內外科病房護理師同時照護四位病人，哪一位應優先進行評估？
A nurse on a medical-surgical floor is caring for four clients. Which client should the nurse assess first?
- AA client with diabetes mellitus requesting a bedtime snack患有糖尿病並要求睡前點心的病人
- BA client 2 days post-op with a temperature of 38.3°C術後第2天體溫38.3°C的病人
- CA client with COPD complaining of increased shortness of breath抱怨呼吸困難加重的COPD病人
- DA client with a new onset of sudden confusion and restlessness✓ 正解新發突發性意識混亂與躁動的病人
多病人優先順序需綜合 ABC 原則與「突發 vs 已知慢性」判斷：D「新發突發混亂與躁動」可能反映腦缺氧、嚴重低血糖、敗血症、腦中風或代謝危機——這些都是危急生命且需立即排除的狀況，故為優先評估對象。其他選項：C COPD 呼吸困難雖然 ABC 原則上呼吸排序高，但這是「已知 COPD」的可預期變化，需處理但相對 D 的『新發症狀』有更明確的因應準則；A 術後發燒可能是肺擴張不全或感染，需處理但屬可預期；B 點心請求為常規需求。注意：若病人 COPD 呼吸困難已達 respiratory failure 程度，則 C 反而會優先；本題以「新發 vs 已知」框架判斷。
Prioritizing among multiple clients requires integration of the ABC principle with a 'new-onset vs. known chronic' framework. Option D, new-onset acute confusion and agitation, may reflect cerebral hypoxia, severe hypoglycemia, sepsis, stroke, or metabolic crisis—all life-threatening conditions that must be ruled out immediately, making this client the priority for assessment. For the other options: although respiratory issues rank high in the ABC principle, option C (a COPD client with dyspnea) represents an expected change in a known chronic condition with clear management guidelines; option B (postoperative fever) may indicate atelectasis or infection and requires attention but is anticipated; option A (a snack request) is a routine need. Note: if the COPD client's dyspnea progressed to respiratory failure, option C would take priority; this question is judged using the 'new-onset vs. known' framework.
美國護理臨床教育中『優先順序』測驗極多，強調『不穩定的病人優先於穩定的病人』；台灣臨床教學中則常強調『病情最重的病人』，但在 NCLEX 考試中，必須嚴格遵守『突發性症狀優先於慢性急性化』的邏輯。