生大黄”的处方，要求煎药时“多煎一会儿更出味”，调剂员正确的用药指导是","options":["告知大黄用于泻下时宜后下，久煎会减弱泻下作用","告知大黄应先煎一小时以充分煎出有效成分","告知大黄需与群药同煎并延长煎煮至一小时","告知大黄应包煎以免药液浑浊影响服用"],"answer":[0],"explanation":"知识点为大黄的煎法与功效关系。生大黄用于泻下时，久煎会破坏致泻成分，宜后下，故第一项正确；先煎一小时会明显减弱泻下力；同煎一小时同样使泻下成分受损；包煎与大黄煎法无关。","tier":"挑战"},{"id":99,"type":"single","stem":"中药调剂称量时，关于戥秤使用的做法，正确的是","options":["称量前先检查戥秤零位并校准，称量时左手持戥、右手抓药","称量时直接把药堆在戥盘外缘以便快速读数","称量不同药物时可连续使用同一戥盘不清理","称量时以目测估计代替戥星读数以提高速度"],"answer":[0],"explanation":"知识点为戥秤规范操作。称量前应检查零位并校准，操作时规范持戥抓药，故第一项正确；药堆在盘外缘影响准确与清洁；连续使用不清理易造成串味和交叉污染；目测代替读数不符合称量准确要求。","tier":"进阶"},{"id":100,"type":"multi","stem":"患者持方前来配药，处方含“制川乌6g（先煎）”，调剂员在审方与交代煎法时，下列哪些做法符合中药调剂与用药指导规范？","options":["制川乌单包并注明先煎，嘱患者先煎30～60分钟后再入群药同煎","因方中制川乌用量未超药典常用量，可不单包直接与其他饮片同煎","交代患者先将制川乌用温水浸泡20分钟，再与群药一起下锅同煎","制川乌单包先煎后，嘱患者将煎得药液与群药煎液兑匀分次服用"],"answer":[0,3],"explanation":"知识点：毒性饮片制川乌的审方、单包先煎与用药指导。制川乌含乌头类生物碱，必须单包标注先煎，久煎可减毒，先煎后与群药同煎或兑匀服用均可，故第1、4项正确。第2项错在用量合规不等于可不先煎，先煎是减毒的程序要求而非用量问题。第3项错在仅温水浸泡不能替代长时间先煎，毒性成分未充分破坏，属看似合理但关键程序错的做法。","tier":"进阶"},{"id":101,"type":"single","stem":"调剂处方中写“二冬”，通常应付的药味组合是","options":["天冬、麦冬","天冬、款冬花","麦冬、款冬花","天冬、冬瓜仁"],"answer":[0],"explanation":"“二冬”是天冬与麦冬的合写，二者常同用养阴润燥。款冬花为止咳药，与天冬、麦冬不构成“二冬”；冬瓜仁属清热化痰药，也不在合写之列。","tier":"基础"},{"id":102,"type":"single","stem":"处方中写“川军”，调剂时应付的饮片是","options":["大黄","黄连","黄芩","川芎"],"answer":[0],"explanation":"“川军”是大黄的别名，因产于四川者质优而得名。黄连、黄芩虽也含“黄”字但非此别名；川芎虽含“川”字，为活血行气药，与川军无关。","tier":"基础"},{"id":103,"type":"single","stem":"中药调剂中“等量递减”分戥法的正确操作是","options":["每味药一次称足总量后平均分份","按处方顺序逐味称取全量后混合","每味药按剂数逐次称取并递减余量","先称总量再按目测分成若干份"],"answer":[2],"explanation":"等量递减法要求每味药按剂数逐次称取，每称一次从总量中递减，保证各剂药量均匀。一次称足后平均分份易造成分份不均；逐味称全量后混合无法分剂；目测分份误差大且不可控。","tier":"基础"},{"id":104,"type":"single","stem":"煎药时需“先煎”的饮片，其正确处置是","options":["与群药同煎至规定时间","先煎20～30分钟后再入群药","包煎后与群药同时下锅","待群药煎沸后立即下入"],"answer":[1],"explanation":"先煎药多为质地坚硬或需减毒之品，应先单独煎煮20～30分钟再入群药同煎。与群药同煎无法达到先煎目的；包煎针对黏性或细小种子；沸后立即下入属于后下操作。","tier":"进阶"},{"id":105,"type":"single","stem":"处方中含“阿胶”时，药房调剂后应另包并注明","options":["先煎","后下","烊化","冲服"],"answer":[2],"explanation":"阿胶为胶类药，直接入煎易粘锅糊化，应另行烊化后兑入药液。先煎针对矿石类，后下针对芳香类，冲服针对贵重或量小的粉末类，均不适用于阿胶。","tier":"基础"},{"id":106,"type":"single","stem":"某患者处方中含“附子”，调剂员在发药交代时最应强调的是","options":["需久煎以确保用药安全","需后下以保留药效","需包煎以防刺激咽喉","需冲服以节省药材"],"answer":[0],"explanation":"附子含毒性成分，久煎可降低毒性，故发药时必须交代先煎久煎。后下适用于芳香药，包煎适用于黏性或毛状药，冲服适用于粉末或贵重药，均与附子减毒无关。","tier":"挑战"},{"id":107,"type":"single","stem":"调剂时发现处方中“甘草”与“甘遂”同方出现，调剂员正确的第一步处置是","options":["照方调配并另包标注","拒绝调配并报告药师审核","自行删去甘遂后调配","减量调配后交代患者"],"answer":[1],"explanation":"甘草与甘遂属于“十八反”配伍禁忌，调剂员不得自行处理，应拒绝调配并交药师审核。照方调配、自行删药、减量调配均属越权且可能造成用药风险。","tier":"挑战"},{"id":108,"type":"single","stem":"某处方中“薄荷”未注明特殊煎法，调剂员应将其另包并注明","options":["先煎","后下","包煎","另煎"],"answer":[1],"explanation":"薄荷含挥发油，久煎易失效，应后下。先煎针对矿石贝壳类，包煎针对黏性及细小种子类，另煎针对贵重药，均不符合薄荷的煎法要求。","tier":"基础"},{"id":109,"type":"single","stem":"中药称量时，戥秤的“定盘星”作用是","options":["确定戥秤的最大称量","校验戥秤零位是否准确","标记常用剂量刻度","固定戥砣防止滑落"],"answer":[1],"explanation":"定盘星是戥秤零位标志，用于校验空秤是否平衡。最大称量由戥秤规格决定；常用剂量靠戥砣位置读取；固定戥砣并非定盘星功能。","tier":"基础"},{"id":110,"type":"single","stem":"患者取药时询问“车前子为什么要装布袋煎”，调剂员正确的解释是","options":["防止有效成分被破坏","避免药液浑浊并防糊锅","增强药物补益作用","减少药物苦味"],"answer":[1],"explanation":"车前子细小且含黏液质，包煎可防止药液浑浊及煎煮时糊锅。包煎不改变有效成分稳定性，也不增强补益或减少苦味，这些说法均无依据。","tier":"进阶"},{"id":111,"type":"multi","stem":"关于中药处方审核中“妊娠禁忌”的处置，下列做法正确的有","options":["发现处方含峻下逐水药应拒绝调配并报告药师","对含活血化瘀药的孕妇处方可直接按方调配","对妊娠用药有疑问时应请医师确认后再调配","将妊娠禁忌药自行减量后调配并交代患者","调剂完成后向孕妇交代用药注意事项"],"answer":[0,2,4],"explanation":"峻下逐水药属妊娠禁用，应拒绝调配并报告药师；有疑问须请医师确认；发药时交代注意事项均正确。活血化瘀药是否禁用需具体分析，不能一律直接调配；自行减量调配属越权且不安全。","tier":"进阶"},{"id":112,"type":"single","stem":"中药调剂员在审核处方时发现处方中写有“川乌9g，先煎”，同时另开“法半夏9g”，关于该处方的处理正确的是","options":["川乌与法半夏属十八反配伍禁忌，应拒绝调配并联系医师确认","川乌先煎即可，法半夏另包先煎，可以正常调配","川乌与法半夏同用属相反，需将法半夏改为姜半夏后调配","川乌需先煎45分钟以上，法半夏后下，可照方调配"],"answer":[0],"explanation":"知识点：十八反中“半蒌贝蔹及攻乌”，川乌与半夏属配伍禁忌。正确项：审核发现十八反配伍应拒绝调配并联系医师。A项正确。B项先煎属煎法处理，不能消除配伍禁忌。C项姜半夏仍属半夏类，不能规避十八反。D项煎法安排不改变配伍禁忌性质。","tier":"挑战"},{"id":113,"type":"single","stem":"某医疗机构中药房收到处方“生大黄6g”，医师未注明煎法，调剂员在发药指导时应告知患者","options":["生大黄应后下，在其他药煎好前5~10分钟投入","生大黄应久煎40分钟以充分煎出有效成分","生大黄应另煎取汁后兑入药液中服用","生大黄应与群药同煎，无需特殊处理"],"answer":[0],"explanation":"知识点：生大黄含泻下成分蒽醌苷类，久煎会被破坏，泻下作用减弱，故应后下。A项正确。B项久煎会破坏泻下成分，错误。C项另煎兑入是针对贵重药如人参，不适用于大黄。D项同煎会降低泻下效力，不符合要求。","tier":"进阶"},{"id":114,"type":"single","stem":"某患者处方中含“薄荷6g”，调剂员在交代煎药方法时应说明","options":["薄荷含挥发油，应后下，煎好前5~10分钟加入","薄荷质地轻浮，应包煎以防漂浮","薄荷应先用冷水浸泡30分钟再与群药同煎","薄荷应另煎取汁，以免挥发油散失"],"answer":[0],"explanation":"知识点：含挥发油类药如薄荷应后下，减少挥发油损失。A项正确。B项包煎针对易漂浮或刺激咽喉的药，不解决挥发油散失。C项浸泡后同煎仍会使挥发油大量挥发。D项另煎并非薄荷常规煎法，后下即可。","tier":"挑战"},{"id":115,"type":"single","stem":"调剂员在核对处方时发现“甘草”与“甘遂”同方出现，正确的判断是","options":["甘草与甘遂属十八反，应拒绝调配并请医师双签字确认","甘草与甘遂属十九畏，需将甘遂减量后调配","甘草与甘遂同用属相须配伍，可增强疗效","甘草与甘遂同用属相畏配伍，甘草可解甘遂毒性"],"answer":[0],"explanation":"知识点：十八反中“藻戟遂芫俱战草”，甘草与甘遂相反。A项正确。B项十九畏是另一类配伍禁忌，且减量不能消除禁忌。C项相须指性能功效相似药配伍增效，与禁忌无关。D项相畏指一种药抑制另一种药毒性，此处属相反。","tier":"挑战"},{"id":116,"type":"single","stem":"某中药房调剂员在称取“细辛3g”时，戥子秤砣挂在标尺3g位置，但药斗中细辛已受潮结块，正确的处置是","options":["将细辛干燥后再称取，确保称量准确","直接称取结块细辛，称量误差在允许范围内","将结块细辛捏碎后估量取用","换用分度值更大的托盘天平称取"],"answer":[0],"explanation":"知识点：饮片受潮结块会影响称量准确性及质量。A项正确。B项结块使实际量偏差，不能保证准确。C项估量取用不符合调剂规范。D项换天平不解决饮片受潮问题。","tier":"进阶"},{"id":117,"type":"single","stem":"处方中开有“车前子9g”，调剂员在调配时应采取的措施是","options":["车前子细小且易漂浮，应装入煎药袋包煎","车前子应后下，煎好前10分钟加入","车前子应烊化后兑入药液","车前子应另煎取汁后与其他药液混合"],"answer":[0],"explanation":"知识点：车前子颗粒细小，直接煎煮易漂浮、糊锅、刺激咽喉，应包煎。A项正确。B项后下针对挥发油类，不适用。C项烊化针对胶类。D项另煎针对贵重药。","tier":"基础"},{"id":118,"type":"single","stem":"患者取药时询问“先煎”的含义，调剂员正确的解释是","options":["先将先煎药煮沸后煎煮20~30分钟，再加入其他药物同煎","先将先煎药浸泡30分钟后与群药同时煎煮","先煎药应最后放入，煎5~10分钟即可","先煎药应单独煎煮后弃去药渣，只取药液兑入"],"answer":[0],"explanation":"知识点：先煎针对质地坚硬或需减毒的药，应先煎20~30分钟再入群药。A项正确。B项浸泡后同煎达不到先煎目的。C项最后放入是后下。D项弃渣只取液不符合先煎后合煎的要求。","tier":"进阶"},{"id":119,"type":"single","stem":"某调剂员在发药时发现处方中“附子15g”未注明先煎，正确的处理是","options":["告知患者附子需先煎60分钟以上，并请医师补注先煎","按处方直接调配，附子与群药同煎即可","将附子减量至9g后调配，避免毒性","将附子改为制附子后无需先煎，直接调配"],"answer":[0],"explanation":"知识点：附子含乌头碱，需先煎久煎减毒。A项正确，应补注并指导。B项同煎减毒不充分，风险大。C项擅自减量不符合处方。D项制附子仍需先煎，不能直接同煎。","tier":"挑战"},{"id":120,"type":"multi","stem":"中药调剂员在审核处方时，下列情况属于应拒绝调配并联系医师确认的有","options":["处方中川乌与半夏同用","处方中甘草与甘遂同用","处方中人参未注明另煎","处方中附子用量15g未注明先煎","处方中薄荷未注明后下"],"answer":[0,1,3],"explanation":"知识点：十八反配伍及毒性药超量未注煎法属审核重点。A项川乌与半夏属十八反，应拒绝。B项甘草与甘遂属十八反，应拒绝。D项附子毒性药未注先煎，应联系医师。C项人参未注另煎属煎法指导问题，一般提醒补注即可。E项薄荷未注后下属煎法指导，提醒即可。","tier":"进阶"},{"id":121,"type":"single","stem":"中药调剂员在收方后审核处方时，发现处方中“川乌”与“半夏”同方配伍，依据中药配伍禁忌应判定为","options":["相反","相畏","相恶","相杀"],"answer":[0],"explanation":"知识点为十八反配伍禁忌。川乌与半夏属于十八反中“半蒌贝蔹及攻乌”的相反配伍，故正确项为相反；相畏指一种药物能抑制另一种药物的毒性，如半夏畏生姜；相恶指两药合用一药降低另一药功效，如人参恶莱菔子；相杀指一种药物能消除另一种药物的毒性反应，如防风杀砒霜毒。","tier":"挑战"},{"id":122,"type":"single","stem":"调剂称量时需临时称取3克朱砂粉，正确的称量操作是","options":["用戥子直接称取后倾入药袋","先在戥盘上垫纸称取后包入","用电子秤称取后研细再称","用戥子称取后过筛再分包"],"answer":[1],"explanation":"知识点为毒性中药及粉末类药物的称量规范。