護理師照顧一位懷疑中風的病患，下列哪項評估結果需要立即通報醫師？
A nurse is managing the care of a client with a suspected stroke. Which assessment finding requires the nurse to notify the physician immediately?
- APresence of facial drooping出現面部下垂
- BA decline in the Glasgow Coma Scale score✓ 正解格拉斯哥昏迷量表（GCS）分數下降
- CDifficulty swallowing liquids難以吞嚥液體
- DBlood pressure 150/90 mmHg血壓 150/90 mmHg
中風病人病情變化的關鍵在於神經功能惡化。GCS 分數下降代表腦水腫加劇、顱內壓升高或缺氧持續惡化，是極為緊急的警訊。BP 150/90 在急性期可能為維持腦灌流的代償反應；吞嚥困難與顏面歪斜則是中風的常見症狀，需處理但不如意識狀態惡化來得緊急。
The critical factor in monitoring stroke clients is neurologic deterioration. A decreasing GCS score indicates worsening cerebral edema, rising intracranial pressure, or persistent hypoxia, and is an extremely urgent warning sign. A blood pressure of 150/90 in the acute phase may represent a compensatory response that maintains cerebral perfusion; dysphagia and facial droop are common stroke manifestations that must be managed but are not as urgent as worsening level of consciousness.
美國醫院強調整體神經監測儀的使用；台灣臨床評估 GCS 仍為主流，且對意識變化的重視程度極高。