一位病人甲狀腺切除術後 2 小時，護理師發現病人出現哮鳴聲與呼吸窘迫。護理師應優先採取哪項措施？
A nurse is assessing a client who is 2 hours postoperative following a thyroidectomy. The nurse notes the client has developed stridor and respiratory distress. Which action is the priority?
- ACall for emergency assistance and prepare for airway management✓ 正解呼叫緊急協助並準備氣道管理
- BPlace the client in high-Fowler's position將病人置於半坐臥位（High-Fowler's position）
- CCheck the surgical dressing for signs of hemorrhage檢查手術敷料是否有出血跡象
- DAdminister an IV analgesic靜脈注射止痛藥
甲狀腺切除後發生哮鳴音強烈暗示氣管受壓（常見於頸部血腫），這是致命的氣道阻塞徵兆。優先處理 ABC 原則，必須立即呼救並準備緊急插管或氣切包，防止窒息。其餘選項如升高床頭雖有幫助但非第一首選，檢查敷料則是次要步驟。
Stridor after thyroidectomy strongly suggests tracheal compression (commonly from a neck hematoma), which is a life-threatening sign of airway obstruction. The ABC principle takes priority: emergency assistance must be called immediately and preparations made for emergency intubation or a tracheostomy kit in order to prevent asphyxiation. Other options, such as elevating the head of the bed, are helpful but are not the first choice, and checking the dressing is a secondary step.
美國護理師對氣道處理有更明確的緊急授權與急救車使用權限；台灣通常需立即通知麻醉科醫師與外科醫師介入。