朱砂为粉末状矿物药，直接倾入戥盘会残留损失且污染器具，故应垫纸称取后包入；直接称取倾入药袋会因粘附导致剂量不准；电子秤称取后研细再称会增加损耗且朱砂不宜大量研磨；称后过筛再分包并非称量环节的必要步骤且朱砂过筛易飞扬。","tier":"基础"},{"id":123,"type":"single","stem":"中药调剂员在斗谱排列时，将“甘草”与“甘遂”安排在同一组药斗中，这一做法的主要问题是","options":["两药功效相近易混淆","两药属于十八反配伍禁忌","两药外观相似易拿错","两药均需单独存放防潮"],"answer":[1],"explanation":"知识点为斗谱排列与配伍禁忌。甘草与甘遂属于十八反中“藻戟遂芫俱战草”的相反配伍，同组存放易在调剂时误配；两药功效并不相近；外观差异较大不易混淆；防潮要求并非二者同组存放的主要问题。","tier":"进阶"},{"id":124,"type":"single","stem":"某患者处方中有“阿胶”，调剂员应告知患者的正确服用方法是","options":["与群药一同煎煮","烊化后兑入煎好的药液中","另煎后与其他药液混合","打碎后直接冲服"],"answer":[1],"explanation":"知识点为胶类药物的烊化操作。阿胶为胶类药，直接煎煮易粘锅糊化，应单独烊化后兑入煎好的药液中；与群药同煎会粘锅；另煎适用于贵重药如人参；打碎冲服不能充分发挥阿胶的滋补作用且不易吸收。","tier":"挑战"},{"id":125,"type":"single","stem":"调剂处方时发现药味“黄芩”应付“酒黄芩”，而药斗中仅有“生黄芩”，正确的处置是","options":["直接用生黄芩替代并注明","用生黄芩炒制后应付","请处方医师确认后改用生黄芩","拒绝调配并要求患者换方"],"answer":[2],"explanation":"知识点为处方应付与炮制品规格。处方写酒黄芩应付酒炙品，药斗无此规格时应请医师确认能否以生黄芩替代，不可擅自替代；直接替代违反处方应付规范；调剂员自行炒制不符合炮制资质要求；拒绝调配并让患者换方过于简单，未走确认程序。","tier":"挑战"},{"id":126,"type":"single","stem":"某药房新到一批“法半夏”，调剂员在验收时发现其表面呈类白色、有轻微麻舌感，正确的判断是","options":["麻舌感属正常，可入库使用","麻舌感明显提示炮制不到位，应退货","类白色为合格标志，可直接使用","轻微麻舌感说明药效强，可正常使用"],"answer":[1],"explanation":"知识点为法半夏的炮制质量要求。法半夏经炮制后应无麻舌感，出现麻舌感提示炮制不到位、毒性成分残留，应退货；麻舌感正常说法错误；类白色虽是法半夏外观特征之一但不能仅凭颜色判断合格；麻舌感强并非药效强的表现而是炮制不合格。","tier":"挑战"},{"id":127,"type":"single","stem":"患者持处方来店调配，处方中“生大黄”注明“后下”，调剂员交代煎药方法时正确的说法是","options":["群药煎沸后10分钟内投入","群药煎沸后30分钟投入","与群药同时入锅煎煮","群药煎好前5分钟投入并久煎"],"answer":[0],"explanation":"知识点为大黄后下的目的与操作。生大黄后下是为保留泻下成分，应在群药煎沸后10分钟内投入；煎沸后30分钟投入时间过长泻下成分被破坏；同时入锅则失去后下意义；煎好前5分钟投入并久煎会使泻下成分分解。","tier":"进阶"},{"id":128,"type":"single","stem":"调剂员在审核处方时，发现处方中“附子”用量为15克且未注明先煎，正确的处理是","options":["按处方直接调配并交代先煎","按处方调配但减量至10克","请医师注明先煎并确认用量后调配","拒绝调配并让患者重新开方"],"answer":[2],"explanation":"知识点为毒性中药附子的处方审核。附子含乌头碱，需先煎降低毒性，处方未注明先煎应请医师补充注明并确认用量；直接调配存在安全风险；擅自减量违反处方规范；拒绝调配并让患者重开方未走沟通确认程序。","tier":"挑战"},{"id":129,"type":"multi","stem":"中药调剂员在煎药室操作时，下列做法符合煎药规范的有","options":["煎药前用冷水将药材浸泡30至60分钟","解表类药煎煮时间宜短，沸后15至20分钟","煎药过程中随时加冷水以保持水量","煎药器具选用砂锅或不锈钢锅","煎好的药液趁热过滤后分装"],"answer":[0,1,3],"explanation":"知识点为中药煎药的标准操作规程。煎药前冷水浸泡30至60分钟有利于有效成分溶出，正确；解表药含挥发性成分，沸后15至20分钟即可，正确；煎药过程中加冷水会使已受热药材骤冷收缩影响成分溶出，错误；砂锅或不锈钢锅化学性质稳定适宜煎药，正确；煎好的药液应趁热过滤分装以减少沉淀和污染，正确。","tier":"进阶"},{"id":130,"type":"single","stem":"调剂处方时发现医师写“川乌6g”，审核应重点核对该药是否","options":["标明先煎并单包","注明后下并另包","注明包煎并另包","注明烊化并另包"],"answer":[0],"explanation":"知识点：毒性中药川乌的煎法要求。川乌含乌头碱，需先煎久煎减毒，故应审出是否标明先煎并单包。注明后下多用于薄荷等含挥发油药；包煎多用于旋覆花等易刺激咽喉或细小种子；烊化多用于阿胶等胶类。","tier":"进阶"},{"id":131,"type":"single","stem":"处方中同时出现“甘草”与“海藻”，审核时应判定为","options":["十八反配伍禁忌，需联系医师确认","十九畏配伍禁忌，需联系医师确认","相须配伍，可增强疗效","相使配伍，可提高疗效"],"answer":[0],"explanation":"知识点：配伍禁忌中的十八反。甘草反海藻、大戟、甘遂、芫花，属十八反。十九畏是硫黄畏朴硝等另一组；相须、相使均为增效配伍，与禁忌相反。","tier":"基础"},{"id":132,"type":"single","stem":"称取黄连3g时，戥子提绳应放在靠近","options":["药斗一端的秤纽上","戥杆中部的秤纽上","戥杆末端的秤纽上","靠近戥星的任意秤纽上"],"answer":[0],"explanation":"知识点：戥秤使用。称量少量药时提靠近药斗端的秤纽，秤量较轻、灵敏度高。中部秤纽称量范围居中，末端秤纽称量较重，任意秤纽不符合分度使用要求。","tier":"基础"},{"id":133,"type":"single","stem":"中药房调剂台称量时，戥盘上垫纸的主要作用是","options":["防止药粉粘盘并便于倒药","增加戥盘自重使称量更稳","避免药材吸潮影响戥星读数","减少戥杆弯曲保证分度准确"],"answer":[0],"explanation":"知识点：调剂称量操作规范。垫纸可防粘、便于将药全部倒入药袋。增加自重、吸潮、防弯曲都不是垫纸的主要作用，且表述不符合戥秤原理。","tier":"基础"},{"id":134,"type":"single","stem":"煎药时处方中有薄荷，正确的下药时机是","options":["其他药煎好前5～10分钟投入","与群药同时冷水浸泡后同煎","其他药煎沸后立即投入同煎30分钟","先煎20分钟后再加入其他药"],"answer":[0],"explanation":"知识点：后下药煎法。薄荷含挥发油，久煎易失效，应后下。同时同煎、沸后久煎都会挥散有效成分；先煎则适用于矿石类、毒性药，不适用于薄荷。","tier":"基础"},{"id":135,"type":"single","stem":"处方中阿胶的正确处理方式是","options":["单独烊化后兑入煎好的药液","打碎后与群药同时煎煮","用纱布包好后与群药同煎","先煎30分钟后再下群药"],"answer":[0],"explanation":"知识点：胶类药煎法。阿胶黏性强，同煎易粘锅并粘附他药，应烊化兑入。打碎同煎、包煎同煎均会粘锅糊化；先煎适用于矿石、贝壳及毒性药。","tier":"基础"},{"id":136,"type":"single","stem":"医师处方写“炒白术”，调剂应付","options":["麸炒白术饮片","生白术饮片","焦白术饮片","土炒白术饮片"],"answer":[0],"explanation":"知识点：炮制品名与饮片对应。处方“炒白术”通常指麸炒白术。生白术偏燥湿利水；焦白术多用于健脾止泻；土炒白术多用于健脾止泻、安胎，均与“炒白术”常规应付不同。","tier":"基础"},{"id":137,"type":"single","stem":"处方写“二花”，调剂时应付","options":["金银花","菊花","款冬花","槐花"],"answer":[0],"explanation":"知识点：中药别名。二花为金银花的别名。菊花、款冬花、槐花虽均为花类药，但别名与二花不符，属易混药名。","tier":"基础"},{"id":138,"type":"single","stem":"患者取回煎好的汤药后询问能否放冰箱，正确的指导是","options":["可冷藏保存，服用前加热至温","必须冷冻保存，服用前解冻","室温阴凉处可存放一周","放在阳光下晒后继续服用"],"answer":[0],"explanation":"知识点：汤剂储存指导。煎好汤剂可冷藏短期保存，服前温热。冷冻会破坏部分药液状态；室温久放易霉变；日晒会加速变质。","tier":"基础"},{"id":139,"type":"single","stem":"处方中附子与半夏同用，审核时最恰当的处理是","options":["属十八反，应请医师双签字确认后调配","属十九畏，应拒绝调配并退方","属相须配伍，可直接调配","属妊娠禁忌，应询问患者孕情"],"answer":[0],"explanation":"知识点：十八反与特殊配伍处理。附子属乌头类，反半夏，属十八反；临床确有同用经验时需医师确认并签字。十九畏为另一组；相须不属禁忌；妊娠禁忌针对孕妇用药，与本题配伍禁忌不同。","tier":"进阶"},{"id":140,"type":"single","stem":"某患者处方含麻黄，自述有高血压病史，调剂后用药指导应强调","options":["监测血压并遵医嘱服用","可与降压药同时加倍服用","服药后多饮酒助药力","血压正常即可长期服用"],"answer":[0],"explanation":"知识点：含麻黄制剂的用药指导。麻黄含麻黄碱，可升高血压，高血压患者应监测血压并遵医嘱。加倍服用、饮酒、长期服用均增加风险。","tier":"挑战"},{"id":141,"type":"single","stem":"处方写“炙甘草”而药房只有生甘草时，调剂员正确的处置是","options":["直接付生甘草并在药袋注明","请处方医师确认改味后调配","自行将生甘草炒至微黄后代用","拒绝调配并让患者去别处配药"],"answer":[1],"explanation":"中药调剂中炮制品与生品功效不同，炙甘草偏补脾益气，生甘草偏清热解毒，不能自行替代。A直接付生甘草改变了处方用意；C自行炒制无规范工艺和质量控制；D拒绝调配并非必要，应先联系医师确认。","tier":"进阶"},{"id":142,"type":"single","stem":"调剂时发现处方中“川乌”与“半夏”同方出现，审核环节应首先做的是","options":["按方称量后另包先煎川乌","请处方医师确认并双签字","将两味药减量后分别包装","把川乌换成制川乌再调配"],"answer":[1],"explanation":"川乌与半夏属十八反配伍禁忌，审核发现后应由处方医师确认并签字方可调配。A未处理禁忌直接称量；C调剂员无权自行减量；D更换炮制品仍不能消除配伍禁忌。","tier":"挑战"},{"id":143,"type":"single","stem":"称量朱砂时，正确的操作是","options":["用铜冲钵研细后分包","用研钵研细并单独称量分包","与群药同研后一起分包","用铁质药碾碾细后称量"],"answer":[1],"explanation":"朱砂主含硫化汞，忌用铜、铁器研磨以免发生反应，应单独研细、单独称量分包。A铜冲钵和D铁碾均可能引起变色变质；C与群药同研易造成剂量不准和污染。","tier":"基础"},{"id":144,"type":"single","stem":"处方中“车前子”与“旋覆花”同方调配时，规范做法是","options":["两味均直接入群药包","车前子包煎、旋覆花另煎","两味均用纱布包好后入群药","旋覆花包煎、车前子先煎"],"answer":[2],"explanation":"车前子细小易浮散、旋覆花有绒毛刺激咽喉，二者均需包煎。A直接入群药会导致药液浑浊或刺激咽喉；B另煎属煎法错用；D把车前子改为先煎不能解决其细小易散的问题。","tier":"基础"},{"id":145,"type":"single","stem":"煎药时处方注明“阿胶烊化”，正确的处理是","options":["与群药同煎至完全融化","单独加水加热溶化后兑入药液","打碎后直接冲入沸水服用","先用黄酒浸泡再与群药同煎"],"answer":[1],"explanation":"胶类药黏性强，与群药同煎会粘锅并影响其他药成分煎出，应单独溶化后兑入煎好的药液中。A、D均与群药同煎属错误；C打碎冲服不能保证烊化完全和剂量准确。","tier":"基础"},{"id":146,"type":"single","stem":"患者持方来配“附子理中丸”，调剂员发现处方未注明附子先煎，正确做法是","options":["按常规群药一同煎煮","提醒医师确认是否需先煎","自行将附子先煎半小时","将附子减量后同煎"],"answer":[1],"explanation":"附子含毒性成分，需久煎减毒，处方未注明时应由医师确认煎法。A同煎可能煎煮时间不足；C调剂员不能自行更改医师煎法；D减量不能替代先煎减毒的处理。","tier":"挑战"},{"id":147,"type":"single","stem":"关于中药斗谱编排，下列做法符合调剂规范的是","options":["质地轻的饮片放在斗架下层","常用饮片放在斗架中层便于取用","毒性饮片与常用饮片同斗存放","外观相似的饮片相邻放置便于识别"],"answer":[1],"explanation":"斗谱编排应把常用饮片放在中层便于调配。A质地轻的饮片一般放上层；C毒性饮片应专柜专账管理，不得与常用饮片同斗；D外观相似饮片相邻易混淆，应分开存放。","tier":"基础"},{"id":148,"type":"single","stem":"处方写“薄荷后下”，其正确煎法是","options":["群药煎沸前投入同煎","群药煎好前5～10分钟投入","群药煎好后趁热投入闷泡","单独煎煮后兑入群药液中"],"answer":[1],"explanation":"薄荷含挥发油，久煎易逸散，应在群药煎好前5～10分钟投入。A煎沸前投入煎煮时间过长；C煎好后投入不能煎出有效成分；D单独煎煮再兑入不符合后下操作要求。","tier":"基础"},{"id":149,"type":"single","stem":"患者取药时询问“这个药要不要忌口”，调剂员回答最恰当的是","options":["服药期间忌食生冷油腻及辛辣","服药期间什么都可以正常吃","只要不喝酒其他都不用忌","忌食所有肉类和蛋类食品"],"answer":[0],"explanation":"一般服药期间应忌生冷、油腻、辛辣等影响药效和脾胃的食物。