一位近期病史有恐慌症的26歲女性正坐在診所的候診區。突然間，她開始劇烈發抖、緊抓自己的胸膛、大量冒汗，並陷入過度換氣。她尖叫著說：「救命！我不能呼吸了！我的心臟要爆炸了，我心臟病發作快要死掉了！這裡根本沒有空氣！」護理師確認其生命徵象功能上皆為正常（除了預期中的心搏與呼吸過速）。針對這場急性的恐慌發作，護理師的首要介入為何？
A 26-year-old female with a recent history of panic disorder is sitting in the clinic waiting area. Suddenly, she begins to tremble violently, clutches her chest, sweats profusely, and hyperventilates. She screams, "Help! I can't breathe! My heart is exploding, I'm having a massive heart attack and I am going to die! There is no air!" The nurse confirms functionally normal vitals (aside from expected tachycardia and tachypnea). What is the priority nursing intervention for this acute panic attack?
- ASpeak in a calm, authoritative but reassuring tone, use simple direct phrases, and stay with her.以平靜、堅定但令人安心的語調說話，使用簡單直接的短句，並在旁陪伴她。正確答案
- BSit down beside her, gently hold her hand to reassure her, and ask her to detailedly describe the underlying stressor that caused this attack.坐在她旁邊，輕握她的手以安撫她，並請她詳細描述引發此次發作的潛在壓力源。
- CFirmly instruct her to snap out of it, reminding her logically that her blood oxygen saturation is perfectly normal and it is all in her mind.堅定地指示她振作起來，並理性提醒她血氧飽和度完全正常，這一切都是心理作用。
- DQuickly leave the waiting area to run to the medication room and retrieve an intramuscular injection of a benzodiazepine.迅速離開候診區去藥房取一支苯二氮平類藥物的肌肉注射劑。
- A以平靜、堅定但令人安心的語調說話，使用簡單直接的短句，並在旁陪伴她。
本題測驗焦慮症狀，尤其是最嚴重的「恐慌發作（Panic Attack）」的護理應對。當患者處於恐慌發作期（Panic level of anxiety）時，其認知與理解能力會縮小至隧道視野，伴隨壓倒性的生理性瀕死感與失控感。任何長篇的問話、邏輯說理或探究原因，此時都毫無意義且會引起極度反彈。正確的介入是：降低周圍環境刺激、護理師絕對不可留病患獨自一人（Do not leave the client alone），並使用平靜明確、簡短具體的指引（calm, short, clear statements）協助病患把注意力帶回現實與呼吸節奏（選項 A 正確）。附帶提醒：紙袋復吸法因有缺氧風險，且可能掩蓋心肌梗塞、肺栓塞或氣喘等器質性病因，現已不建議常規使用。選項 B 探究病源屬「降低到輕度焦慮後」才能進行的心理治療，此刻時機錯誤。選項 D 離開病患去拿藥是大忌，會讓病患感覺被拋棄而更確信自己要死了。選項 C 的責罵或以血氧數值說服，完全否認了她的情緒體驗。
- A · 正確答案以平靜、堅定但令人安心的語調說話，使用簡單直接的短句，並在旁陪伴她。
陪伴在病患身旁提供了現實的錨點，而簡短、堅定的教導則限制了認知超載，並透過生理焦點來矯正過度換氣。
- B坐在她旁邊，輕握她的手以安撫她，並請她詳細描述引發此次發作的潛在壓力源。
在恐慌級別的焦慮下，認知處理系統已完全關機；在危機期間啟動深層心理分析只會加劇他們壓倒性的感覺。
- C堅定地指示她振作起來，並理性提醒她血氧飽和度完全正常，這一切都是心理作用。
將恐怖的生理症狀說成只是『在她的腦中』，抹滅了她發自內臟的真實體驗，並破壞了治療性關係。
- D迅速離開候診區去藥房取一支苯二氮平類藥物的肌肉注射劑。
留下一位正在經歷瀕死邊緣恐懼感的病患獨自一人，會急遽惡化他們的害怕與孤立感。
Stay with the client (待在病患身旁) 是精神科恐慌症發作護理的第一天條。不管是台美，留下發做中的恐慌症病患獨自去打電話或找藥都是護理上的嚴重失職。
English explanation
Option A is correct because during a panic attack, cognition and comprehension narrow to tunnel vision while the client experiences overwhelming physical sensations of impending death and loss of control. The nurse should reduce environmental stimulation, remain with the client, and use a calm, authoritative, reassuring tone with short, clear, direct statements to redirect attention toward reality and the breathing rhythm. Option B is incorrect because detailed questioning about the underlying stressor is useful only after anxiety has decreased to a mild level; during panic it is poorly timed and ineffective. Option C is incorrect because scolding the client or trying to persuade her with normal oxygen saturation dismisses her emotional experience and can provoke resistance. Option D is incorrect because leaving to obtain medication makes the client feel abandoned and can intensify her belief that she is dying. Paper-bag rebreathing is not routinely recommended because it risks hypoxia and may obscure myocardial infarction, pulmonary embolism, or asthma.