— 照護管理 · HARD · MCQ —
一位護理師正在接收入院一位有中風病史的病人。哪項評估發現需要立即報告？
A nurse is admitting a client with a history of stroke. Which assessment finding requires immediate reporting?
- AArm drift.手臂無力下垂
- BFacial droop.臉部下垂
- CLeg weakness.腿部無力
- DSudden difficulty speaking or understanding.✓ 正解突然說話困難或理解障礙
— Explanation · 中文詳解 —
中風（Stroke）病人的神經功能評估至關重要。言語障礙（Speech deficit）或理解力突然改變，通常暗示大腦語言中樞（如布若卡氏區 Broca's area 或韋尼克氏區 Wernicke's area）的血流灌注異常。相較於肢體無力（可能是慢性症狀），言語功能的急性惡化往往是病情急劇變化的警訊，需立即啟動 Stroke Alert 進行腦部影像評估。
Neurologic assessment is critical in a client with stroke. A sudden change in speech or comprehension typically suggests abnormal perfusion to a language center of the brain (such as Broca's or Wernicke's area). Compared with limb weakness, which may be a chronic finding, acute deterioration of speech function is often a sign of rapid clinical change and requires immediate activation of a Stroke Alert for brain imaging.