B完全不忌口不符合用药指导；C只忌酒范围过窄；D忌所有肉蛋类过于绝对且无依据。","tier":"进阶"},{"id":150,"type":"single","stem":"调剂完毕后进行复核，发现一方中“白芍”误配为“赤芍”，正确的处理是","options":["在药袋上注明替换原因后发出","立即更换为白芍并重新复核","让患者自行到窗口说明更换","将赤芍与白芍各半混合后发出"],"answer":[1],"explanation":"复核发现错配应立即更换并重新复核，保证用药准确。A注明原因不能改变错配事实；C让患者自行处理不符合调剂责任；D混合发出既错配又造成剂量不准。","tier":"挑战"},{"id":151,"type":"single","stem":"某患者处方中有“生大黄”，注明“后下”，调剂员正确的操作是","options":["群药煎沸后10～15分钟投入","与群药同时煎煮40分钟","群药煎毕后投入闷泡5分钟","单独久煎后与群药液混合"],"answer":[0],"explanation":"生大黄用于泻下时，久煎会破坏泻下成分，应在群药煎沸后10～15分钟投入。B同煎时间过长泻下力减弱；C煎毕后闷泡不能充分煎出；D单独久煎同样破坏泻下成分。","tier":"挑战"},{"id":152,"type":"multi","stem":"下列情形中，中药调剂员应当拒绝调配或请医师确认后处理的有","options":["处方中川乌与半夏同方未双签字","处方中附子未注明先煎","处方中甘草与海藻同方出现","处方中生姜与大枣同方出现","处方中麻黄与桂枝同方出现"],"answer":[0,1,2],"explanation":"川乌与半夏、甘草与海藻属十八反配伍禁忌，须医师双签字；附子需先煎以确保减毒，未注明应请医师确认。D生姜配大枣和E麻黄配桂枝均为临床常用配伍，不属于拒绝调配情形。","tier":"进阶"},{"id":153,"type":"single","stem":"中药调剂员在审核处方时发现医师签名处为打印体姓名而无手写签名，该处方应如何处置","options":["拒绝调配并联系医师补签","正常调配后由药师补签姓名","先调配再让医师事后补签","按打印姓名核对医师备案后调配"],"answer":[0],"explanation":"知识点：处方审核中签名真实性要求。正确项对在打印体签名无法证明医师本人开具，须补签后方可调配。正常调配后由药师补签属越权代签；先调配再补签违反先审后方原则；按打印姓名核对备案仍不能替代本人签名确认。","tier":"挑战"},{"id":154,"type":"single","stem":"调剂含麻黄的中药处方时，药师发现患者同时服用降压药，最应提醒患者注意的是","options":["麻黄可能减弱降压效果并升高血压","麻黄会增强降压药疗效导致低血压","麻黄与降压药同服仅影响吸收速度","麻黄需与降压药间隔两小时服用"],"answer":[0],"explanation":"知识点：麻黄与降压药的相互作用。正确项对在麻黄含麻黄碱有升压作用，可能拮抗降压药。增强降压药疗效说法相反；仅影响吸收速度低估了药理拮抗；间隔两小时不能消除升压拮抗作用。","tier":"挑战"},{"id":155,"type":"single","stem":"煎煮含阿胶的处方时，正确的处理方式是","options":["阿胶另行烊化后兑入煎好的药液","阿胶与群药同煎以利于成分溶出","阿胶先煎三十分钟再下群药","阿胶包煎以避免粘锅糊化"],"answer":[0],"explanation":"知识点：胶类药的特殊煎法。正确项对在阿胶属胶类，需单独烊化兑服。同煎会粘锅并影响其他药成分；先煎同样粘锅；包煎不能解决胶类糊化粘附问题。","tier":"基础"},{"id":156,"type":"single","stem":"处方中标注“先煎”的磁石，调剂员正确的操作是","options":["磁石先煎二十分钟后再入群药","磁石与群药同时下锅煎煮","磁石打碎后另煎取汁兑入","磁石先煎五分钟以去除毒性"],"answer":[0],"explanation":"知识点：矿物类先煎药的操作。正确项对在磁石质地坚硬需先煎二十分钟以上利于有效成分煎出。同时下锅成分难以煎出；另煎取汁兑入不符合先煎共煮要求；先煎五分钟时间不足。","tier":"基础"},{"id":157,"type":"single","stem":"药师在发药交代时，对含附子的处方应特别强调的是","options":["附子需先煎以降低毒性成分","附子需后下以保留挥发成分","附子需包煎以防刺激咽喉","附子需冲服以避免高温破坏"],"answer":[0],"explanation":"知识点：有毒药物的煎法交代。正确项对在附子含乌头碱需先煎降低毒性。后下说法与减毒目标相反；包煎针对细小或刺激性药材；冲服不适用于附子减毒。","tier":"基础"},{"id":158,"type":"single","stem":"调剂处方时发现某味药剂量超出《中国药典》规定上限，调剂员首先应做的是","options":["联系开方医师确认并签字","按药典上限自行减量调配","按处方原量调配并记录","拒绝调配并将处方退回患者"],"answer":[0],"explanation":"知识点：超量处方的处理程序。正确项对在超量须经医师确认并签字方可调配。自行减量属擅自修改处方；按原量调配未尽审核职责；直接退回患者未给医师确认机会。","tier":"挑战"},{"id":159,"type":"single","stem":"需要特殊管理的毒性中药饮片在调剂时，正确的做法是","options":["凭有资质医师处方按规定限量调配","凭患者身份证即可购买常用量","凭药店登记本记录后即可调配","凭普通处方按常规饮片调配"],"answer":[0],"explanation":"知识点：毒性中药饮片的管理要求。正确项对在须凭有资质医师处方并按限量调配。仅凭身份证不符合处方要求；仅登记不能替代处方；普通处方未经资质审核不能调配毒性饮片。","tier":"进阶"},{"id":160,"type":"single","stem":"患者取药时询问服药期间能否饮酒，药师针对含大黄的清热方应回答","options":["不宜饮酒以免影响药效和加重胃肠刺激","可以少量饮酒以助药力发散","饮酒与中药疗效之间没有关联","需饮酒后间隔四小时再服药"],"answer":[0],"explanation":"知识点：服药期间的饮食禁忌。正确项对在酒可能影响清热药疗效并加重对胃肠刺激。少量饮酒助药力不适用于清热方；称无关联忽视相互作用；间隔服药不能消除酒精影响。","tier":"进阶"},{"id":161,"type":"single","stem":"调剂时发现处方中“川贝”写为“浙贝”，调剂员正确的处置是","options":["联系医师确认是写错还是有意替代","按浙贝母直接调配并注明","按川贝母调配忽略处方写法","两种贝母各配一半以兼顾"],"answer":[0],"explanation":"知识点：易混药名审核。正确项对在川贝与浙贝功效不同，须经医师确认。直接按浙贝调配属擅自改方；按川贝调配忽略处方原文；各配一半无依据且改变处方。","tier":"挑战"},{"id":162,"type":"single","stem":"煎药室接到一剂含薄荷的处方，正确的煎煮安排是","options":["薄荷在群药煎好前五分钟下锅","薄荷与群药同时下锅煎煮","薄荷先煎十分钟再下群药","薄荷单独煎煮一小时后兑入"],"answer":[0],"explanation":"知识点：后下药的操作。正确项对在薄荷含挥发油，宜群药煎好前五分钟下锅。同时下锅挥发油损失；先煎更易挥发；单独久煎同样破坏挥发成分。","tier":"基础"},{"id":163,"type":"single","stem":"患者反馈服用含甘草的方剂后出现水肿和血压升高，药师分析最可能的原因是","options":["甘草长期过量服用引起假性醛固酮增多","甘草与方中其他药产生沉淀反应","甘草煎煮时间过长导致毒性增加","甘草未先煎使有效成分未完全溶出"],"answer":[0],"explanation":"知识点：甘草的不良反应。正确项对在甘草酸长期过量可致水钠潴留、血压升高。沉淀反应不会引起水肿；久煎不产生此类毒性；未先煎与水肿无直接关联。","tier":"进阶"},{"id":164,"type":"multi","stem":"中药调剂员在复核处方时，下列哪些情形应当拒绝调配并联系医师处理","options":["处方中药物剂量超出药典规定上限且无医师签字","处方中有妊娠禁忌药用于孕妇且无特别注明","处方字迹潦草无法辨认药名和剂量","处方中正常用量的人参配伍常规剂量的白术","处方开具日期为当日的普通感冒方"],"answer":[0,1,2],"explanation":"知识点：处方复核中应拒绝调配的情形。超量无签字、孕妇用禁忌药无注明、字迹无法辨认均属应联系医师处理。人参配白术为常规配伍无禁忌；当日普通感冒方为正常处方，均应正常调配。","tier":"挑战"},{"id":165,"type":"single","stem":"医师处方写“焦白术”，药房应调配的饮片是","options":["白术片炒至表面焦褐色","白术片炒至表面黑褐色","白术片炒至表面黄白色","白术片蒸至透心后切片"],"answer":[0],"explanation":"焦白术属炒焦法，药物炒至表面焦褐色、内部焦黄色，故A对；B为炒炭程度，黑褐色属炭药标准；C为清炒或麸炒偏轻的火候，未达焦化；D为蒸法，与炒焦炮制不同。","tier":"基础"},{"id":166,"type":"single","stem":"处方中写“二冬”，通常应付的饮片组合是","options":["天冬、麦冬","天门冬、冬瓜仁","麦冬、款冬花","天冬、忍冬藤"],"answer":[0],"explanation":"“二冬”是临床常用并开药名，指天冬与麦冬，故A对；B冬瓜仁、C款冬花、D忍冬藤均非“二冬”所指，属名称相邻而易混。","tier":"基础"},{"id":167,"type":"single","stem":"中药调剂时发现处方中有“十八反”配伍，正确的第一处置是","options":["拒绝调配并请处方医师确认","按处方原量先行调配","将相反药减量后调配","用同类功效药自行替代"],"answer":[0],"explanation":"十八反属配伍禁忌，调剂人员发现后应拒绝调配并联系医师确认，故A对；B明知禁忌仍调配有风险；C自行减量不能消除配伍禁忌；D调剂人员无权自行替代处方药味。","tier":"挑战"},{"id":168,"type":"single","stem":"煎药时某处方含车前子，正确的处理方式是","options":["用纱布包煎后再入锅","直接入锅与其他药同煎","先煎半小时再下他药","另煎取汁后兑入药液"],"answer":[0],"explanation":"车前子细小且含黏液质，易糊锅、刺激咽喉，应包煎，故A对；B直接入锅易漂浮糊底；C先煎不解决细粒混悬问题；D另煎适用于贵重药，不适用于车前子。","tier":"基础"},{"id":169,"type":"single","stem":"需要“后下”的药物，其目的是","options":["减少挥发性成分的损失","使质地坚硬的药先软化","降低药物的毒性","避免药液煎煮时外溢"],"answer":[0],"explanation":"后下多为薄荷、砂仁等含挥发性成分的药，久煎易逸失，故A对；B是矿石类先煎的目的；C是毒性药炮制或先煎的目的；D是煎煮操作问题，不是后下的主要目的。","tier":"基础"},{"id":170,"type":"single","stem":"某处方开“川贝母3g”，药房应付的规格是","options":["川贝母粉冲服","川贝母整粒入煎","川贝母与浙贝母各半","川贝母先煎半小时"],"answer":[0],"explanation":"川贝母量小且贵重，常研粉冲服，故A对；B整粒入煎有效成分不易煎出；C擅自以浙贝母替代属更改处方；D先煎不适用于川贝母，且量小无须先煎。","tier":"基础"},{"id":171,"type":"single","stem":"调配处方时电子秤显示“0.00”，放上称量纸后显示“0.35”，正确的下一步是","options":["按去皮键归零后再称药","直接称取并减去0.35","将称量纸取下重新开机","把药与纸一起称后记录"],"answer":[0],"explanation":"称量纸有重量，应先去皮归零，故A对；B靠人工减纸重误差大且不合规范；C重新开机仍会出现纸重；D记录总重会导致剂量偏差。","tier":"进阶"},{"id":172,"type":"single","stem":"处方中“生大黄”注明“后下”，其主要理由是","options":["久煎会减弱泻下作用","久煎会增强补益作用","久煎会降低药物毒性","久煎会使其质地变软"],"answer":[0],"explanation":"大黄泻下成分受热易被破坏，后下可保留泻下力，故A对；B大黄并非以补益为主；C后下不是为减毒；D质地变软不是后下的目的。","tier":"基础"},{"id":173,"type":"single","stem":"患者取药时询问“阿胶怎么用”，调剂员正确的指导是","options":["另行烊化后兑入药液","与群药一同入锅煎煮","先煎半小时后再下群药","研粉后直接干吞服"],"answer":[0],"explanation":"阿胶属胶类，宜烊化兑服，故A对；B同煎易粘锅并粘附其他药渣；C先煎不适用于胶类；D干吞易刺激咽喉且不利吸收。","tier":"基础"},{"id":174,"type":"single","stem":"某处方中有“制川乌6g”，调剂时最应注意的是","options":["先煎并交代煎煮时间","后下以避免成分破坏","包煎以防止刺激咽喉","烊化以减少胃肠反应"],"answer":[0],"explanation":"制川乌含毒性成分，需先煎以降低毒性，故A对；B后下反而增加毒性风险；C包煎针对细小或毛类药；D烊化针对胶类药，均不适用。","tier":"基础"},{"id":175,"type":"single","stem":"调剂完成后发现某味药剂量少于处方量，正确的处置是","options":["补足差额并复核签名","将其他药按比例减少","把该药单独包后不补","重新打印标签后发出"],"answer":[0],"explanation":"剂量不足应补足并复核，保证处方准确，故A对；B擅自减其他药会改变整方；C不补足仍属剂量不符；D换标签不能解决缺量问题。","tier":"挑战"},{"id":176,"type":"single","stem":"处方中写“焦白术”，调剂时应付","options":["白术饮片炒至表面焦褐色、内部焦黄色","白术饮片炒至表面黄棕色、有焦香气","白术饮片炒至表面黑褐色、内部焦黑色","白术饮片炒至表面微黄色、略带焦斑"],"answer":[0],"explanation":"焦白术属炒焦法，标准为表面焦褐色、内部焦黄色，兼有焦香气。