一位腫瘤科護理師正在照顧一位最近被診斷出罹患第四期乳癌的 45 歲女性。在與她的腫瘤科醫師諮詢完關於安寧化療的選項後，醫師離開了病房。病患轉向護理師，哭泣著說：『他用了好多深奧的醫學詞彙。我的第四期診斷是代表我已經絕對沒有存活的機會，而且很快就會死了嗎？』護理師最恰當的處置為何？
An oncology nurse is caring for a 45-year-old female client recently diagnosed with stage IV breast cancer. Following a consultation with her oncologist regarding palliative chemotherapy options, the physician leaves the room. The client turns to the nurse, crying, and says, 'He used so many big medical words. Does my stage IV diagnosis mean I have absolutely no chance of surviving and will die soon?' What is the most appropriate action by the nurse?
- AExplain the exact statistical five-year survival rates for stage IV breast cancer comprehensively to the client.向病人全面說明第四期乳癌的確切五年存活率統計數據。
- BAcknowledge her profound fear of dying and ask her to express exactly what she understood from the conversation.肯定她對死亡的深切恐懼，並詢問她從對話中具體理解了什麼。
- CContact the oncologist immediately and request that they return to deeply clarify the clinical prognosis with the client.✓ 正解立即聯絡腫瘤科醫師，請求其返回與病人深入澄清臨床預後。
- DReassure her immediately that modern medicine possesses miracle cures and gently encourage her to fight strongly.立即安慰她現代醫學擁有奇蹟療法，並溫和地鼓勵她奮力對抗。
本題測驗專業界線與護理倡導 (Client Advocacy / Interdisciplinary Team / Ethical Boundaries)。當病患針對「存活率 (prognosis)」、「診斷 (diagnosis)」或「手術確切風險」提出直接疑問，且明顯表現出他們對醫師剛才的解釋感到困惑與誤解時，護理師的法律與倫理底線是：不可以超越職權 (out of scope of practice) 去代替醫師做疾病預後的解釋宣判。第四期癌症的預後解釋極為複雜且敏感，這專屬醫療提供者（Provider/Physician）的法定職責。因此，護理師最精準、合法的行動是「把離開的醫師叫回來重新解釋，並陪伴在側確認病患理解（選 C 正確）」。選項 D 的「保證會有奇蹟」是殘酷的虛假安慰 (False reassurance)。選項 A 護理師向病患報出存活率統計數字已經嚴重越權，且數字缺乏醫師的整體臨床考量，易造成極端恐慌。選項 B 雖然看似是一套標準的開放式治療性溝通，但在這個情境中，病患的「認知缺口」是來自於聽不懂剛剛的醫學詞彙，首要任務是先找醫師來填補這項對抗癌症的關鍵醫療資訊。
This question tests professional boundaries and nursing advocacy (Client Advocacy / Interdisciplinary Team / Ethical Boundaries). When a client asks direct questions about survival rates (prognosis), diagnosis, or precise surgical risks and clearly appears confused or misunderstands the physician's explanation, the nurse's legal and ethical baseline is: do not exceed scope of practice by replacing the physician in interpreting the disease prognosis. Explaining prognosis in stage IV cancer is highly complex and sensitive and is exclusively the legal responsibility of the provider/physician. Therefore the most accurate and lawful action is to 'call the physician back to re-explain and remain with the client to confirm understanding (option C is correct).' Option D's 'reassurance of miracle' is cruel false reassurance. Option A – quoting survival statistics – exceeds the nurse's scope, and the numbers lack the physician's overall clinical context and may cause extreme panic. Option B, while appearing to be a standard open-ended therapeutic communication, is inappropriate here because the client's cognitive gap arose from not understanding the medical terminology just used; the first task is to bring the physician back to fill that critical medical information gap.
不管在台灣還是美國，護士不能跟病人報「你剩幾個月可以活（Prognosis）」，那是一定會被家屬告上法院的。只要家屬或病人聽不懂醫生的病情解釋，護理師的唯一解答就是：call 醫生回來重講！