一位50歲被診斷為身體症狀障礙症（疑病症）的女性來訪精神科門診。過去六個月內她已進行了三次皆顯示正常的腦部核磁共振，但仍堅定地深信自己患有一顆未被發現的晚期腦瘤。當正在量血壓時，她倒抽一口氣說：「看！我的小指剛才抽動了一秒鐘！這絕對是腦瘤壓迫神經的確鑿證據。我需要立刻進行急診電腦斷層！」護理師最恰當的處置為何？
A 50-year-old female with Somatic Symptom Disorder visits the mental health clinic. She has undergone three normal brain MRIs in the past six months but remains thoroughly convinced she has an undetected, terminal brain tumor. While taking her blood pressure, she gasps, "Look! My pinky finger just twitched for a second! This is absolute, definitive proof that the brain tumor is pressing on a nerve. I need a stat CT scan immediately!" What is the most appropriate action by the nurse?
- ASpend the next 20 minutes meticulously examining the twitched pinky finger and discussing the intricate neural pathways of the hand with her.花費接下來的 20 分鐘仔細檢查抽動的小指，並與她討論手部複雜的神經路徑。
- BImmediately alert the provider and advocate for an expedited CT scan to ensure her complaints are comprehensively investigated.立即通知醫師並倡議安排加速的電腦斷層掃描，以確保她的抱怨得到全面調查。
- CPerform a brief, neutral review of the reported physical symptom to rule out an emergency, then attempt to redirect the conversation to her current emotional stressors.✓ 正解對報告的生理症狀進行簡短、中立的檢視以排除急症，然後嘗試將對話轉移至她目前的情緒壓力源。
- DInform her abruptly that she is faking the symptom for attention and that her medical charts prove she does not have cancer.直接告知她為了尋求注意而在裝病，且她的病歷證明她沒有癌症。
本題測驗對於身體症狀障礙症 (Somatic Symptom Disorder) 的治療性與界限設定（Limit-setting）溝通。罹患此類精神疾病的個案，並非刻意裝病（不是 Malingering 或 Munchausen）。他們的焦慮會透過被他們放大、災難化的身體輕微變化來投射（如小指抽動）。護理重點在於：首先，必須始終保持警覺，即使有精神病史，絕不能武斷忽略新的主訴（因病患仍可能發生真正的中風），因此必須簡短、中立地進行客觀評估。當排除急性危險之後，為了避免提供「次發性獲益 (Secondary gain，例如過多的關注與檢查)」，護理師必須立刻將話題引導離開（Redirect）無止盡的身體症狀，並強行轉向探討她生活中的現實心理壓力（選項C正確）。選項B（一直幫她安排檢查）或選項A（鉅細靡遺關注她的手指）正是該疾病所渴求的次發獲益，會直接滋養且惡化她的恐懼；選項D則完全缺乏同理心，指責病患裝病會徹底破壞護病關係。
This question tests therapeutic communication and limit-setting for Somatic Symptom Disorder. Clients are not malingering or feigning illness; their anxiety is projected as catastrophized minor bodily changes (e.g., a pinky twitch). Nursing care must: first remain vigilant—never dismissively ignore new complaints, since real medical issues (e.g., stroke) can still occur—so a brief, neutral objective assessment is required. Once acute danger is ruled out, the nurse must avoid reinforcing secondary gain (excessive attention/testing) by redirecting away from endless somatic complaints toward emotional stressors (C). Option B (relentless additional testing) and A (extensive focus on the twitch) feed secondary gain. Option D (accusing the client of faking) lacks empathy and destroys rapport.
面對疑病症，全球最經典的考題標準都是「Brief check then redirect (簡短檢查後轉移話題)」。你不能完全忽視他（誰知道他是不是剛好真的心肌梗塞），但也不能跟著他的妄想一起深入檢查病況。