B是炒黄程度，C是炒炭（黑褐色、内部焦黑色），D描述的是炒黄轻症或带焦斑，均非炒焦标准。","tier":"基础"},{"id":177,"type":"single","stem":"审方时发现处方写“川贝母 3g 研粉冲服”，而药房只有浙贝母，正确处置是","options":["以浙贝母等量代替并注明","以浙贝母加倍量代替并注明","联系医师确认能否以浙贝母代替","先按浙贝母调配再口头告知患者"],"answer":[2],"explanation":"川贝母与浙贝母虽同属贝母类，但功效偏重不同（川贝润肺、浙贝清热散结），价格差异大，替换必须经处方医师同意。A、B自行等量或加倍替换均属无依据变更；D先调配后告知违反审方程序，患者已无法阻止。","tier":"挑战"},{"id":178,"type":"single","stem":"调剂处方中“生大黄”注明“后下”，其目的是","options":["减少大黄泻下成分受热破坏","防止大黄中蒽醌类成分挥发","避免大黄与群药发生沉淀反应","使大黄质地变软便于煎出"],"answer":[0],"explanation":"大黄泻下主要靠结合型蒽醌，久煎易水解失效，故后下以保留泻下作用。B蒽醌类并非挥发油，不因挥发损失；C沉淀反应非后下理由；D质地变软是浸泡或先煎类考虑，与后下目的不符。","tier":"基础"},{"id":179,"type":"single","stem":"需要“烊化”的饮片，正确操作是","options":["与其他饮片同煎并延长煎煮时间","单独加水或黄酒加热溶化后兑入药液","用纱布包好后与群药同煎","先煎半小时后再加入群药共煎"],"answer":[1],"explanation":"烊化针对阿胶、鹿角胶等胶类，直接煎易粘锅糊化并粘附他药，应单独溶化后兑入。A同煎延长会糊锅；C包煎用于粘毛类、粉末类；D先煎用于矿石、贝壳类，均不适用于胶类。","tier":"基础"},{"id":180,"type":"single","stem":"处方中“车前子”应采用的煎法处理是","options":["先煎","后下","包煎","另煎"],"answer":[2],"explanation":"车前子颗粒细小且含粘液质，煎煮时易糊锅、药液浑浊，须用纱布包煎。A先煎用于矿石贝壳及毒性药；B后下用于含挥发油或久煎失效的药；D另煎用于贵重药如人参，均不对应车前子。","tier":"基础"},{"id":181,"type":"single","stem":"某处方开“制川乌 6g”，调剂时最应关注的是","options":["必须单包并注明先煎","必须研粉冲服","必须后下以保留药效","必须与甘草同包同煎"],"answer":[0],"explanation":"制川乌含乌头类生物碱，虽经炮制仍需先煎久煎以进一步减毒，故单包注明先煎。B研粉冲服会使毒性成分吸收过快；C后下反使毒性成分煎出增加；D与甘草同煎虽为传统配伍减毒法，但不能替代先煎这一关键操作。","tier":"基础"},{"id":182,"type":"single","stem":"药师发药时交代“滋补药宜饭前服”，其主要依据是","options":["饭前胃内空虚利于滋补药吸收","饭前服药可减少对胃黏膜刺激","饭前服药能避免与食物发生配伍禁忌","饭前服药可加快药物经肾排泄"],"answer":[0],"explanation":"补益类药物饭前空腹服用利于吸收发挥补益作用。B减少刺激通常是饭后服；C食物与药物相互作用并非滋补药饭前服的主要依据；D加快排泄与服药时间无直接关系。","tier":"基础"},{"id":183,"type":"single","stem":"处方中同时出现“藜芦”与“细辛”，调剂员应","options":["照方调配并提醒患者分时服用","照方调配并将两药分别包装","拒绝调配并请处方医师修改","减量调配藜芦后正常发药"],"answer":[2],"explanation":"藜芦属“十八反”中反细辛的药物，属配伍禁忌，调剂员应拒绝调配并联系医师。A分时服用不能消除配伍禁忌；B分别包装只解决煎法问题，不解决相反；D减量调配仍属违规配出禁忌配伍。","tier":"基础"},{"id":184,"type":"single","stem":"煎药时发现药液外溢，正确的下一步处置是","options":["立即关小火并稍掀锅盖继续煎","立即加冷水至原刻度继续煎","立即将药液倒出弃去重煎","立即关火待冷却后重新加水煎"],"answer":[0],"explanation":"药液外溢多因火大或药液沸腾过猛，应减小火力并稍掀盖降温，继续煎至规定时间。B加冷水会稀释药液、改变浓度；C弃去重煎浪费药材且无法保证疗效；D关火冷却再加水相当于重新开始，煎出成分已损失。","tier":"进阶"},{"id":185,"type":"single","stem":"某患者持处方来配“七剂”，方中“砂仁”每剂 3g，调剂员正确的处理是","options":["砂仁 21g 全部与群药同煎","砂仁 21g 单包，注明后下","砂仁 21g 单包，注明先煎","砂仁 21g 研粉后与群药同煎"],"answer":[1],"explanation":"砂仁含挥发油，久煎有效成分易散失，应后下；七剂共21g，需单包并注明后下。A同煎会致挥发油损失；C先煎更易使挥发油散失；D研粉同煎同样受热过久，且未体现后下要求。","tier":"挑战"},{"id":186,"type":"single","stem":"中药调剂员在收方后审核处方时，发现处方中写有“川乌9g”，最应先关注的处理环节是","options":["核对该药是否已标注先煎并要求另包","询问患者是否曾服用过该方","将该药直接与其他饮片混合调配","按处方剂量称取后交煎药室处理"],"answer":[0],"explanation":"川乌属毒性中药饮片，调剂审核时必须关注其是否标注先煎、另包等特殊处理要求，以保证用药安全。B项询问服药史属于用药指导环节，不是收方审核该药时的首要处理；C项直接混合调配违反毒性饮片先煎管理要求；D项未处理先煎要求即交煎药室，存在安全隐患。","tier":"挑战"},{"id":187,"type":"single","stem":"调剂称量时，处方要求“阿胶6g烊化兑服”，调剂员正确的处置是","options":["将阿胶单独包装并注明烊化兑服","将阿胶与群药同包并注明先煎","将阿胶打粉后混入其他饮片共煎","将阿胶按每剂6g称取后并入煎药袋"],"answer":[0],"explanation":"阿胶为胶类药，需单独包装并注明烊化兑服，避免与群药同煎造成粘锅或糊化。B项阿胶不需先煎；C项打粉混入共煎仍属与群药同煎，不符合烊化要求；D项并入煎药袋共煎同样错误。","tier":"进阶"},{"id":188,"type":"single","stem":"中药房收到一张处方，其中“薄荷”排在群药之后并注明“后下”，调剂员在配药时正确的操作是","options":["将薄荷单独包装并注明后下","将薄荷与群药同包并注明先煎","将薄荷研粉后冲服并注明包煎","将薄荷放于煎药袋底部并注明久煎"],"answer":[0],"explanation":"薄荷含挥发油，煎煮过久有效成分易散失，应单独包装并注明后下。B项先煎与薄荷用法相反；C项薄荷一般不需研粉冲服；D项久煎会破坏薄荷有效成分，不符合后下要求。","tier":"进阶"},{"id":189,"type":"single","stem":"某处方中同时出现“海藻”和“甘草”，调剂员审核时正确的判断是","options":["属十八反配伍禁忌，应拒绝调配并联系医师","属相须配伍，可增强化痰散结作用","属相畏配伍，可降低海藻毒性","属妊娠禁忌，应询问患者是否怀孕"],"answer":[0],"explanation":"海藻与甘草属十八反中的相反配伍，原则上不宜同方使用，审核发现应拒绝调配并联系医师确认。B项相须指性能功效类似药物合用增效，不适用于海藻甘草；C项相畏指一种药物抑制另一种药物的毒性，与此不符；D项妊娠禁忌针对孕妇禁用或慎用药，不是海藻甘草配伍的核心问题。","tier":"进阶"},{"id":190,"type":"single","stem":"煎药室收到一剂含“车前子”的处方，调剂员在包装时最恰当的处理是","options":["将车前子单独包装并注明包煎","将车前子与群药同包并注明先煎","将车前子炒黄后与群药同包","将车前子研细后冲服并注明另煎"],"answer":[0],"explanation":"车前子细小且含黏液质，煎煮时易糊锅或刺激咽喉，应单独包装并注明包煎。B项先煎不针对车前子；C项炒黄不能解决其细小易糊的问题；D项研细冲服并另煎不符合车前子常规煎法。","tier":"进阶"},{"id":191,"type":"single","stem":"调剂员在称量“细辛3g”时，处方未超量，但患者要求“多抓一点效果更好”，正确的应对是","options":["按处方剂量称取并说明细辛用量不宜随意增加","按患者要求增加至6g并请医师补签","按处方剂量称取后另包一份备用","按患者要求增加剂量并口头告知风险"],"answer":[0],"explanation":"细辛用量应严格按处方和药典规定执行，调剂员不得擅自增加剂量。B项擅自加量并事后补签不符合调剂规范；C项另包备用等于变相多配，仍属违规；D项口头告知不能替代依法依规调剂，擅自加量仍错误。","tier":"进阶"},{"id":192,"type":"single","stem":"某患者处方中“人参”与“莱菔子”同用，调剂员审核时最合理的处理是","options":["提示医师二者合用可能削弱人参补益作用","直接按方调配并在发药时告知患者多饮水","将人参改为党参后按方调配","将莱菔子改为莱菔叶后按方调配"],"answer":[0],"explanation":"人参补气，莱菔子降气消食，合用可能削弱人参补益作用，审核时应提示医师权衡。B项直接调配未处理配伍疑问；C项擅自更换饮片品种属越权；D项擅自更换药味同样不符合处方审核要求。","tier":"挑战"},{"id":193,"type":"single","stem":"中药调剂员在发药时对患者进行用药指导，针对含“附子”的处方，最重要的交代是","options":["必须先煎并久煎，不可自行缩短煎煮时间","可与群药同煎以节省时间","煎好后立即服用以免药效散失","可自行加大剂量以增强温阳效果"],"answer":[0],"explanation":"附子含毒性成分，需先煎久煎以降低毒性，发药时必须重点交代。B项同煎不能保证减毒；C项煎后是否立即服应遵医嘱，不是附子用药指导核心；D项擅自加量极不安全。","tier":"进阶"},{"id":194,"type":"single","stem":"某医疗机构中药房调剂员在复核时发现一剂药中“大黄”标注为“后下”，但实际包装为与群药同包，正确的处置是","options":["拆包将大黄单独分出并注明后下","维持原包装并在袋外补写后下","将整剂药退回医师重新开方","将大黄取出弃去后按剩余药调配"],"answer":[0],"explanation":"复核发现大黄未按后下要求单独包装，应拆包分出并注明后下，保证煎药质量。B项仅在袋外补写不能改变实际同包状态；C项退回医师重新开方属于过度处理；D项弃去大黄会造成缺味，不能保证疗效。","tier":"挑战"},{"id":195,"type":"single","stem":"患者取药时询问“处方里的阿胶怎么吃”，调剂员最恰当的指导是","options":["按医嘱将阿胶单独烊化后兑入煎好的药液中","将阿胶与群药一起放入砂锅同煎","将阿胶直接嚼碎后用药液送服","将阿胶放入煎药袋与群药共煎两次"],"answer":[0],"explanation":"阿胶应单独烊化后兑入煎好药液中服用，避免与群药同煎粘锅。B项同煎易糊锅；C项嚼碎送服不符合烊化要求；D项共煎同样破坏阿胶用法。","tier":"进阶"},{"id":196,"type":"single","stem":"中药调剂员在调配含“芒硝”的处方时，正确的包装和交代是","options":["单独包装并注明溶化兑服","与群药同包并注明先煎","单独包装并注明后下","与群药同包并注明包煎"],"answer":[0],"explanation":"芒硝为矿物盐类，易溶于水，应单独包装并注明溶化兑服。B项先煎不适用于芒硝；C项后下针对含挥发油类药，不是芒硝；D项包煎针对细小或带绒毛易刺激药，不符合芒硝用法。","tier":"基础"},{"id":197,"type":"multi","stem":"中药调剂员在审核一张含“罂粟壳”的处方时，符合管理要求的做法有","options":["核对处方是否使用专用处方并按规定留存","按处方剂量称取并单独登记管理","凭普通处方即可调配且无需登记","按患者要求增加剂量以增强止痛效果","将罂粟壳与群药同包并注明先煎"],"answer":[0,1],"explanation":"罂粟壳属特殊管理中药，审核时应核对专用处方并按规定留存，同时按剂量称取并单独登记。C项普通处方且不登记不符合管理要求；D项擅自加量违规；E项罂粟壳通常不需先煎，且该做法回避了特殊管理要求。","tier":"进阶"},{"id":198,"type":"single","stem":"药师审核处方时发现某患者处方中写有“川乌9g，先煎”，该处置的重点应是","options":["先煎30分钟以上再入他药","与他药同煎并延长总煎煮时间","先用冷水浸泡2小时再同煎","另煎取汁后兑入药液中服用"],"answer":[0],"explanation":"知识点：毒性中药川乌的煎法。川乌含乌头碱，需先煎久煎以减毒，故A对；B同煎不能充分降低毒性；C浸泡不能破坏乌头碱；D另煎兑入是贵重药或特殊药的用法，不适用于川乌减毒。","tier":"挑战"},{"id":199,"type":"single","stem":"调剂处方中同时出现“生大黄”与“制大黄”，正确的调剂处理是","options":["按处方分别称取，不可互相替代","统一按生大黄称取后另包","统一按制大黄称取并注明","询问医师后任选一种称取"],"answer":[0],"explanation":"知识点：生大黄与制大黄功效不同，属不同饮片。A对，必须分别称取；B、C改变了处方饮片品种；D自行任选违反处方审核要求。","tier":"基础"},{"id":200,"type":"single","stem":"某处方要求“阿胶烊化兑服”，调剂员正确的交代是","options":["将阿胶加黄酒或水加热溶化后兑入药液","将阿胶打碎后与群药一同煎煮","将阿胶用纱布包好与群药同煎","将阿胶研粉用开水冲服即可"],"answer":[0],"explanation":"知识点：胶类药烊化法。A对，阿胶需单独溶化后兑服；B、C同煎易粘锅糊化并粘附他药；D仅冲服不能充分发挥烊化兑服的要求。","tier":"基础"},{"id":201,"type":"single","stem":"煎药时处方中含“薄荷”，为减少挥发油损失，正确的入煎时机是","options":["群药煎好前5～10分钟加入","与群药同时浸泡后同煎","群药煎好后趁沸立即加入","先煎20分钟后加入群药"],"answer":[0],"explanation":"知识点：后下药。薄荷含挥发油，宜后下，A对；B同煎挥发油损失大；C煎好后再加不能煎出有效成分；D先煎与后下相反。","tier":"基础"},{"id":202,"type":"single","stem":"调剂称量时需“等量递减、逐剂复戥”，其主要目的是","options":["保证每剂药各味药量准确均匀","提高称量速度减少患者等待","避免戥秤反复归零造成磨损","便于将饮片按体积大小分堆"],"answer":[0],"explanation":"知识点：中药调剂分戥操作。