護理師照護一位患有慢性阻塞性肺病（COPD）且正以鼻導管接受 2 L/min 氧氣治療的病人。護理師發現病人的呼吸速率從每分鐘 20 次下降到 10 次，且變得嗜睡。護理師應優先採取哪項行動？
A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) who is receiving oxygen at 2 L/min via nasal cannula. The nurse notes the client's respiratory rate has decreased from 20 to 10 breaths/min and the client is becoming lethargic. Which action should the nurse take first?
- AIncrease the oxygen flow rate to 4 L/min將氧氣流量增加至 4 L/min
- BStop the oxygen and re-evaluate停止氧氣並重新評估
- CPerform a neurological assessment進行神經系統評估
- DNotify the rapid response team✓ 正解通知快速反應小組
這題描述的是典型的「CO2 滯留與呼吸抑制」。部分末期 COPD 病人依賴低氧驅動（hypoxic drive）來維持呼吸。當給予過多氧氣時，血氧升高會使呼吸中樞失去刺激，導致通氣不足，進而引發 CO2 蓄積（CO2 narcosis），臨床表現為呼吸減慢與意識狀態改變（嗜睡）。此時病人已處於急性呼吸衰竭邊緣，這是一個緊急狀況（Medical Emergency）。單純降低氧氣（B）可能讓已衰竭的病人血氧更低；增加氧氣（A）會加重抑制。優先行動應是啟動緊急醫療應變（如快速反應小組），準備提供通氣支持（如 BiPAP 或插管）。
This scenario describes the classic picture of CO2 retention and respiratory depression. Some clients with end-stage COPD rely on a hypoxic drive to maintain respiration. When excessive oxygen is administered, rising oxygen levels remove the stimulus to the respiratory center, leading to hypoventilation, CO2 accumulation, and CO2 narcosis, clinically manifested as a slowing respiratory rate and altered level of consciousness (lethargy). At this point the client is on the verge of acute respiratory failure, which is a medical emergency. Simply lowering the oxygen (B) may worsen hypoxemia in a client whose ventilation is already failing; increasing the oxygen (A) further suppresses respiration. The priority action is to activate emergency assistance such as the rapid response team and to prepare for ventilatory support (such as BiPAP or intubation).
美國 NCLEX 強調護理師在發現病人病情變化（Change in condition）時應具備啟動 RRT 的自主權；台灣臨床通常會先試著叫醒病人、測量 SpO2 並立即打電話給值班醫師，流程較偏向階層式回報。