一位 45 歲患有廣泛性焦慮症的病人，出現心跳過速與呼吸困難。哪項護理介入是最高優先級？
A 45-year-old client with a history of generalized anxiety disorder presents with rapid heart rate and difficulty breathing. Which nursing intervention is the highest priority?
- AInstruct the client to breathe into a paper bag指導個案用紙袋呼吸
- BRemain with the client and provide calm, clear communication✓ 正解留在個案身邊並提供平靜、清晰的溝通
- CInitiate a referral to a psychiatrist啟動精神科轉介
- DAdminister an as-needed benzodiazepine給予處方用(benzodiazepine)苯二氮平類藥物
面對焦慮發作（panic attack）的病人，首要任務是提供安全且穩定的環境，護理師保持冷靜陪伴可降低病人對失控的恐懼，這是緩解焦慮的基石。使用紙袋呼吸已不建議，因可能導致缺氧。藥物給予與轉介諮商皆為後續處置，非急性期的第一要務。
For a client experiencing a panic attack, the first priority is to provide a safe and stable environment; the nurse's calm presence reduces the client's fear of losing control, which is the foundation of relieving anxiety. Paper bag breathing is no longer recommended because it can cause hypoxia. Medication administration and referral for counseling are subsequent interventions and not the first priority during the acute phase.
美國護理師常主導執行危機介入（Crisis intervention）；台灣臨床通常優先請醫師評估是否給藥。