護理師正為一位即將接受手術的病人做術前準備。病人表示：「我改變主意了，我不想做這個手術。」護理師應優先採取哪項行動？
A nurse is caring for a client who is being prepared for surgery. The client says, 'I changed my mind; I don't want to go through with this procedure.' Which action should the nurse take first?
- ADocument the refusal in the medical record在病歷中記錄拒絕手術
- BExplain the risks of refusing the surgery說明拒絕手術的風險
- CNotify the surgeon immediately立即通知外科醫師
- DAsk the client to explain their concerns✓ 正解詢問病人說明其擔憂
尊重病人自主權（Autonomy）是護理倫理的核心。當病人表達拒絕意願時，護理師的第一步應是評估與溝通。透過開放式提問了解病人改變主意的原因（如恐懼、缺乏資訊或誤解），才能提供適切的後續處置。若直接通知醫師或進行衛教，可能會忽略病人的內心核心問題。在確認病人充分理解資訊後，若其仍堅持拒絕，護理師才需依序通知醫療團隊並完成法律文件記錄。此題考驗護理評估優於立即執行的判斷力。
The nurse must first assess the client’s specific concerns or reasons for changing their mind to respect autonomy and ensure informed decision-making. Only after understanding the client's perspective should the nurse notify the surgeon, provide further education, or document the refusal.
美國非常強調病人自主權與知情拒絕權（Informed Refusal）。在台灣，臨床上常會先由護理師安撫並通知家屬，但在美國考題中，直接與病人溝通其擔憂是絕對優先的護理處置。