一位有酗酒史的病人因食道靜脈曲張入院。護理師應避免哪項行動？

此題的核心概念是食道靜脈曲張（esophageal varices）病人的護理禁忌，特別是避免任何可能導致曲張靜脈破裂出血的侵入性操作。食道靜脈曲張通常發生在有肝硬化（liver cirrhosis）和門脈高壓（portal hypertension）病史的病人，如長期酗酒者。這些曲張的靜脈壁薄且脆弱，極易因壓力增加或機械性損傷而破裂，導致大量上消化道出血，這是一種危及生命的急症。 正確答案 C (Inserting a nasogastric (NG) tube) 是護理師應避免的行動。將鼻胃管插入食道時，其機械性摩擦或壓力可能會直接損傷脆弱的食道靜脈曲張，導致其破裂並引發嚴重出血。因此，對於已知或疑似有食道靜脈曲張的病人，除非有非常明確且緊急的醫療指徵，否則應避免放置鼻胃管。 臨床思路：護理師在照顧食道靜脈曲張病人時，應以預防出血為最高優先。除了避免插入鼻胃管，還應衛教病人避免用力咳嗽、嘔吐、便秘用力排便等增加腹壓的行為。監測生命徵象、觀察有無出血跡象（如黑便、吐血），並準備好處理出血的藥物和設備，都是護理師的重要職責。在美國，護理師在執行侵入性操作前，必須全面評估病人的病史和風險，確保病人安全。

The core concept is the nursing contraindications for clients with esophageal varices, especially avoiding any invasive procedure that could cause variceal rupture and bleeding. Esophageal varices typically occur in clients with cirrhosis and portal hypertension, such as those with chronic alcohol abuse. The walls of these varices are thin and fragile and rupture easily from increased pressure or mechanical injury, leading to massive upper GI bleeding, a life-threatening emergency. The correct answer, C (Inserting a nasogastric (NG) tube), is the action the nurse should avoid. Passing an NG tube through the esophagus can directly traumatize the fragile varices through mechanical friction or pressure and cause rupture and severe hemorrhage. For known or suspected esophageal varices, NG tube placement should be avoided unless there is a clear and urgent medical indication. Clinical reasoning: when caring for a client with esophageal varices, bleeding prevention is the top priority. In addition to avoiding NG tube insertion, teach the client to avoid forceful coughing, vomiting, and straining during defecation, all of which raise intra-abdominal pressure. Monitoring vital signs, watching for signs of bleeding (melena, hematemesis), and being prepared with medications and equipment to manage hemorrhage are all important nursing responsibilities. In the US, nurses must thoroughly assess the client's history and risks before any invasive procedure to ensure safety.