護理師協助一位術後活動受限的病人首次坐於床緣。護理師的首要行動為何？
A nurse is assisting a client with limited mobility to sit at the edge of the bed for the first time after surgery. What should be the nurse's priority action?
- AEncourage the client to stand up quickly to increase blood flow鼓勵個案快速站起以增加血流
- BAssist the client to dangle their feet for a few minutes✓ 正解協助個案將雙腳懸垂幾分鐘
- CCall for another nurse to assist with the transfer呼叫另一位護理師協助轉移
- DPerform passive range of motion exercises first先執行被動關節活動運動
術後病人首次坐於床緣（Dangling），最主要的風險是姿位性低血壓（Orthostatic hypotension）。由於術後臥床過久，血管收縮功能減弱，快速改變體位易導致腦部灌流不足而暈厥。懸垂雙腳能讓病人適應體位變化，同時給予護理師評估的機會（觀察是否有頭暈、臉色蒼白）。若個案穩定，才可進行後續轉位。
When a post-operative client sits at the edge of the bed for the first time (dangling), the main risk is orthostatic hypotension. Because of prolonged bed rest after surgery, vascular constriction is impaired, and rapid changes in position can cause cerebral hypoperfusion and syncope. Dangling the legs allows the body to adjust to position change and gives the nurse an opportunity to assess (observing for dizziness and pallor). Only if the client remains stable can subsequent transfer occur.