A对，等量递减可保证每剂含量均匀；B速度不是主要目的；C戥秤磨损不是调剂要求；D按体积分堆不能保证剂量准确。","tier":"基础"},{"id":203,"type":"single","stem":"处方中“车前子”未注明包煎，调剂员正确的处理是","options":["仍按包煎处理并告知患者","直接入煎并嘱患者多搅拌","改为另煎后兑入药液","研成细粉后冲服"],"answer":[0],"explanation":"知识点：细小种子类及含黏液药宜包煎。车前子易糊锅、刺激咽喉，A对；B直接入煎易糊化粘锅；C另煎不解决糊锅问题；D冲服改变用法且未包煎仍不妥。","tier":"基础"},{"id":204,"type":"single","stem":"患者取药时询问“先煎药”与“后下药”能否一起浸泡，调剂员正确的回答是","options":["分别浸泡，先煎药先煎、后下药后下","一起浸泡，煎时再按顺序投放","一起浸泡，先煎药煎好后捞出后下药","后下药先浸泡，先煎药直接入锅"],"answer":[0],"explanation":"知识点：特殊煎法药的浸泡与投放。A对，两类药应分别处理并按先后投放；B一起浸泡后仍难分先后；C煎好再捞不符合后下；D先煎药不浸泡影响煎出。","tier":"进阶"},{"id":205,"type":"single","stem":"调剂完成后发现某剂中“甘草”多称了2g，正确的处置是","options":["将该剂饮片倒回药斗重新称配","从该剂中取出约2g甘草后继续","在下一剂中少称2g甘草以平衡","将多出的甘草另包让患者自行处理"],"answer":[0],"explanation":"知识点：调剂差错处理。A对，剂量不准应倒回重配，保证每剂准确；B凭感觉取出难以准确；C拆东补西仍造成剂量不均；D将差错转给患者。","tier":"挑战"},{"id":206,"type":"single","stem":"煎药室接到一剂含“附子”的处方，正确的煎煮要求是","options":["先煎30～60分钟至口尝无麻舌感","与他药同煎并浓缩至小半碗","用开水浸泡后直接武火煎10分钟","另煎取汁后与群药液混合"],"answer":[0],"explanation":"知识点：附子毒性及先煎减毒。A对，附子需先煎久煎至无麻舌感；B同煎时间不足；C煎煮时间过短毒性大；D另煎不适用于附子减毒。","tier":"基础"},{"id":207,"type":"single","stem":"某患者处方中“人参”与“莱菔子”同用，药师审核时最应关注的是","options":["两药配伍是否属相恶而需医师确认","人参是否需另煎后兑入药液","莱菔子是否需包煎后下","两药剂量是否超过常用量上限"],"answer":[0],"explanation":"知识点：配伍禁忌与审核。人参恶莱菔子属相恶配伍，A对，应请医师确认；B、C是煎法问题，不是该配伍审核重点；D剂量审核虽重要，但本对药的核心是配伍关系。","tier":"挑战"},{"id":208,"type":"single","stem":"审核处方时发现处方中“川乌”未标注先煎，调剂员正确的处理是","options":["按处方直接与其他药同煎","请医师补注先煎后再调剂","自行改为后下以减毒","将川乌研粉冲服以缩短煎煮"],"answer":[1],"explanation":"知识点：毒性中药川乌的煎法审核。川乌含乌头碱需先煎久煎减毒，处方未注明先煎应请医师补注。直接同煎毒性成分溶出多；后下更不能减毒；研粉冲服反而增加毒性风险。","tier":"挑战"},{"id":209,"type":"single","stem":"中药调剂称量时，处方写“三七粉3g冲服”，调剂员正确的操作是","options":["将三七粉与群药同包后同煎","将三七粉单独包好并注明冲服","将三七粉混入煎好的药液中再煎","将三七粉与群药共煎后弃渣服汁"],"answer":[1],"explanation":"知识点：贵重药及粉末药的调配。三七粉属冲服药物，应单独包好注明冲服。与群药同煎或共煎会损失有效成分；混入药液再煎同样破坏冲服药物的用法。","tier":"进阶"},{"id":210,"type":"single","stem":"中药房煎药室使用煎药机煎煮含挥发油较多的薄荷，正确的煎煮安排是","options":["与群药同煎并延长煎煮时间","在群药煎好前5至10分钟放入","在群药煎煮前先煎20分钟","煎煮结束后将薄荷放入焖泡"],"answer":[1],"explanation":"知识点：后下药的煎煮时机。薄荷含挥发油，应后下，在群药煎好前5至10分钟放入。延长同煎、先煎或煎后焖泡都会使挥发油散失或提取不当。","tier":"进阶"},{"id":211,"type":"single","stem":"调剂处方时发现处方中“阿胶”未注明烊化，调剂员正确的处理是","options":["请医师补注烊化后再行调剂","将阿胶打碎与群药同煎","将阿胶直接放入煎药机共煎","将阿胶研粉后与药液同服即可"],"answer":[0],"explanation":"知识点：胶类药的烊化处理。阿胶属胶类，需烊化兑服，处方未注明应请医师补注。打碎同煎或共煎易粘锅糊化并粘附其他药渣；研粉同服并非烊化，影响吸收与用法规范。","tier":"挑战"},{"id":212,"type":"single","stem":"患者持处方到中药房调配，处方中含“罂粟壳”，调剂员核查处方时发现无麻醉药品专用处方标识，正确处置是","options":["按普通处方直接调配","拒绝调配并向患者说明需专用处方","减量调配以降低风险","先登记患者身份后调配"],"answer":[1],"explanation":"知识点：特殊管理药品的处方审核。罂粟壳属特殊管理药品，须凭专用处方调配。普通处方直接调配或减量调配均违规；登记身份不能替代专用处方要求。","tier":"挑战"},{"id":213,"type":"single","stem":"中药调剂员在称量“细辛”时，处方用量为3g，正确的称量器具选择是","options":["选用分度值1g的台秤称量","选用分度值0.1g的电子天平称量","选用分度值5g的戥子称量","选用分度值0.5g的托盘天平称量"],"answer":[1],"explanation":"知识点：小剂量毒性药的称量精度。细辛用量小且属毒性药，应选用分度值0.1g的电子天平保证准确。1g台秤、5g戥子、0.5g托盘天平精度不足，易造成剂量偏差。","tier":"进阶"},{"id":214,"type":"single","stem":"中药房收到一张处方，处方中“大黄”注明“后下”，调剂员在发药时对患者的用药指导正确的是","options":["大黄与其他药同时下锅久煎","大黄在群药煎好前5至10分钟下锅","大黄在群药煎煮前先煎30分钟","大黄煎煮后弃渣另煎取汁"],"answer":[1],"explanation":"知识点：后下药的用药指导。大黄后下是为保留泻下成分，应在群药煎好前5至10分钟下锅。同煎久煎、先煎或弃渣另煎均不符合后下要求。","tier":"进阶"},{"id":215,"type":"single","stem":"调剂员在调配处方时发现“人参”与“莱菔子”同方，正确的审核意见是","options":["两者属配伍禁忌应拒绝调配","两者同用会降低人参补益作用应提请医师确认","两者同用会增强人参补气作用可放心调配","两者同用属十八反应请医师修改"],"answer":[1],"explanation":"知识点：人参恶莱菔子的配伍关系。莱菔子行气破气，与人参同用可能削弱人参补益作用，应提请医师确认。此非十八反禁忌，不能直接拒绝调配；说增强补气或归为十八反均错误。","tier":"挑战"},{"id":216,"type":"single","stem":"患者取回中药后反映煎药时药液外溢，调剂员询问后发现患者将“旋覆花”未包煎直接入锅，正确的指导是","options":["旋覆花应包煎后再与群药同煎","旋覆花应先煎30分钟再入群药","旋覆花应后下以免有效成分破坏","旋覆花应烊化后兑入药液"],"answer":[0],"explanation":"知识点：包煎药的种类与原因。旋覆花有绒毛，易刺激咽喉并致药液混浊外溢，应包煎。先煎、后下、烊化均不符合旋覆花的煎法要求。","tier":"挑战"},{"id":217,"type":"multi","stem":"中药调剂员在审核处方时，下列哪些情形应当拒绝调配并联系处方医师","options":["处方中附子未注明先煎","处方中甘草与海藻同方","处方中阿胶未注明烊化","处方中川乌与半夏同方"],"answer":[1,3],"explanation":"知识点：处方审核中拒绝调配的情形。甘草反海藻、川乌反半夏均属十八反配伍禁忌，应拒绝调配并联系医师。附子未注明先煎、阿胶未注明烊化属煎法缺漏，应请医师补注后调剂，不属于必须拒绝调配的配伍禁忌。","tier":"挑战"},{"id":218,"type":"single","stem":"中药调剂员审核处方时，发现医师写“川贝母 6g 吞服”，正确的调剂处理是","options":["按处方直接调配川贝母粉供吞服","改为川贝母煎汤后药汁送服","将川贝母研粉后冲入煎好的药液中","请医师改为浙贝母后调配"],"answer":[0],"explanation":"知识点为处方审核中的特殊煎服法。川贝母研粉吞服可减少有效成分损失，属常见用法，故A正确；B错在川贝母煎汤会损失部分有效成分且非处方要求；C错在冲入药液属另一种用法，与“吞服”不符；D错在浙贝母与川贝母功效偏性不同，不可擅自代用。","tier":"挑战"},{"id":219,"type":"single","stem":"调剂称量时，戥秤使用后砣与盘应","options":["砣挂原位，盘放平稳处","砣取下，盘反扣于台面","砣与盘一并收入盒内","砣挂原位，盘悬空挂起"],"answer":[0],"explanation":"知识点为戥秤的规范保养。戥秤用后砣挂原位、盘放平稳处可防止刀口受损和部件丢失，故A正确；B错在盘反扣易压坏秤盘边缘；C错在砣盘收入盒内非戥秤常规存放法；D错在盘悬空挂起易使秤盘变形。","tier":"基础"},{"id":220,"type":"single","stem":"中药房收到含“生川乌 3g”的处方，调剂前首要核对的是","options":["是否标注先煎及医师签名","是否与甘草同方配伍","是否用蜂蜜另煎兑服","是否需研粉冲服"],"answer":[0],"explanation":"知识点为毒性中药处方审核。生川乌属毒性中药，必查先煎标注与医师签名，故A正确；B错在配伍核对属次要环节，不能替代毒性药品的法定审核；C错在蜂蜜兑服非生川乌法定先煎要求；D错在研粉冲服会加大毒性风险，非审核首要项。","tier":"基础"},{"id":221,"type":"single","stem":"煎药室接到“薄荷 6g 后下”的处方，正确的后下时机是","options":["群药煎沸前5分钟投入","群药煎沸后5分钟投入","群药煎至一半时投入","群药煎好后趁热投入"],"answer":[1],"explanation":"知识点为特殊煎法中的后下。薄荷含挥发油，宜在群药煎沸后5分钟投入，故B正确；A错在煎沸前投入挥发油散失过多；C错在煎至一半时投入时间仍偏早；D错在煎好后再投入有效成分无法溶出。","tier":"基础"},{"id":222,"type":"single","stem":"某患者持“阿胶 10g”单味药处方来药店，调剂员正确的处理是","options":["将阿胶打碎后与群药同煎","将阿胶用开水溶化后兑入药液","将阿胶直接放入群药中烊化","将阿胶炒珠后研粉冲服"],"answer":[1],"explanation":"知识点为胶类药的烊化处理。阿胶宜用开水或黄酒溶化后兑入煎好药液，故B正确；A错在同煎易粘锅糊化并粘附他药；C错在直接入群药无法控制烊化过程；D错在炒珠后功用偏于止血，与处方补血意图不符。","tier":"挑战"},{"id":223,"type":"single","stem":"处方写“车前子 15g”，煎药前应做的处理是","options":["先煎30分钟","包煎后入群药","另煎兑服","研粉冲服"],"answer":[1],"explanation":"知识点为包煎药物的品种与理由。车前子细小且含黏液质，需包煎以防糊锅和刺激咽喉，故B正确；A错在先煎用于矿石类，不适用于车前子；C错在另煎用于贵重药，与车前子不符；D错在研粉冲服非处方要求且易糊咽。","tier":"基础"},{"id":224,"type":"single","stem":"中药调剂员在调配“朱砂 0.5g 冲服”时，正确的操作是","options":["用研钵加水研成极细粉后冲服","直接取朱砂粗粉包入煎药袋","将朱砂与群药同煎取汁","将朱砂用醋淬后入煎剂"],"answer":[0],"explanation":"知识点为朱砂的炮制与用法。朱砂需水飞成极细粉后冲服，故A正确；B错在粗粉冲服难吸收且刺激胃肠；C错在朱砂同煎受热会析出有毒汞；D错在醋淬会使朱砂成分改变，非内服冲服法。","tier":"基础"},{"id":225,"type":"single","stem":"调剂复核时发现一方中“甘草 10g”与“海藻 10g”同用，正确的处置是","options":["照方调配并注明十八反","拒绝调配并请医师确认","将海藻减量后调配","将甘草改为炙甘草后调配"],"answer":[1],"explanation":"知识点为配伍禁忌十八反。甘草与海藻属十八反，须请医师确认，故B正确；A错在明知反药仍调配风险大；C错在减量不能消除配伍禁忌；D错在炙甘草仍属甘草，反药关系不变。","tier":"挑战"},{"id":226,"type":"single","stem":"中药房收到“制附子 10g”的处方，煎药时正确的处理是","options":["先煎30至60分钟再入群药","后下5分钟以保药性","与群药同煎40分钟","包煎后与群药同煎"],"answer":[0],"explanation":"知识点为毒性中药附子的煎法。制附子需先煎以减毒，故A正确；B错在后下无法破坏毒性成分；C错在同煎时间不足以充分减毒；D错在包煎用于细小或刺激药，与附子减毒无关。","tier":"基础"},{"id":227,"type":"single","stem":"中药调剂员在审核处方时发现处方中写有“川乌9g”，现行《中国药典》规定川乌的常用量是1.5～3g，此时正确的处置是","options":["按处方剂量调配并在发药时口头提醒患者先煎久煎","拒绝调配并联系处方医师确认是否需要修改剂量","将川乌自动减为3g调配后请复核人签字","先按处方调配再由复核人标注超量后放行"],"answer":[1],"explanation":"知识点：毒性中药饮片处方剂量审核与超量处置。川乌为毒性中药，药典规定常用量1.5～3g，超量使用必须由处方医师确认并签字，调剂员无权自行更改或放行，故正确做法是拒绝调配并联系医师。