一位 45 歲患有廣泛性焦慮症的病人出現呼吸急促、心跳過速及瀕死感。護理師應優先採取哪項行動？
A 45-year-old client with a history of generalized anxiety disorder presents with rapid breathing, tachycardia, and a sense of impending doom. Which action is the priority for the nurse?
- AAdminister an as-needed benzodiazepine給予處方備用苯二氮平類藥物
- BPerform a physical examination to rule out cardiac issues進行身體檢查以排除心臟問題
- CInstruct the client to breathe into a paper bag指示病人對著紙袋呼吸
- DStay with the client and provide calm, clear reassurance✓ 正解陪伴病人並提供平靜、清晰的安慰
核心概念：處理廣泛性焦慮症（Generalized Anxiety Disorder, GAD）急性發作（恐慌發作，Panic Attack）的優先護理措施。 為何正確答案對： C. 病人出現呼吸急促、心悸、瀕死感等症狀，顯示其處於高度焦慮狀態。護理師應立即在病人身邊提供穩定、支持性的陪伴，創造一個平靜、低刺激的環境。護理師的臨在（Presence）與鎮靜的態度本身就是一種重要的介入，能幫助病人感到安全，逐漸緩和其恐慌情緒。 為何其他選項錯： C. 紙袋呼吸（Breathing into a paper bag）在過去用於治療過度換氣，但現已不被推薦，因為可能導致二氧化碳滯留，加劇缺氧感，甚至引起暈厥。對於恐慌發作，其效果與安全性均存疑。 B. 雖然病人有焦慮症病史，但立即給予鎮靜藥物（Benzodiazepine）並非首要措施。在藥物介入前，應先透過非藥物性支持穩定病人情緒，並評估其臨床狀況。藥物使用需經醫師處方與評估。 D. 雖然排除心臟問題很重要，但在病人急性恐慌發作時，首要任務是處理其當前的心理生理極度不適，確保其安全感。進行詳細的身體評估應在病人情緒較為穩定後進行，或同時由其他醫護人員協調進行，而非作為當下最優先的護理行動。
Priority care for an acute anxiety episode (panic attack) in GAD: The client's tachypnea, tachycardia, and sense of impending doom indicate severe anxiety. The nurse should remain with the client providing calm, supportive presence in a low-stimulation environment. Therapeutic presence itself is a critical intervention that fosters safety and de-escalates panic. Paper bag breathing (C) is no longer recommended (risk of hypoxia). Medications (A) are secondary to nonpharmacological support. Physical exam (B) is important but not the immediate priority during acute panic.