一位 25 歲廣泛性焦慮症患者出現說話快速、躁動與顫抖。護理師首要採取的措施為何？
A 25-year-old client with generalized anxiety disorder presents with rapid speech, restlessness, and trembling. Which initial action by the nurse is most appropriate?
- AEncourage the client to ventilate their fears鼓勵病人抒發恐懼
- BProvide a calm, quiet, and low-stimulus environment✓ 正解提供平靜、安靜且低刺激的環境
- CInstruct the client to practice deep breathing exercises指導病人練習深呼吸運動
- DAdminister an as-needed dose of benzodiazepine給予處方備用的苯二氮平類藥物劑量
廣泛性焦慮症（Generalized Anxiety Disorder, GAD）的特點是持續的、過度的擔憂，常伴隨生理症狀，如心跳加速、呼吸急促、顫抖、坐立不安等。當個案出現急性焦慮症狀時，首要任務是降低外在刺激，創造一個有利於情緒穩定與後續介入的環境。 正確答案 B 提供了最適合的初步介入措施。提供一個平靜、安靜且低刺激的環境，能減少感官輸入，避免加劇個案的焦慮反應。這符合「安全優先」原則，為後續的評估與治療打下基礎。 選項 C（深呼吸練習）與 D（給予苯二氮平類藥物）雖然是處理焦慮的有效方法，但通常在初步穩定環境後才進行。在個案處於高度焦慮狀態時，可能難以有效執行深呼吸；藥物則屬於醫囑，需經醫師評估開立，且非首要環境穩定措施。 選項 A（鼓勵傾訴恐懼）在某些情況下適用，但當個案處於急性生理症狀（如說話快速、躁動）時，其認知功能可能受損，難以有條理地表達，此時強迫傾訴反而可能增加其壓力。因此，先降低環境刺激是更安全的起始點。
Generalized anxiety disorder (GAD) is characterized by persistent, excessive worry, often accompanied by physiological symptoms such as a rapid heart rate, rapid breathing, tremor, and restlessness. When a patient presents with acute anxiety symptoms, the first priority is to reduce external stimuli and create an environment conducive to emotional stabilization and subsequent intervention. Correct answer B provides the most appropriate initial intervention. Providing a calm, quiet, low-stimulation environment reduces sensory input and prevents worsening of the patient's anxiety response. This is consistent with the safety first principle and lays the foundation for further assessment and treatment. Although options A (deep-breathing exercises) and D (administration of a benzodiazepine) are effective ways to manage anxiety, they are usually applied only after the environment has been initially stabilized. When the patient is in a state of severe anxiety, it may be difficult to perform deep breathing effectively; medications are a physician's order and must be evaluated and prescribed by a physician, and they are not the primary measure for stabilizing the environment. Option A (encouraging the patient to verbalize fears) is appropriate in some situations, but when the patient has acute physiological symptoms (such as rapid speech and agitation), cognitive function may be impaired, making it difficult for them to express themselves coherently; forcing them to talk at this time may actually increase their stress. Therefore, first reducing environmental stimulation is a safer starting point.