A项调配后再口头提醒不能替代医师对超量的确认；C项调剂员自行减量属于擅自修改处方；D项复核标注超量仍不能补正处方合法性。","tier":"挑战"},{"id":228,"type":"single","stem":"调剂处方中写有“先煎”的饮片时，正确的操作是","options":["将该饮片单独先煎20～30分钟后再与其余饮片同煎","将该饮片与其余饮片同时入锅但延长总煎煮时间","将该饮片装入包煎袋后与其余饮片同煎","将该饮片在其余饮片煎好前5分钟投入锅中"],"answer":[0],"explanation":"知识点：特殊煎法之先煎。先煎药需单独先煎20～30分钟（矿石类、毒性类等）后再入其余药同煎。B项同时入锅不能实现先煎目的，延长总时间也不等同于先煎；C项包煎用于黏毛类或细小种子类，不是先煎；D项后下才是煎好前5～10分钟投入，与先煎相反。","tier":"进阶"},{"id":229,"type":"single","stem":"处方中写有“车前子”且未标注特殊煎法，调剂员按常规应作的处理是","options":["先煎30分钟","后下5分钟","包煎后入锅","另煎兑服"],"answer":[2],"explanation":"知识点：特殊煎法之包煎。车前子为细小种子类，易浮散糊锅，须装包煎袋后入煎。A项先煎用于矿石、贝壳、毒性药；B项后下用于含挥发性成分或久煎易破坏的药；D项另煎用于贵重药如人参，均不适用于车前子。","tier":"进阶"},{"id":230,"type":"single","stem":"处方中写有“三七粉3g冲服”，调剂时正确的处理是","options":["将三七粉与其余饮片同包后交代患者一起煎煮","将三七粉单独包好交患者用药液或温水冲服","将三七粉在煎药结束前5分钟撒入锅中","将三七粉用纱布包好后与其余饮片同煎"],"answer":[1],"explanation":"知识点：冲服药的调剂与用药交代。三七粉等贵重、用量小或不耐煎的药宜冲服，应单独包好交患者。A项同煎会使其有效成分受热破坏且难以控制剂量；C项撒入锅中仍经煎煮，不符冲服本意；D项包煎用于防糊锅或去毛，不适用于三七粉冲服。","tier":"进阶"},{"id":231,"type":"single","stem":"药师在审核一张含“附子”的处方时，发现医师未标注先煎，调剂员正确的做法是","options":["按处方调配并在发药时口头交代患者先煎久煎","自行在处方上补写“先煎”后调配","拒绝调配并请医师在处方上补充先煎标注","按常规与其余药同煎后交代患者分次服用"],"answer":[2],"explanation":"知识点：附子等毒性饮片的处方审核与先煎要求。附子需先煎久煎以减毒，处方未标注属不规范，应请医师补充标注后再调配。A项仅口头交代不能替代处方规范标注，责任不清；B项调剂员无权在处方上自行补写医嘱；D项同煎不能保证减毒效果。","tier":"挑战"},{"id":232,"type":"single","stem":"调剂称量时发现戥子（或电子秤）零点漂移，正确的处理是","options":["在称量结果中减去估计的漂移量后继续使用","先调零或校准后再进行称量并记录","换一台秤称量后按经验取两次平均值","继续使用但每称一味药后重新估计零点"],"answer":[1],"explanation":"知识点：调剂称量器具的校准与使用规范。称量前应检查并调零或校准，保证剂量准确。A项凭估计扣减漂移量无依据；C项取经验平均值不能替代校准；D项继续使用并估计零点仍无法保证准确。","tier":"挑战"},{"id":233,"type":"single","stem":"某处方中同一味饮片分两处开写，调剂员正确做法是","options":["只调配一处，另一处视为重复开写忽略","分别称量后合并为总量调配","按两处中较大的剂量调配一次","先按第一处调配，第二处请示医师后决定"],"answer":[1],"explanation":"知识点：处方中同名饮片分写时的剂量处理。同一饮片分多处开写应分别称量后合并，总量即为处方用量。A项忽略会造成剂量不足；C项只取较大剂量不能反映处方总量；D项只调第一处同样会造成剂量不足。","tier":"进阶"},{"id":234,"type":"single","stem":"患者取药时询问“煎药前饮片要不要洗”，调剂员正确的回答是","options":["用清水快速冲洗一遍再浸泡煎煮","用温水冲洗并搓去表面浮尘后煎煮","一般不宜水洗，直接加水浸泡后煎煮","用纱布包好冲洗后再入锅煎煮"],"answer":[2],"explanation":"知识点：煎药前饮片处理与用药指导。饮片一般不宜水洗，以免水溶性有效成分流失或辅料损失，直接加水浸泡即可。A、B项冲洗搓洗均会造成成分流失；D项包纱布冲洗同样不能避免有效成分损失。","tier":"进阶"},{"id":235,"type":"single","stem":"处方中写有“生大黄”并标注“后下”，调剂员正确的操作是","options":["在其余饮片煎好前5～10分钟投入同煎","与其余饮片同时入锅并缩短总煎煮时间","单独煎煮20分钟后将药液兑入其余药液","装入包煎袋后与其余饮片同时入锅"],"answer":[0],"explanation":"知识点：后下药的煎法。生大黄后下是为保留泻下成分，应在其余药煎好前5～10分钟投入。B项同时入锅久煎会破坏泻下成分；C项单独煎20分钟已属久煎，不符合后下；D项包煎不影响煎煮时间，仍会久煎。","tier":"进阶"},{"id":236,"type":"single","stem":"某患者持处方到药店调配，处方中“罂粟壳”未单独开具专用处方，调剂员正确的处置是","options":["按普通饮片直接调配并登记患者信息","请医师按规定使用专用处方后再调配","将罂粟壳减量后按普通饮片调配","先调配其他饮片，罂粟壳让患者自行购买"],"answer":[1],"explanation":"知识点：麻醉药品及特殊管理中药饮片的处方管理。罂粟壳属特殊管理品种，须使用专用处方并按规定调配。A项普通处方调配不符合管理规定；C项减量调配仍属违规；D项让患者自行购买更不符合规定。","tier":"挑战"},{"id":237,"type":"single","stem":"药师审核一张含“十八反”药味的中药处方时，下列哪组药物同时出现应判定为配伍禁忌","options":["甘草与甘遂","黄芪与当归","白术与茯苓","陈皮与半夏"],"answer":[0],"explanation":"知识点为十八反中“藻戟遂芫俱战草”，甘草与甘遂属相反配伍禁忌。黄芪与当归为补气养血常用配伍；白术与茯苓健脾利湿常同用；陈皮与半夏为二陈汤核心配伍，均非禁忌。","tier":"进阶"},{"id":238,"type":"single","stem":"调剂称量毒性中药时，关于衡器的选择与使用，下列做法正确的是","options":["用戥秤称量并每次校对零位","用电子台秤称量后直接分包","用普通药匙估量后按经验分装","用托盘天平称量后不清零直接续称"],"answer":[0],"explanation":"毒性中药须用专用戥秤，称前校对零位以保证剂量准确。电子台秤感量偏大不适合小剂量毒性药；药匙估量无法保证剂量；托盘天平不清零续称会造成累积误差。","tier":"进阶"},{"id":239,"type":"single","stem":"某患者处方开有“先煎”标记的磁石，调剂员在包装时正确的处理方式是","options":["单独包先煎药并注明煎法","与群药同包并口头告知","与群药同包在袋上盖先煎章","单独包但无需另行注明"],"answer":[0],"explanation":"需特殊煎法的饮片应单独包装并附煎法说明，防止患者混煎。与群药同包易被忽略；盖章不显眼且患者可能不留意；单独包不注明患者不知如何操作。","tier":"挑战"},{"id":240,"type":"single","stem":"处方中出现“炒白术”而药斗内只有生白术，调剂员正确的处置是","options":["退回处方请医师确认或改方","自行取生白术代替炒白术","取生白术后自行炒制后调配","先配生白术并备注说明"],"answer":[0],"explanation":"饮片炮制品与生品功效不同，不得擅自替代，应退回处方请医师确认或改方。自行替代、自行炒制均超出调剂员权限；备注说明不能改变用药事实。","tier":"进阶"},{"id":241,"type":"single","stem":"关于中药煎药加水量，下列判断方法较为合理的是","options":["加水没过药面约二至三厘米","加水至药面以下一厘米","加水与药面齐平即可","加水至煎药锅最大刻度"],"answer":[0],"explanation":"常规煎药以水没过药面二至三厘米为宜，可保证有效成分浸出。加水低于药面易煎干；齐平浸出不足；加至最大刻度可能过多致药液过稀。","tier":"进阶"},{"id":242,"type":"single","stem":"解表类中药处方煎煮时，为防止挥发性成分散失，通常采用的煎法是","options":["武火煮沸后改文火短煎","文火久煎一小时以上","武火久煎至药汁浓稠","冷水浸泡一夜后久煎"],"answer":[0],"explanation":"解表药含挥发油，宜武火煮沸后文火短煎，减少挥发性成分损失。久煎、久煎浓稠、浸泡一夜久煎均会破坏或散失有效成分。","tier":"进阶"},{"id":243,"type":"single","stem":"某患者同时服用含附子的中药汤剂与含半夏的中成药，调剂员进行用药指导时应提示的重点是","options":["两药含相反配伍风险应告知医师","两药均需饭后服用即可","两药均需冷服以减少刺激","两药可同煎以增强疗效"],"answer":[0],"explanation":"附子属乌头类，与半夏同用涉及十八反中“半蒌贝蔹及攻乌”，存在配伍风险。饭后、冷服、同煎均未针对配伍禁忌，不能消除风险。","tier":"挑战"},{"id":244,"type":"single","stem":"调剂完成后进行处方复核时，发现某味药剂量超出常规用量且无医师双签名，正确处置是","options":["暂缓发药并联系医师确认","按处方剂量照常发药","自行减至常规剂量后发药","改为分次小剂量发药"],"answer":[0],"explanation":"超量处方须有医师双签名确认，无签名应暂缓发药并联系医师。照常发药、自行减量、分次发药均属擅自变更处方，存在用药风险。","tier":"挑战"},{"id":245,"type":"single","stem":"需要“包煎”的旋覆花在调剂时的正确处理是","options":["装入纱布袋后与群药同煎","直接与群药同煎后过滤","单独先煎后再兑入药液","研成细粉后冲服"],"answer":[0],"explanation":"旋覆花有绒毛，包煎可防止刺激咽喉并便于过滤。直接同煎易致绒毛混入；先煎兑入不能去除绒毛；研粉冲服改变用法且仍刺激咽喉。","tier":"进阶"},{"id":246,"type":"single","stem":"某药店调剂员在给患者发药时，患者询问“后下”药应何时放入，正确的指导是","options":["群药煎好前五至十分钟放入","与群药同时冷水下锅","群药煎好后立即放入闷泡","群药煎至一半时放入"],"answer":[0],"explanation":"后下药含挥发性成分，宜在群药煎好前五至十分钟放入。同时下锅、煎一半放入均致成分散失；煎好后闷泡有效成分浸出不足。","tier":"进阶"},{"id":247,"type":"single","stem":"关于中药斗谱排列，下列做法符合调剂便利与防混原则的是","options":["常用药放中层便于取用","毒性药放斗架最高层","外形相似药相邻放置","质轻药放斗架最底层"],"answer":[0],"explanation":"常用药置中层便于取用，符合斗谱原则。毒性药应专柜专锁管理；外形相似药应分开放置防混；质轻药多放上层，底层易受潮。","tier":"进阶"},{"id":248,"type":"single","stem":"中药调剂员在审核处方时发现医师开具的“川乌6g”未标注先煎，正确的处置方式是","options":["按处方直接调配并嘱咐患者自行久煎","拒绝调配并要求医师在处方上补充先煎脚注","将川乌改为制川乌后直接调配","把川乌另包并口头告知患者先煎一小时"],"answer":[1],"explanation":"知识点：毒性中药处方审核与脚注管理。川乌属毒性中药，内服须先煎久煎以减毒，处方未注明先煎属脚注缺失，应由医师补充更正后调配。按原方直接调配并让患者自行久煎，把安全责任转给患者，不合规。自行改药味属调剂员越权。另包并口头交代不能替代处方脚注的正式更正，仍属审核不严。","tier":"挑战"},{"id":249,"type":"single","stem":"调剂处方中同时出现“生半夏”和“法半夏”时，审方环节应重点核对的是","options":["两者是否属于同一药材的不同炮制品而重复开方","两者总量是否超过单味药常用上限","两者是否需要分别单包后合并","两者是否可在同一斗谱中相邻存放"],"answer":[0],"explanation":"知识点：同名异炮制品重复用药审核。生半夏与法半夏来源相同、炮制不同，同方并用易造成同味药重复，审方时应核对是否属重复开方。总量上限是次要核对点，不是两者并用的首要问题。是否单包、斗谱存放属调剂操作层面，与审方核对重点无关。","tier":"进阶"},{"id":250,"type":"single","stem":"处方中“阿胶”应采用的调剂处理方式是","options":["与群药同煎以便充分溶出","另包并嘱咐患者烊化兑服","打碎后与群药同包同煎","先煎半小时后再入群药"],"answer":[1],"explanation":"知识点：胶类药的调剂与煎服处理。阿胶为胶类，直接同煎易粘锅糊化并粘附他药，应另包嘱咐烊化兑服。同煎、打碎同煎均会造成粘锅损失。先煎属矿物类、毒性类的处理，不适用于胶类。","tier":"基础"},{"id":251,"type":"single","stem":"某患者处方含“薄荷”，调剂员在发药交代煎法时，薄荷应","options":["先煎二十分钟再下群药","与群药同时入锅同煎","后下，群药煎好前五分钟投入","包煎，避免药液浑浊"],"answer":[2],"explanation":"知识点：特殊煎法之后下。薄荷含挥发油，久煎易挥散失效，应后下，一般在群药煎好前5分钟投入。先煎、同煎均致挥发油损失。包煎用于细小种子、绒毛类药材，与薄荷后下无关。","tier":"挑战"},{"id":252,"type":"single","stem":"煎药时发现药液因火候过大迅速减少，正确的处置是","options":["立即加冷水至原水位继续煎","关小火并补加适量热水继续煎","把药液倒出后重新加水煎第二次","维持大火煎至规定时间"],"answer":[1],"explanation":"知识点：煎药火候与水量控制。煎药中途失水应减小火力并补加热水，避免药液骤冷影响有效成分溶出。加冷水会致药液温度骤降。倒出重煎会损失已溶出成分。维持大火会使药液煎干糊化。","tier":"挑战"},{"id":253,"type":"single","stem":"患者取药时询问“附子理中丸”与“附子理中片”能否自行互换服用，调剂员应回答","options":["两者同名同方可以直接等量互换","剂型不同但功效相同可随意替换","应按处方标注剂型服用，不可自行替换","丸剂作用缓和，可加大剂量替代片剂"],"answer":[2],"explanation":"知识点：中成药不同剂型的合理使用。