— 照護管理 · MEDIUM · MCQ —
下列哪項評估發現需立即報告醫師？
Which assessment finding requires immediate reporting to the provider?
- AA client with a sudden change in mental status and confusion✓ 正解一位突然出現精神狀態改變和混亂的病人
- BA client with a stable, low-grade temperature of 99.2°F一位穩定、低燒攝氏37.3度（華氏99.2度）的病人
- CA client with a 1-inch area of redness at an IV site一位靜脈注射部位有1英寸紅腫區域的病人
- DA client requesting a refill of their scheduled sleep medication一位要求補充其定時睡眠藥物的病人
— Explanation · 中文詳解 —
突然的意識改變（Mental Status Change）通常暗示嚴重的生理失調，如敗血症、缺氧、中風或電解質不平衡，屬醫療緊急情況。輕微針孔泛紅可觀察處理，微溫屬正常波動，續藥需求則可按醫囑執行，不具緊急性。
Sudden mental status changes typically signal serious physiologic derangement such as sepsis, hypoxia, stroke, or electrolyte imbalance and constitute a medical emergency. Mild redness at an IV site can be monitored, a low-grade temperature is within normal variation, and medication refill requests can be handled per orders and are not urgent.
✦ 台美臨床差異
美國護理師常依 SBAR 模式精準傳達變況；台灣護理師在觀察到意識改變時，需迅速排除低血糖等常見原因後立即回報。