急診室通報內外科病房，即將湧入大量傷患，要求必須立即清空至少一張病床。護理長應建議將下列哪一位病患進行最迅速的出院手續或轉往低配備照護機構？
The emergency department alerts the medical-surgical unit that an impending surge of mass-casualty victims requires the immediate availability of at least one bed. Which patient should the charge nurse recommend for the promptest discharge or transfer to a lower-acuity facility?
- AA 24-year-old postoperative day 1 after a laparoscopic appendectomy, afebrile, pain controlled with oral analgesics.✓ 正解24歲，腹腔鏡闌尾切除術後第一天，無發燒，口服止痛藥即可控制疼痛。
- BA 54-year-old with heart failure who was weaned off BiPAP yesterday, current SpO2 93%.54歲，患有心力衰竭，昨日已脫離BiPAP（雙水平正壓呼吸器），目前SpO2為93%。
- CA 40-year-old admitted for unstable angina who experienced chest tightness relieved by PRN nitroglycerin last night.40歲，因不穩定型心絞痛入院，昨晚曾出現胸部緊縮感，經PRN（按需）硝酸甘油緩解。
- DA 68-year-old on day 3 of IV antibiotics for pneumonia, currently Febrile at 38.3°C (100.9°F) with purulent sputum.68歲，肺炎接受靜脈注射抗生素治療第3天，目前發燒38.3°C（100.9°F），並有膿性痰。
本題測驗大量傷患災難情況下的病床管理與轉出優先順序。當需要緊急騰出病床時，護理師必須挑選生理狀況最穩定（Most Stable）、治療已接近完成、且轉出後惡化風險最低的病患。選項B的病患剛從非侵入性呼吸器脫離，隨時有體液再度積聚於肺部的風險；選項D仍在發燒且有黃綠色濃痰，顯示感染未受控，需持續靜脈抗生素治療；選項C患有不穩定性心絞痛，且昨夜才發作過，隨時有爆發心肌梗塞的致命危險。選項A的闌尾炎術後病患目前體溫正常（無感染跡象），且已過渡至口服止痛藥（顯示腸胃道恢復且疼痛控制良好），是唯一達到完全穩定並適合提早出院的病患。
This item tests bed management and discharge prioritization in a mass-casualty situation. When beds must be cleared urgently, the nurse must choose the most physiologically stable patient whose treatment is nearly complete and whose risk of deterioration after discharge is lowest. The patient in option B has just been weaned from noninvasive ventilation and is at ongoing risk of fluid re-accumulating in the lungs; the patient in option D still has a fever and yellow-green purulent sputum, indicating uncontrolled infection that requires continued IV antibiotics; the patient in option C has unstable angina and had another episode the previous night, putting them at imminent risk of a life-threatening myocardial infarction. The patient in option A, who is postoperative for appendicitis, is currently afebrile (no signs of infection) and has been transitioned to oral analgesics (indicating that GI function has returned and pain is well controlled), making this the only patient who is fully stable and suitable for early discharge.
台灣與美國在面臨急診滿床或災難調度時的「出院判定邏輯」是一致的。此類型管理題強調的生命徵象穩定度與疼痛藥物轉換（從 IV 轉為 PO）皆為全球標準化的出院指標。