一名患有思覺失調症的病人出現聽幻覺，聲稱「聲音叫我去傷害自己」。護理師的優先處置為何？
A client with schizophrenia is experiencing auditory hallucinations, stating that 'the voices are telling me to hurt myself.' Which action is the priority for the nurse?
- APlace the client in a quiet, low-stimulation environment將病人安置在安靜、低刺激的環境中
- BImplement suicide precautions and ensure safety✓ 正解實施自殺預防措施並確保安全
- CAsk the client what the voices are saying詢問病人聲音說了什麼
- DAdminister the prescribed PRN antipsychotic medication給予處方中的 PRN 抗精神病藥物
當思覺失調症（Schizophrenia）病人出現命令式幻覺（Command Hallucinations）且內容涉及自我傷害時，護理師的首要任務是「確保病人安全」。根據護理優先順序，安全（Safety）永遠是第一位。在病人處於急性危險狀態時，應立即啟動自殺防範措施（Suicide Precautions），包括移除危險物品、加強監測，必要時安排一對一照護，防止幻覺演變為實際行動。
When a client with schizophrenia experiences command hallucinations directing self-harm, the nurse's first priority is to 'ensure the client's safety.' According to nursing priority frameworks, safety always comes first. When the client is in acute danger, suicide precautions must be implemented immediately, including removing dangerous objects, increasing monitoring, and arranging one-to-one observation if needed, to prevent the hallucinations from being acted upon.