— 心理社會完整性 · EASY · MCQ —
一位 45 歲患有廣泛性焦慮症的病人出現心悸、出汗和即將死亡的感覺。護理師應優先執行哪項措施？
A 45-year-old client with a history of generalized anxiety disorder presents with reports of palpitations, sweating, and feelings of impending doom. Which intervention should the nurse prioritize?
- AAdminister the prescribed PRN anxiolytic medication給予處方之按需（PRN）抗焦慮藥物
- BEncourage the client to discuss the stressors鼓勵病人討論壓力源
- CStay with the client in a quiet environment✓ 正解陪伴病人在安靜的環境中
- DPerform a comprehensive head-to-toe physical assessment執行全面性的頭到腳身體評估
— Explanation · 中文詳解 —
面對急性焦慮發作的病人，首要任務是提供安全且穩定的環境。陪伴能減少病人的無助感與恐懼，靜謐的環境可降低刺激，減緩激動狀態。在病人情緒平穩前，進行深入諮商或繁瑣檢查反而會增加病人的認知負擔，藥物則是輔助，非首選處置。
For a client in an acute anxiety attack, the priority is providing a safe and stable environment. The nurse's presence reduces helplessness and fear, and a quiet setting reduces stimulation and helps calm agitation. Before the client is calmer, in-depth counseling or detailed examinations increase cognitive burden; medication is adjunctive, not the first action.
✦ 台美臨床差異
美國護理師常需獨立評估焦慮程度並啟動非藥物護理；台灣臨床多由醫師開立抗焦慮藥物後由護理師執行，護理師衛教角色較重。