一名慢性阻塞性肺病（COPD）病患正透過鼻導管接受每分鐘 2 公升的氧氣治療。護理師發現病患變得嗜睡且難以喚醒。護理師應首先採取哪項行動？
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at 2 L/min via nasal cannula. The nurse finds the client lethargic and difficult to arouse. Which action should the nurse take first?
- APrepare to administer a dose of methylprednisolone準備給予甲基潑尼松龍劑量
- BPerform a fingerstick glucose test進行指尖血糖測試
- CAssess the client's respiratory rate and depth✓ 正解評估病人的呼吸頻率與深度
- DIncrease the oxygen flow rate to 4 L/min將氧氣流量增加至每分鐘 4 公升
COPD 病人若氧氣濃度過高，可能抑制其缺氧驅動呼吸（hypoxic drive），導致二氧化碳滯留（CO2 Narcosis）。意識改變（嗜睡、混亂）是 CO2 蓄積導致中毒的早期紅旗。在採取任何介入前，護理師應先「評估」（Assessment First），確認呼吸是否變淺慢。若確實呼吸抑制，則需降低氧氣濃度或準備通氣支持。雖然低血糖（B）也可能導致意識改變，但根據病史，呼吸抑制是更直接相關且致命的風險，必須先釐清呼吸狀態。增加氧氣（D）會使情況惡化。
When the oxygen concentration is too high in a client with COPD, the hypoxic drive may be suppressed, leading to CO2 retention (CO2 narcosis). Changes in consciousness (lethargy, confusion) are early red flags of CO2 accumulation and toxicity. Before any intervention, the nurse should first assess — confirming whether respirations have become shallow and slow. If respiratory depression is present, the oxygen concentration should be reduced or ventilatory support prepared. Although hypoglycemia (B) can also alter consciousness, given the client's history, respiratory depression is the more directly relevant and life-threatening risk and must be evaluated first. Increasing oxygen (D) would worsen the situation.
美國 NCLEX 對於 COPD 的 Hypoxic Drive 理論考察非常嚴謹；台灣臨床實務中，對於此類病患通常會直接使用血氧監測及動脈血氣分析（ABG）來佐證，護理師需具備判讀 Paco2 升高的能力。