同方不同剂型在辅料、释放、用法用量上存在差异，应按处方标注剂型服用，不可自行替换。直接等量互换、随意替换均忽视剂型差异。自行加大剂量属超量用药，风险更大。","tier":"进阶"},{"id":254,"type":"single","stem":"调剂含有“车前子”的处方时，正确的处理是","options":["单包后嘱咐患者先煎","用纱布包煎后与群药同煎","研成细粉后冲服","用温水浸泡后取上清液煎"],"answer":[1],"explanation":"知识点：特殊煎法之包煎。车前子为细小种子，煎煮时易浮散糊锅，应纱布包煎后与群药同煎。先煎、研粉冲服、取上清液均不符合车前子的常规煎法。","tier":"进阶"},{"id":255,"type":"single","stem":"调配完成后进行复核时，发现一方中“炙甘草”错配为“生甘草”，正确的处置是","options":["将生甘草挑出后补入炙甘草即可发出","在复核记录中注明后按原方发出","将全方退回重配并查明原因后再复核","让患者自行决定是否接受"],"answer":[2],"explanation":"知识点：调剂复核与差错处理。炮制品错配改变药性，应将全方退回重配并查明原因，重新复核合格后方可发出。挑出补入会造成交叉污染且难保准确。注明后发出、让患者决定均属把不合格药品放行。","tier":"挑战"},{"id":256,"type":"single","stem":"一位患者持方来取“生大黄”，调剂员交代煎法时应说明","options":["先煎半小时以增强泻下作用","后下或开水泡服以保留泻下成分","与群药同煎一小时以缓和药性","包煎以防止刺激胃肠"],"answer":[1],"explanation":"知识点：大黄不同用法与煎法。生大黄用于泻下时应后下或开水泡服，久煎会使致泻成分破坏而减弱泻下作用。先煎、久煎同煎均使泻下力下降。包煎与其刺激性无关。","tier":"进阶"},{"id":257,"type":"single","stem":"中药调剂员在收方后审核处方时，发现处方中麻黄与苦杏仁同用，这属于哪类需要重点关注的配伍关系","options":["相须为用，可增强平喘止咳之力","相畏为制，可降低麻黄发汗之力","相恶为忌，会削弱苦杏仁止咳之功","相反为禁，属十八反禁忌范畴"],"answer":[0],"explanation":"知识点是七情配伍与处方审核。麻黄配苦杏仁属相须为用，麻黄宣肺平喘、苦杏仁降气止咳，一宣一降增强平喘止咳，故正确项对。相畏为制是药物间相互抑制毒性或副作用，与麻黄杏仁关系不符；相恶是两药合用一药降低另一药功效，此处并非削弱关系；相反属十八反，麻黄与苦杏仁不在十八反之列。","tier":"挑战"},{"id":258,"type":"single","stem":"调剂处方时需先煎的药物，正确的操作是","options":["将药物先煎20至30分钟后再纳入群药同煎","将药物单包后与群药同时入锅煎煮","将药物后下并在煎煮结束前5分钟投入","将药物研成细粉后在煎煮结束时冲服"],"answer":[0],"explanation":"知识点是特殊煎法先煎。先煎药多为矿物、贝壳类或需减毒的药材，应先煎20至30分钟再入群药，故正确项对。单包与群药同煎混淆了先煎与另包处理；后下适用于含挥发油或久煎易失效的药物；研粉冲服适用于贵重、不宜煎煮的药物，均非先煎操作。","tier":"基础"},{"id":259,"type":"single","stem":"某处方开具朱砂0.5克冲服，调剂员称量时正确的做法是","options":["用研钵将朱砂研细后以药匙分取冲服量","用普通戥秤直接称取后包入群药同煎","用不锈钢药匙刮取后混入煎好的药液中","用电子秤称取后与群药一同放入煎药袋"],"answer":[0],"explanation":"知识点是贵重药与毒性药的称量及用法。朱砂含硫化汞，不宜煎煮，须研细后冲服，故正确项对。朱砂入群药同煎会使有效成分不易溶出且不宜高温久煎；用不锈钢药匙刮取不便控制剂量且易混入金属屑；与群药同入煎药袋同样违反朱砂冲服的用法要求。","tier":"进阶"},{"id":260,"type":"single","stem":"调剂处方时发现处方中有附子且未标注先煎，中药调剂员应当首先采取的措施是","options":["联系处方医师确认是否需要先煎并补注","按常规群药一同煎煮以免耽误患者用药","自行将附子先煎30分钟再纳入群药煎煮","将附子退回库房并拒绝调配该处方"],"answer":[0],"explanation":"知识点是处方审核与附子先煎要求。附子含乌头类生物碱，需先煎降低毒性，处方未注明时应联系医师确认，故正确项对。按常规群药同煎会增大毒性风险；自行先煎虽方向对，但调剂员不应擅自更改处方而未与医师沟通；直接退回拒绝调配并非首选处置，应先沟通确认。","tier":"挑战"},{"id":261,"type":"single","stem":"处方中同时出现海藻和甘草，审核时正确的判断是","options":["属十八反禁忌，应联系医师确认或拒绝调配","属相须配伍，可增强软坚散结之功","属妊娠禁忌，孕妇禁用但非孕妇可用","属相畏配伍，可降低海藻的毒性"],"answer":[0],"explanation":"知识点是十八反与处方审核。海藻与甘草属十八反中甘草反海藻，原则上不宜同用，应联系医师确认或拒绝调配，故正确项对。相须是增强功效的配伍，与此相反禁忌不符；妊娠禁忌针对孕妇用药，与海藻甘草关系无关；相畏是相互抑制毒性，并非十八反内容。","tier":"进阶"},{"id":262,"type":"single","stem":"煎药室收到一剂含薄荷的处方，煎煮时正确的火候与时间安排是","options":["武火煎沸后改用文火煎10至15分钟","文火慢煎40分钟使有效成分充分溶出","武火煎沸后继续武火煎30分钟即可","先武火煎20分钟再文火煎20分钟"],"answer":[0],"explanation":"知识点是煎药火候与含挥发油药物的煎煮。薄荷含挥发油，宜武火煎沸后文火短煎10至15分钟，故正确项对。文火慢煎40分钟会使挥发油大量散失；武火煎沸后再武火煎30分钟同样挥散过多；先武火20分钟再文火20分钟总时间过长，不适于薄荷类芳香药。","tier":"进阶"},{"id":263,"type":"single","stem":"患者取药时询问阿胶如何服用，调剂员正确的指导是","options":["将阿胶单独烊化后兑入煎好的药液中服用","将阿胶与群药一同放入锅中煎煮30分钟","将阿胶研粉后与群药同煎以利于吸收","将阿胶用冷水浸泡后与群药同煎"],"answer":[0],"explanation":"知识点是胶类药的烊化用法。阿胶为胶类，宜单独烊化后兑入药液，故正确项对。与群药同煎会粘锅并影响其他药物煎出；研粉同煎仍易粘锅糊化；冷水浸泡后同煎同样会造成粘锅和药液浑浊，均不符合烊化要求。","tier":"进阶"},{"id":264,"type":"single","stem":"某处方中大黄标注“后下”，调剂员在煎药时正确的操作是","options":["在群药煎煮结束前5至10分钟投入大黄","将大黄与群药同时入锅煎煮","将大黄先煎20分钟后再纳入群药","将大黄研粉后在服药前冲入药液"],"answer":[0],"explanation":"知识点是后下药的操作。大黄后下意在保留泻下成分，应在煎煮结束前5至10分钟投入，故正确项对。与群药同煎会使泻下成分久煎破坏；先煎20分钟同样破坏泻下成分；研粉冲服虽可保留成分，但不符合处方标注的后下煎法。","tier":"进阶"},{"id":265,"type":"single","stem":"调剂员在称量处方中“三七粉3克”时，正确的分剂量方法是","options":["用电子天平称取3克后单独包成冲服小包","用戥秤称取3克后混入群药包同煎","用戥秤称取3克后与群药同包并注明先煎","用电子天平称取3克后与群药同包并注明后下"],"answer":[0],"explanation":"知识点是贵重药粉末的分剂量与用法。三七粉贵重且宜冲服，应称取后单独包成冲服小包，故正确项对。混入群药同煎会浪费有效成分；注明先煎与三七粉用法不符；注明后下同样不符合三七粉冲服的用法要求。","tier":"进阶"},{"id":266,"type":"single","stem":"患者反映煎好的药液表面有一层白色浮沫且有糊味，最可能的原因是","options":["煎药时未搅拌导致底部药物焦糊","煎药时间过短有效成分未溶出","煎药容器未加盖使挥发油散失","煎药前药物浸泡时间不足30分钟"],"answer":[0],"explanation":"知识点是煎药异常判断。药液有糊味多因煎煮时未搅拌、底部焦糊，故正确项对。煎煮时间过短主要表现为药液味淡，不会出现糊味；未加盖主要造成挥发油散失，与糊味无关；浸泡时间不足影响煎出率，也不会产生糊味。","tier":"进阶"},{"id":267,"type":"single","stem":"某患者处方中含川乌，调剂员在发药指导时特别强调的正确内容是","options":["药液需煎煮时间足够并观察有无口舌麻木","药液宜冷服以减少对胃肠的刺激","药液应与其他滋补药同服以增强疗效","药液需在饭前空腹大量服用以利吸收"],"answer":[0],"explanation":"知识点是含毒性药物川乌的用药指导。川乌需久煎减毒，服药后应观察有无口舌麻木等中毒表现，故正确项对。冷服不能降低毒性且可能刺激胃肠；与滋补药同服可能影响药效并增加风险；空腹大量服用会加重不良反应，均非正确指导。","tier":"挑战"},{"id":268,"type":"multi","stem":"中药调剂员在审核处方时，下列哪些情形应当联系处方医师确认后再行调配","options":["处方中川乌未注明先煎","处方中甘草与海藻同用","处方中大黄标注后下","处方中妊娠患者使用活血化瘀药","处方中薄荷未注明后下"],"answer":[0,1,3],"explanation":"知识点是处方审核中需联系医师的情形。川乌未注明先煎涉及毒性药煎法安全，需确认；甘草与海藻属十八反禁忌，需确认；妊娠患者使用活血化瘀药涉及妊娠禁忌，需确认，故这三项正确。大黄标注后下是明确且合理的煎法，按标注执行即可，无需确认；薄荷未注明后下属常规情况，可按常规煎煮或根据医师习惯执行，一般不作为必须联系医师确认的情形。","tier":"挑战"},{"id":269,"type":"single","stem":"审核处方时发现医师写有“川乌9g，先煎”，该处方还应特别关注哪一味药的用量与炮制","options":["附子","干姜","甘草","白芍"],"answer":[0],"explanation":"知识点是十八反与毒性中药管理。川乌与附子同属乌头类，常同方配伍，审核时须同时核对附子是否制用、剂量是否在安全范围。干姜、甘草、白芍虽常与川乌同用，但不属同类毒性药，不是该处方的核心风险点。","tier":"挑战"},{"id":270,"type":"single","stem":"调剂时处方写“生大黄后下”，正确的操作是","options":["群药煎煮结束前5~10分钟投入","与群药同时加水煎煮","群药煎煮前单独浸泡30分钟","群药煎沸后立即投入再煎30分钟"],"answer":[0],"explanation":"知识点是特殊煎法。生大黄后下意在保留泻下成分，应在群药即将煎好前投入短煎。与群药同煎、久煎会使泻下成分破坏；提前浸泡再入煎同样会过度煎煮；沸后投入再煎30分钟也属久煎，均不符合后下要求。","tier":"进阶"},{"id":271,"type":"single","stem":"一张处方中同时出现“海藻”与“甘草”，调剂员首先应当","options":["暂停调剂并请处方医师确认或双签字","按处方照配并在袋上注明两药同煎","将甘草改为炙甘草后继续调剂","把海藻减量至3g后继续调剂"],"answer":[0],"explanation":"知识点是十八反。海藻与甘草属十八反配伍禁忌，调剂员不得擅自更改或照配，应先与处方医师沟通确认并按规定处理。自行改炙甘草、减量或照配均属越权处置，不能规避配伍风险。","tier":"进阶"},{"id":272,"type":"single","stem":"处方中“薄荷”注明后下，若调剂员将其与群药同煎，主要影响是","options":["挥发性有效成分随蒸汽散失，药效降低","薄荷中的鞣质大量溶出，刺激胃肠","薄荷与群药中金属离子结合产生沉淀","薄荷煎煮后产生毒性成分，增加不良反应"],"answer":[0],"explanation":"知识点是含挥发油中药的后下原理。薄荷主要含挥发油，久煎会使有效成分挥发损失。鞣质刺激、金属离子沉淀、产生毒性成分均不是薄荷久煎的主要问题，属混淆概念。","tier":"进阶"},{"id":273,"type":"single","stem":"中药房收到一张儿科处方，其中黄连用量为成人常用量上限，调剂员正确的做法是","options":["与处方医师联系核对患儿年龄体重后再定","直接按处方量调配并交代分次服用","自行将黄连减半后调配并告知家长","拒绝调配并让家长重新挂号开方"],"answer":[0],"explanation":"知识点是特殊人群用药审核。儿童用药须结合年龄体重核算，发现用量可疑应与医师核对。直接照配可能超量；自行减半属越权改方；简单拒配未履行沟通职责，均不妥。","tier":"进阶"},{"id":274,"type":"single","stem":"煎药机煎煮前，将饮片装入布袋并留出约三分之一空间，主要目的是","options":["便于药液对流和有效成分溶出","防止布袋被煎药机内胆刮破","减少煎煮过程中药液产生泡沫","使布袋受热更均匀缩短煎煮时间"],"answer":[0],"explanation":"知识点是煎药装袋操作。装袋过满会压紧饮片，阻碍药液对流，有效成分难以溶出，故留出空间。防刮破、减泡沫、均匀受热均非留空间的根本目的，属相邻但错误的解释。","tier":"进阶"},{"id":275,"type":"single","stem":"患者取药时询问“先煎药”与“后下药”能否一起放入锅中，调剂员应告知","options":["先煎药先煮一段时间后再下后下药","两者同时下锅，先煎药切薄片即可","两者同时下锅，后下药包双层纱布","先煎药与后下药分别煎好后混合药液"],"answer":[0],"explanation":"知识点是特殊煎法的执行顺序。先煎药需先煮以减毒或增溶，后下药在煎毕前短时投入，二者不能同时下锅。切薄片、包双层纱布、分别煎后混合均不能同时满足先煎与后下的时间要求。","tier":"进阶"},{"id":276,"type":"single","stem":"某调剂员将处方中“麸炒白术”误配为“生白术”，其性质属于","options":["炮制品规格不符的调剂差错","剂量偏差类调剂差错","给药途径类调剂差错","用法交代类调剂差错"],"answer":[0],"explanation":"知识点是调剂差错分类。麸炒白术与生白术功效偏性不同，属炮制品规格不符。