護理師照護一位患有嚴重慢性阻塞性肺病（COPD）且主訴入睡困難的病人。護理師應採取哪項措施？
The nurse is caring for a client with severe chronic obstructive pulmonary disease (COPD) who reports difficulty sleeping. Which intervention should the nurse implement?
- AEncourage the client to drink a glass of warm milk before sleep鼓勵病患睡前喝一杯溫牛奶
- BAdminister the prescribed PRN dose of lorazepam at bedtime睡前給予處方之備用劑量勞拉西泮
- CIncrease the oxygen flow rate by 2 L/min during the night夜間將氧氣流量增加2 L/min
- DAssist the client into a high-Fowler's position with pillows to support the arms✓ 正解協助病患採高福氏臥位並以枕頭支撐雙臂
COPD 病人的睡眠困難通常源於生理上的呼吸費力（Orthopnea）。採取高半坐臥位（High-Fowler's）並利用枕頭支撐雙臂，可以增加肺部擴張空間，降低橫膈膜受腹部臟器的擠壓，從而減輕呼吸功，這才是「治本」的舒適護理。選項 B 是極大禁忌，苯二氮平類藥物（Lorazepam）會抑制呼吸中樞，對 COPD 病人可能導致致命的 CO2 滯留；A 選項雖然有助眠傳聞，但奶類可能增加痰液黏稠度，非首選；C 選項盲目調高氧氣會抑制 COPD 的缺氧驅動呼吸。護理師應運用非藥物措施改善呼吸力學，這是 Basic Care 的最高境界：安全且生理友善。
Sleep difficulty in clients with COPD typically stems from physiologic labored breathing (orthopnea). Placing the client in a high-Fowler's position with pillows supporting both arms increases lung expansion and reduces compression of the diaphragm by the abdominal organs, thereby decreasing the work of breathing; this is the true root-cause comfort intervention. Option B is a major contraindication: benzodiazepines (lorazepam) depress the respiratory center and may cause fatal CO2 retention in COPD clients. Although option A (warm milk) is popular as a sleep aid, milk may increase mucus thickness and is not a first choice. Option C, blindly increasing oxygen, can suppress the hypoxic respiratory drive in COPD. The nurse should use nonpharmacologic measures to improve respiratory mechanics, representing the highest standard of basic care: safe and physiologically appropriate.
美國 NCLEX 極度重視「呼吸抑制藥物」在肺病病人身上的風險（Safety priority）。台灣臨床上有時會因病人吵鬧而給予輕微鎮靜劑，但在國際考試中，這是必錯選項，護理師必須優先考慮體位與呼吸生理。