一位28歲女性個案近期遭受嚴重的右脛骨骨折並已打上石膏，目前正在接受腋下拐杖的正確使用衛教。護理師正在指導她如何在沒有扶手的情況下安全地「上樓梯」。護理師應衛教病患『上』樓梯時最先執行的動作順序為何？
A 28-year-old female client, who recently suffered a severe right tibial fracture and has a cast applied, is being educated on the proper use of axillary crutches. The nurse is instructing her on how to safely ascend a flight of stairs without a handrail. What is the correct sequence of movements the nurse should teach the client to perform first to go UP the stairs?
- ATransfer body weight entirely onto the crutches, then step up with the uninjured left leg first.✓ 正解將體重完全轉移至拐杖上，然後先用未受傷的左腳踏上階梯。
- BSimultaneously lift the left leg and both crutches onto the higher step to maintain immediate balance.同時將左腳和兩支拐杖抬起至較高的階梯上，以保持即時平衡。
- CPlace both crutches securely on the higher step first, then hop up with the uninjured left leg.先將兩支拐杖穩固地放置在較高的階梯上，然後用未受傷的左腳跳上去。
- DStep up with the injured right leg first to clear the step, followed by the left leg and crutches.先用受傷的右腳踏上階梯，接著再上左腳和拐杖。
本題測驗基礎照護中的安全輔具活動（Mobility with assistive devices）。拐杖上下樓梯的世界通用原則是：「好腳上天堂，壞腳下地獄（Up with the good, Down with the bad）」。當病患要『上樓梯（Ascending）』時，首要動作是將雙手的重量穩穩支撐在原本階梯的拐杖上，接著先將『未受傷的好腳（Uninjured leg，此例為左腳）』踏上較高一階（選項A正確）。當好腳踏穩後，再將重心轉移到好腳上，最後把『雙側拐杖與受傷的壞腳』一起提上來。選項C錯誤，如果先將拐杖放上階梯，病患身體重心會前傾，此時若在下方以好腳起跳，極容易失去平衡而向後摔落致命。選項D錯誤，先用受傷的壞腳（此例為右腳）上樓梯會使其無法支撐向上提舉的重量，導致劇痛與跌倒。選項B同時移動好腳與拐杖會完全喪失三角支撐力而直接摔倒。
This item tests basic care of safe mobility with assistive devices. The universal principle for ascending and descending stairs with crutches is: "Up with the good, down with the bad." When the client is ascending stairs, the first action is to stabilize body weight through both hands on the crutches resting on the lower step, and then advance the uninjured (good) leg (the left leg in this example) onto the higher step (option A is correct). Once the good leg is firmly planted, the weight is shifted onto it, and the crutches together with the injured (bad) leg are then lifted onto the same step. Option C is incorrect: placing the crutches on the upper step first shifts the center of gravity forward, and pushing off below with the good leg would easily cause loss of balance and a potentially fatal backward fall. Option D is incorrect: leading with the injured (bad) leg (the right leg in this example) is unable to support the upward lift of the body weight, producing severe pain and a fall. Option B, moving the good leg and the crutches together, abolishes the tripod support and causes an immediate fall.
世界級復健醫學鐵律。台灣的復健護理師與病房教學中，口訣「好人上天堂，壞人下地獄」與美國 NCLEX 的 'Up with the good, down with the bad' 完全字對字意譯相通。