— 安全與感染控制 · MEDIUM · MCQ —
護理師需優先照顧哪位病人？
A nurse is prioritizing care for several clients. Which client should the nurse see first?
- AA client with a routine scheduled medication due 30 minutes ago常規用藥已過期 30 分鐘的病人
- BA client with a history of MRSA who requires a wound dressing change有 MRSA 病史且需要更換傷口敷料的病人
- CA client with a fever of 38.5C (101.3F) and a new order for blood cultures體溫 38.5°C (101.3°F) 且有新開血液培養醫囑的病人
- DA client with a sudden onset of dyspnea and SpO2 of 88%✓ 正解突發呼吸困難且 SpO2 為 88% 的病人
— Explanation · 中文詳解 —
NCLEX 考試中，處理多位病人的優先順序必須嚴格遵循 ABC 原則（氣道 Airway、呼吸 Breathing、循環 Circulation）以及 Maslow 的需求層次理論。突發呼吸困難伴隨低血氧（SpO2 88%）顯示病人處於急性呼吸窘迫或潛在的肺栓塞（PE）風險，直接威脅生命，必須優先評估與處置。其他選項雖重要，但均非立即危及生命。
On the NCLEX, prioritization among multiple clients must strictly follow the ABC principle (Airway, Breathing, Circulation) and Maslow's hierarchy of needs. Sudden onset dyspnea with hypoxemia (SpO2 88%) indicates acute respiratory distress or potential pulmonary embolism (PE), directly threatening life, and must be evaluated and managed first. The other options are important but are not immediately life-threatening.