— 心理社會完整性 · MEDIUM · MCQ —
一位被診斷為創傷後壓力症候群 (PTSD) 的個案。為促進心理社會完整性，護理師應優先執行哪項措施？
A client is diagnosed with post-traumatic stress disorder (PTSD). Which nursing intervention should the nurse prioritize to foster psychosocial integrity?
- AChallenge the client's distorted perceptions of the event immediately.立即挑戰病人對該事件的扭曲認知。
- BAdminister PRN anxiolytics before every therapy session.在每次治療前給予需醫師處方的鎮靜劑。
- CEstablish a consistent and predictable environment to promote a sense of safety.✓ 正解建立一致且可預測的環境，以促進安全感。
- DEncourage the client to discuss the details of the traumatic event daily.鼓勵病人每天討論創傷事件的細節。
— Explanation · 中文詳解 —
PTSD 患者的核心需求是安全感與穩定感。在疾病初期或急性期，強迫回憶創傷細節可能導致二度創傷（D錯誤）。營造一個可預期、結構化的環境，能降低其對於突發外在刺激的過度反應，這是心理復原的重要基礎。挑戰認知扭曲（A）應在建立穩定關係後進行，而非優先事項。
PTSD clients need safety and stability above all. Forcing trauma recall early can re-traumatize (A wrong). A predictable, structured environment lowers hyperarousal and is a foundation for psychological recovery. Cognitive restructuring (A) belongs to later phases after a therapeutic alliance is built, not the initial priority.
✦ 台美臨床差異
美國護理模式強調結構化環境的建立；台灣多由精神專科醫師主導藥物治療，心理層面的護理介入常受限於人力結構。