頸動脈內膜切除術後，哪項評估發現最令人擔心？

此題旨在評估護理師對於頸動脈內膜切除術（carotid endarterectomy）術後潛在併發症的識別能力，特別是那些可能危及病人生命的緊急情況。頸動脈內膜切除術是為了清除頸動脈斑塊以預防中風的手術。術後最令人擔憂的併發症之一是頸部出血或血腫形成，這可能壓迫氣道，導致呼吸困難。 正確答案 C (Increased neck circumference and stridor) 是最令人擔心的評估發現。頸部周圍增加（Increased neck circumference）提示頸部可能發生血腫或水腫，而喘鳴音（stridor）則是上呼吸道阻塞的徵兆。這兩者結合起來，強烈暗示氣道受到壓迫，可能導致呼吸窘迫甚至窒息，這是一種醫療急症，需要立即介入。護理師必須將維持病人呼吸道通暢（Airway）作為最高優先事項。 臨床思路：在頸動脈內膜切除術後，護理師應密切監測病人的呼吸狀態、頸部腫脹情況和聲音變化。任何呼吸困難、喘鳴、吞嚥困難或頸部快速腫脹的跡象都應立即報告醫師。護理師應隨時準備應對氣道危機，包括準備氣管插管或氣管切開術所需的設備。此外，術後血壓管理也至關重要，因為血壓過高可能增加出血風險，過低則可能影響腦部灌流。

This question evaluates the nurse's ability to recognize potential post-operative complications after carotid endarterectomy, especially those that may be life-threatening. Carotid endarterectomy is performed to remove plaque from the carotid artery to prevent stroke. One of the most worrisome post-operative complications is neck bleeding or hematoma formation, which can compress the airway and cause respiratory distress. The correct answer C (Increased neck circumference and stridor) is the most concerning assessment finding. Increased neck circumference suggests neck hematoma or edema, while stridor signals upper airway obstruction. Together they strongly suggest airway compression, possibly leading to respiratory distress or asphyxiation — a medical emergency requiring immediate intervention. The nurse must prioritize maintaining airway patency (Airway) as the highest priority. Clinical reasoning: After carotid endarterectomy, the nurse should closely monitor respiratory status, neck swelling, and voice changes. Any signs of respiratory difficulty, stridor, dysphagia, or rapid neck swelling must be reported to the physician immediately. The nurse should be prepared to manage an airway emergency, including readying intubation or tracheostomy equipment. Postoperative blood pressure management is also critical — hypertension increases bleeding risk while hypotension may impair cerebral perfusion.