— 照護管理 · MEDIUM · MCQ —
護理師交接班後，優先評估哪位病人？
A nurse receives a change-of-shift report. Which client should be assessed first?
- AA client with a healing fracture who is requesting pain medication骨折癒合中並要求止痛藥的病人
- BA client who is scheduled for a diagnostic test in one hour一小時後預定接受診斷檢查的病人
- CA client with an asthma exacerbation complaining of chest tightness✓ 正解氣喘惡化並抱怨胸部緊繃的病人
- DA client with a localized wound infection who requires antibiotics局部傷口感染且需要抗生素的病人
— Explanation · 中文詳解 —
護理師在交接班後，必須根據 ABC 原則（Airway, Breathing, Circulation）進行優先級排序。氣喘發作引起的胸悶代表潛在的呼吸道阻塞或受限，屬於急性呼吸困難，若不處理可能導致缺氧甚至呼吸衰竭，危險性遠高於傷口感染、慢性疼痛或檢查安排。這類病人必須優先評估，以確認呼吸狀態與血氧飽和度。
Using the ABC (Airway, Breathing, Circulation) framework, the client with an asthma exacerbation requires immediate assessment because chest tightness indicates potential airway compromise and respiratory distress. This acute breathing difficulty poses a higher risk of hypoxia and respiratory failure compared to the stable conditions of the other clients.