— 心理社會完整性 · HARD · MCQ —
一位 45 歲第一型雙極性疾患個案出現躁期症狀（快語、睡眠需求減少）。護理師的首要行動為何？
A 45-year-old client with bipolar I disorder is exhibiting signs of mania, including rapid speech and reduced need for sleep. Which nursing action is the priority?
- AEncourage the client to lead a group discussion.鼓勵個案帶領團體討論。
- BReduce environmental stimuli.✓ 正解減少環境刺激。
- CEngage the client in a competitive game.讓個案參與競爭性遊戲。
- DAdminister the prescribed mood stabilizer.給予處方的情緒穩定劑。
— Explanation · 中文詳解 —
躁期病人對環境刺激敏感，過度刺激會加劇躁動。優先提供低刺激環境（低光、安靜）是護理首要措施，以穩定情緒。D雖重要但屬醫囑給藥；C 與 A 會增加個案的興奮與激動，應避免；C 為環境控制的安全護理措施。
Clients in a manic state are highly sensitive to environmental stimuli, which can exacerbate agitation and impulsivity. The priority nursing action is to reduce environmental stimulation by providing a quiet, low-light setting to help stabilize the client's mood and ensure safety before administering medication.
✦ 台美臨床差異
美台精神科病房均遵循 Safety First 原則，但在非強制住院個案的處理上，台灣受限於法規規範較嚴謹。