一位 45 歲焦慮症病史的病人出現呼吸急促、心搏過速，並感到瀕死感。護理師首要介入措施為何？

核心概念：急性焦慮發作（acute anxiety attack）的護理介入優先順序。 為什麼正確答案 D 對：當病人出現急性焦慮症狀，如呼吸急促、心悸、瀕死感時，他們處於高度生理與心理壓力狀態，難以處理複雜的刺激。護理師的首要任務是提供一個「安全、平靜、低刺激」的環境（calm, quiet, low-stimulus environment）。減少外界干擾，例如關閉電視、降低燈光、保持安靜，有助於降低病人的焦慮水平，幫助他們逐漸穩定下來。 為什麼其他選項錯： C. 紙袋呼吸（breathing into a paper bag）曾被用於處理過度換氣，但現已不被推薦，因其可能導致二氧化碳濃度過高，且可能加劇幽閉恐懼感。急性焦慮時，更應關注提供安全感與降低刺激。 A. 給予抗焦慮藥物（anxiolytic medication）需要醫師的醫囑，且通常是在其他支持性措施（如環境控制、陪伴）無效或病人情況嚴重時考慮。它不是護理師的首要介入措施。 B. 教導病人焦慮減緩技巧（anxiety-reducing techniques）是重要的長期照護，但急性發作時，病人可能無法有效學習或應用這些技巧。應先穩定其急性症狀，待病人較平靜後再進行衛教。 臨床思路：此題考量的是「病人安全」與「急性期照護的優先順序」。在病人處於急性焦慮狀態時，提供一個穩定、低刺激的環境是首要任務，能幫助病人降低生理反應，為後續的介入奠定基礎。

Core concept: priority of nursing interventions during an acute anxiety attack. Why the correct answer D is correct: When the client experiences acute anxiety symptoms such as rapid breathing, palpitations, and a sense of impending doom, they are in a state of high physiological and psychological stress and have difficulty processing complex stimuli. The nurse's primary task is to provide a calm, quiet, low-stimulus environment. Reducing external interference, such as turning off the television, dimming the lights, and maintaining quiet, helps lower the client's anxiety level and gradually stabilize them. Why the other options are incorrect: A. Breathing into a paper bag was once used to manage hyperventilation but is no longer recommended because it may lead to elevated carbon dioxide and exacerbate claustrophobia. During acute anxiety, attention should be focused on providing safety and reducing stimuli. C. Administering anxiolytic medication requires a physician's order and is generally considered only when other supportive measures (such as environmental control and companionship) are ineffective or the client's condition is severe. It is not the nurse's first intervention. D. Teaching anxiety-reducing techniques is important for long-term care, but during an acute attack the client may not be able to effectively learn or apply these techniques. Acute symptoms should be stabilized first, and education provided once the client is calmer. Clinical reasoning: This question considers patient safety and prioritization in acute care. When the client is in an acute anxious state, providing a stable, low-stimulus environment is the primary task; it helps lower physiological responses and lays the foundation for subsequent interventions.