— 基本照護與舒適 · MEDIUM · MCQ —
護理師照護一名有癲癇史的病人。哪項舒適與安全措施是必要的？
A nurse is caring for a client with a history of seizures. Which comfort and safety measure is essential?
- APad the side rails of the bed✓ 正解為床欄加裝軟墊
- BRestrain the client's limbs during a seizure在癲癇發作期間約束病人肢體
- CPlace the client in a supine position during a seizure在癲癇發作期間將病人置於仰臥位
- DKeep a tongue blade at the bedside在床邊備妥壓舌板
— Explanation · 中文詳解 —
本題旨在考驗護理師對於癲癇（seizure）病人安全照護措施的了解。核心概念是預防病人在癲癇發作期間因撞擊或跌倒而受傷。癲癇發作時，病人可能出現全身性抽搐或意識喪失，導致頭部、四肢或其他身體部位與周圍環境發生碰撞。因此，護理師應採取預防措施，例如在床欄上加裝軟墊（padding the side rails），以減少病人撞擊硬物造成的傷害。同時，護理師也應清楚了解哪些措施是危險且不應採取的，例如在發作時將東西塞入病人嘴中或試圖限制其肢體活動。
Padding the side rails is essential to protect a client with a seizure history from trauma during convulsions. Restraining limbs or inserting objects into the mouth can cause fractures or airway obstruction, while side-lying positioning is preferred over supine to prevent aspiration.