剂量偏差指用量错误；给药途径指内服外用混淆；用法交代指煎服说明错误，均与本例不符。","tier":"进阶"},{"id":277,"type":"multi","stem":"中药房调剂下列情形中，应当拒绝调配并及时报告的情形包括","options":["处方中有十八反配伍且无医师双签字","处方中罂粟壳未使用专用处方","处方中药物剂量字迹模糊无法辨认","处方中同时开具两种功效相近的感冒中成药","处方中饮片名称使用省级炮制规范别名"],"answer":[0,1,2],"explanation":"知识点是处方审核与拒绝调配情形。十八反无确认、麻醉药品未用专用处方、剂量字迹无法辨认均属不得调配并需报告的情形。同类中成药联用属合理用药审核提示，别名属规范允许范围，均不构成拒绝调配的法定情形。","tier":"进阶"},{"id":278,"type":"single","stem":"患者煎药时发现药液表面浮有一层白色泡沫，担心药液变质，调剂员正确的解释是","options":["含皂苷类成分的中药煎煮时起泡属正常现象","泡沫说明饮片已霉变，应弃去药液","泡沫是煎药锅涂层脱落，应换锅重煎","泡沫提示煎煮时间不足，应继续久煎"],"answer":[0],"explanation":"知识点是煎药常见现象判断。甘草、桔梗等含皂苷，煎煮时产生泡沫属正常。霉变、涂层脱落、煎煮不足均缺乏依据，属把正常现象误判为异常，会误导患者。","tier":"挑战"},{"id":279,"type":"single","stem":"中药调剂员在审核处方时发现医师写明“川乌6g”，正确的后续处置是","options":["按方直接调配，川乌先煎即可","请医师确认是否改为制川乌并注明先煎","将川乌研粉后随群药同煎以减毒","把川乌剂量减半后直接调配"],"answer":[1],"explanation":"知识点：毒性中药饮片处方审核。川乌生品毒性大，内服须用制川乌并先煎，处方写“川乌”应请医师确认炮制品种并注明先煎。A错在未确认炮制品且未标注先煎要求；C错在毒性饮片不宜研粉随群药同煎，易致中毒；D错在调剂员无权擅自减量，应由医师修改并签字。","tier":"挑战"},{"id":280,"type":"single","stem":"处方中同时出现“丁香”与“郁金”，调剂员审核时应判定为","options":["相须配伍，可增强温中行气之力","相使配伍，郁金引丁香入肝经","配伍禁忌，应请医师重新开具","妊娠禁忌，孕妇禁用即可调配"],"answer":[2],"explanation":"知识点：中药配伍禁忌“十九畏”。丁香畏郁金属于十九畏范畴，同方配伍属禁忌，应请医师修改处方。A、B错在将禁忌误判为相须、相使增效配伍；D错在混淆了妊娠禁忌与配伍禁忌，且即使非孕妇也不能同用。","tier":"进阶"},{"id":281,"type":"single","stem":"某处方开“生大黄9g，后下”，调剂员在发药时应向患者交代的煎法是","options":["与群药同时入煎，煎足30分钟","群药煎好前5～10分钟放入大黄","群药煎沸后立即放入大黄并久煎","先煎大黄20分钟再入群药同煎"],"answer":[1],"explanation":"知识点：特殊煎法之后下。大黄后下意在保留泻下成分，应在群药煎好前5～10分钟投入。A错在久煎会破坏泻下成分；C错在“立即放入并久煎”仍属久煎；D错在把后下误作先煎。","tier":"进阶"},{"id":282,"type":"single","stem":"调剂处方中写“阿胶9g”时，正确的调剂与交代方式是","options":["与群药同煎，起胶类黏合作用","另用开水或黄酒溶化后兑入药液","先煎30分钟使胶质充分溶出","研成细粉后随群药包煎"],"answer":[1],"explanation":"知识点：胶类中药的煎服方法。阿胶宜烊化兑服，即另用开水或黄酒溶化后兑入煎好的药液中。A错在同煎易粘锅糊化并影响其他药；C错在先煎会使胶质糊底；D错在阿胶不宜包煎，包煎多用于含黏液、绒毛或细小种子类药。","tier":"进阶"},{"id":283,"type":"single","stem":"中药调剂称量时，处方开“细辛3g”，调剂员使用戥子的正确操作是","options":["左手持戥杆，右手取药，目视戥星","右手持戥杆，左手取药，目视戥星","把药放在戥盘一侧，凭手感估量","先称总药量再按比例分份"],"answer":[0],"explanation":"知识点：戥子称量操作规范。正确姿势为左手持戥杆、右手取药，目视戥星，逐味称准。B错在左右手分工颠倒；C错在戥子称量须看戥星而非凭手感；D错在分份估量不能保证单味剂量准确。","tier":"进阶"},{"id":284,"type":"single","stem":"调剂员在称量“朱砂1.5g”时，正确的处理方式是","options":["与群药同煎，使药效均匀","研细粉后随汤药冲服","先煎40分钟以减毒","包煎后与群药同煎"],"answer":[1],"explanation":"知识点：矿物类、毒性中药的用法。朱砂含汞，不宜入煎，宜研细粉冲服且不可过量。A错在朱砂同煎会受热分解并增加毒性；C错在先煎不能减毒反而破坏成分；D错在包煎仍入煎剂，不适用于朱砂。","tier":"进阶"},{"id":285,"type":"single","stem":"患者持处方来店调配，处方写“罂粟壳6g”，调剂员正确的处理是","options":["按普通饮片直接调配，无需特殊手续","凭处方调配并按规定留存处方备查","拒绝调配，罂粟壳一律不得药用","改为等量诃子后直接调配"],"answer":[1],"explanation":"知识点：麻醉药品及特殊管理中药的调剂。罂粟壳属特殊管理品种，须凭处方调配并按规定留存处方备查。A错在忽视特殊管理要求；C错在一律不得药用过于绝对，符合规定可药用；D错在调剂员无权擅自替换药味。","tier":"进阶"},{"id":286,"type":"single","stem":"煎药室收到一张处方，其中“薄荷6g”标注“后下”，正确的煎药操作是","options":["薄荷与群药同煎20分钟","薄荷在群药煎好前5～10分钟加入","薄荷先煎15分钟再入群药","薄荷单独煎煮1小时后兑入"],"answer":[1],"explanation":"知识点：含挥发性成分中药的后下。薄荷含挥发油，久煎易失效，应在群药煎好前5～10分钟加入。A、D错在煎煮过久致挥发油散失；C错在把后下误作先煎。","tier":"进阶"},{"id":287,"type":"single","stem":"调剂员发药时应向患者交代“车前子”的正确煎法是","options":["先煎20分钟再入群药","包煎后与群药同煎","后下5分钟即可","烊化后兑入药液"],"answer":[1],"explanation":"知识点：包煎的适用品种。车前子细小且含黏液质，易糊锅、刺激咽喉，应包煎后与群药同煎。A错在先煎不解决细小种子糊锅问题；C错在车前子不需后下；D错在烊化是胶类药的用法。","tier":"进阶"},{"id":288,"type":"single","stem":"某患者取回汤药后询问“药液煎好后如何保存”，调剂员正确的指导是","options":["趁热装入保温杯，常温放置次日服用","放凉后冷藏，服用前加热至沸","置于阳光下晒凉，可保存三天","与群药渣一起浸泡，随取随服"],"answer":[1],"explanation":"知识点：汤药煎好后的保存与服用。药液应放凉后冷藏，服用前加热至沸，以防变质。A错在保温杯常温放置易酸败；C错在阳光暴晒且保存三天易变质；D错在药渣浸泡会继续溶出杂质并滋生细菌。","tier":"挑战"},{"id":289,"type":"single","stem":"患者反映服用含“人参”的汤药期间又自行饮浓茶，调剂员最恰当的指导是","options":["浓茶可助人参吸收，继续同服","服人参期间不宜饮浓茶，建议停茶","改为用浓茶送服人参以增效","把人参改在睡前服用即可"],"answer":[1],"explanation":"知识点：服用人参的饮食禁忌。茶叶含鞣酸等成分，与人参同服可能影响吸收，服人参期间不宜饮浓茶。A、C错在认为浓茶能增效或助吸收；D错在改变服用时间并不能消除浓茶干扰。","tier":"进阶"},{"id":290,"type":"single","stem":"调剂员审核处方时发现医师写“制川乌9g”，处方其余药味为常规用量，该处方最恰当的处理方式是","options":["按方调配，但先煎制川乌30分钟","按方调配，制川乌与群药同煎即可","拒绝调配并请医师重新签章确认","将制川乌减量为6g后调配"],"answer":[0],"explanation":"知识点：毒性中药制川乌的用法与处方审核。制川乌含乌头碱类毒性成分，常规需先煎以降低毒性，9g在常用剂量范围内，故可调配但必须先煎；B项同煎会因毒性成分溶出过快而增加中毒风险；C项9g未超量，无需拒绝或重新签章；D项调剂员无权擅自更改医师处方剂量。","tier":"挑战"},{"id":291,"type":"single","stem":"中药房调剂时发现处方中“炙甘草”与“甘遂”同方出现，调剂员正确的处置是","options":["按方调配并叮嘱患者分时服用","按方调配并注明两药间隔两小时","拒绝调配并联系医师确认是否需调整","将甘遂减量后与炙甘草同方调配"],"answer":[2],"explanation":"知识点：十八反配伍禁忌。甘遂与甘草属十八反，同方属配伍禁忌，应拒绝调配并请医师确认；A、B项虽分时服用但同方仍属禁忌，不能规避；D项调剂员擅自减量不能消除禁忌且越权。","tier":"挑战"},{"id":292,"type":"single","stem":"调剂处方中写“川贝母3g，研粉冲服”，中药房现有川贝母原药材而无打粉设备，正确做法是","options":["将川贝母打碎后与群药同煎","整粒川贝母与群药同煎后服汤","请患者自行捣碎后冲服","告知医师缺药并请其修改用法"],"answer":[3],"explanation":"知识点：处方应付与药房调剂条件。处方要求研粉冲服而药房无打粉条件，应告知医师修改用法后再调配；A项打碎同煎不符合冲服要求且影响疗效；B项整粒同煎有效成分难溶出；C项让患者自行处理易造成剂量不准且不合规。","tier":"进阶"},{"id":293,"type":"single","stem":"处方写“阿胶6g”，调剂员在煎药环节的正确处置是","options":["与群药同煎30分钟","先煎20分钟再入群药","单独烊化后兑入煎好的药液","另包后与群药同包同煎"],"answer":[2],"explanation":"知识点：胶类药的煎法。阿胶属胶类，需单独烊化后兑入药液，避免粘锅和影响其他药味煎出；A、B、D项均将阿胶与群药同煎，属常见错误操作。","tier":"进阶"},{"id":294,"type":"single","stem":"调剂员称取“细辛3g”时，电子秤显示0.5g起跳，最恰当的做法是","options":["直接称取3g，读数即可","先称容器归零后再称取3g","凭经验估取约3g","将细辛与群药合并称取"],"answer":[1],"explanation":"知识点：中药调剂称量规范。称量应先归零再称，保证准确；A项直接称取未归零会引入容器重量误差；C项估取不符合剂量准确要求；D项合并称取无法核对单味剂量，细辛属有小毒药更需准确。","tier":"进阶"},{"id":295,"type":"single","stem":"某处方中“薄荷”与“龙骨”同方，煎药时正确的处理是","options":["龙骨先煎，薄荷后下","薄荷先煎，龙骨后下","两药同时先煎","两药同时后下"],"answer":[0],"explanation":"知识点：先煎与后下的综合应用。龙骨属矿物类需先煎，薄荷含挥发油需后下，二者处理相反；B项颠倒两药处理；C、D项混同两药煎法，均不符合各自要求。","tier":"进阶"},{"id":296,"type":"single","stem":"患者取药时询问“附子理中丸”与“清热类中成药”能否同服，调剂员最恰当的答复是","options":["可以同服，间隔半小时即可","可以同服，药性互不影响","不宜同服，一温一寒应请医师确认","不宜同服，必须停用其中一种"],"answer":[2],"explanation":"知识点：中成药联用的药性配伍。附子理中丸属温中散寒，清热类中成药属寒凉，一温一寒联用可能相互抵消或加重胃肠反应，应请医师确认；A、B项忽视药性冲突；D项调剂员无权要求停用其中一种。","tier":"进阶"},{"id":297,"type":"single","stem":"调配处方时发现“炒麦芽15g”写成“生麦芽15g”，调剂员正确的处置是","options":["按处方所写生麦芽调配","按医师原意改炒麦芽调配","拒绝调配并请医师确认","两种各半调配以兼顾"],"answer":[2],"explanation":"知识点：处方应付与炮制品差异。生麦芽与炒麦芽功效侧重不同，调剂员不得擅自更改或替代，应请医师确认；A、B、D项均属擅自处理，不符合处方审核要求。","tier":"挑战"},{"id":298,"type":"single","stem":"某患者自述煎药时把“旋覆花”直接倒入锅中与群药同煎，调剂员指出其中错误环节是","options":["旋覆花应先煎30分钟","旋覆花应包煎以防绒毛刺激","旋覆花应后下以保挥发油","旋覆花应烊化后兑入"],"answer":[1],"explanation":"知识点：包煎药的范围。旋覆花含绒毛，易刺激咽喉，需包煎；A项先煎不是旋覆花要求；C项后下不针对绒毛问题；D项烊化适用于胶类，不适用旋覆花。","tier":"挑战"},{"id":299,"type":"multi","stem":"调剂员在审核一张含“麻黄”的处方时，下列哪些情况应引起注意并请医师确认","options":["患者自述有高血压病史","处方中麻黄用量为6g","患者同时服用降压药","处方中麻黄与石膏同用","患者自述有心悸失眠"],"answer":[0,2,4],"explanation":"知识点：麻黄用药指导与处方审核。麻黄含麻黄碱，高血压、心悸失眠者及与降压药同用需警惕，应请医师确认；B项6g在常用剂量范围内；D项麻黄与石膏同用属麻杏石甘汤类常规配伍，不属异常。","tier":"进阶"},{"id":300,"type":"multi","stem":"中药房接到一张含“制川乌9g”的处方，调剂员在审核与调剂环节的下列做法中，正确的有","options":["先核查处方是否有医师双签名及先煎标注，再单独称取制川乌并注明先煎","因制川乌属毒性中药，直接按普通饮片与其余药味混包后统一交代久煎","称量时用同一戥盘连续称取制川乌和甘草，称完再一并倒入药袋","发现处方未标注先煎，退回请医师补充标注后再行调剂","调配完毕后按普通处方常规交代煎法，不单独说明制川乌先煎"],"answer":[0,3],"explanation":"知识点：毒性中药（制川乌）的处方审核与调剂规范。制川乌含乌头类生物碱，需先煎久煎以减毒，处方须有医师签名并标注先煎，调剂时应单独称取、单独包装并注明先煎。正确项0：先审核签名与先煎标注，再单独称取并注明先煎，符合毒麻类中药调剂要求。正确项3：处方缺先煎标注时退回医师补充，属审核不通过的正确处置。错误项1：与普通饮片混包无法保证先煎，且失去单独交代先煎的条件。错误项2：毒性饮片应单独称取、单独包装，与甘草共用戥盘且混倒易造成交叉污染与剂量混淆。错误项4：制川乌必须先煎，仅按普通处方常规交代煎法会遗漏关键减毒步骤。","tier":"挑战"}]}