一位病人正處於氣喘急性發作。護理師聽到呼氣時有高音調的哮鳴音（Wheezing）。在給予霧化沙丁胺醇（Albuterol）治療後，護理師發現哮鳴音消失，但呼吸音顯著減弱。護理師首要應採取什麼行動？
A client is experiencing an acute asthma attack. The nurse hears high-pitched wheezing on expiration. After administering a nebulized albuterol treatment, the nurse notes that the wheezing has stopped and the breath sounds are greatly diminished. What should the nurse do first?
- AEncourage the client to use an incentive spirometer鼓勵病人使用誘發性肺量計
- BDocument the improvement in the client's condition記錄病人狀況改善
- CAdminister a second dose of albuterol給予第二劑沙丁胺醇
- DImmediately notify the healthcare provider or rapid response team✓ 正解立即通知醫療保健提供者或快速反應團隊
這題是氣喘評估中的「沈默胸腔（Silent Chest）」陷阱。在急性氣喘發作時，哮鳴音消失且呼吸音減弱並非代表好轉，而是代表氣道阻塞已嚴重到幾乎沒有空氣可以流動（氣體流量極低）。這是一個危急生命、即將發生呼吸衰竭的紅旗徵象。護理師必須立即啟動急救機制（D）。選項 B 錯誤地解讀了徵象；選項 A（誘發性肺量計）在此時完全無效且會浪費時間；選項 C 雖然是治療的一環，但在「沈默胸腔」出現時，病人可能需要插管與緊急醫療介入，單純加藥已不足夠。此題測驗護理師識別病情惡化隱藏徵象的能力。
This question concerns the 'silent chest' pitfall in asthma assessment. During an acute asthma attack, the disappearance of wheezing along with diminished breath sounds does not indicate improvement; rather, it means that airway obstruction has become so severe that almost no air is moving (extremely low airflow). This is a life-threatening red flag of impending respiratory failure. The nurse must immediately activate emergency response (D). Option B misinterprets the finding; option A (incentive spirometry) is completely ineffective at this time and would waste time; and although option C is part of treatment, in a silent chest the client may require intubation and emergency medical intervention, and simply giving another dose is inadequate. This question tests the nurse's ability to recognize subtle signs of clinical deterioration.
美國 NCLEX 對於『Silent Chest』的定義非常嚴謹，是最高優先級的呼吸急症。台灣臨床實務中，護理師在發現呼吸音變弱時也應具有此警覺，但有時會誤以為病人安靜下來是藥物起效，這是考試中必須排除的錯誤邏輯。