— 降低風險 · HARD · MCQ —
護理師評估一位病人是否有肺栓塞跡象，下列哪項發現需立即通知醫師？
A nurse is assessing a client for signs of pulmonary embolism. Which finding requires immediate notification of the physician?
- ASudden onset of dyspnea and tachycardia✓ 正解突發性呼吸困難與心搏過速
- BCrackles at the lung base肺底部出現囉音
- CLow-grade fever of 100.2 F攝氏37.9度（華氏100.2度）的低燒
- DComplaint of mild calf tenderness抱怨小腿輕微壓痛
— Explanation · 中文詳解 —
肺栓塞（PE）是致命性併發症，典型症狀為突發性呼吸困難、心搏過速及胸痛。選項 A 代表血流動力學不穩定的高風險徵兆。雖然下肢壓痛（D）是深部靜脈栓塞（DVT）徵兆，但 PE 的呼吸循環障礙需優先處理。
Sudden onset of dyspnea and tachycardia are classic, life-threatening signs of a pulmonary embolism that require immediate physician notification. While calf tenderness suggests deep vein thrombosis, the respiratory and hemodynamic instability associated with a pulmonary embolism poses the most urgent threat to the client's safety.
✦ 台美臨床差異
美國醫院常見使用 Rapid Response Team（RRT）處理這類突發情況；台灣則多由值班醫師或住院醫師直接處置。