— 照護管理 · EASY · MCQ —
護理師在內外科病房工作，哪位病人應優先評估？
A nurse is working on a medical-surgical unit. Which client should the nurse assess first?
- AA client scheduled for discharge teaching預約接受出院衛教的病人
- BA client requesting assistance with morning hygiene請求協助晨間清潔的病人
- CA client reporting sudden onset of shortness of breath and chest pain✓ 正解主訴突發呼吸困難和胸痛的病人
- DA client with a scheduled dressing change for a surgical wound預約進行手術傷口換藥的病人
— Explanation · 中文詳解 —
急重症護理中，優先順序必須遵循 ABC（Airway, Breathing, Circulation）原則。選項 C 的病人呈現急性呼吸困難與胸痛，這是肺栓塞（PE）或急性心肌梗塞（MI）的典型表現，屬於危及生命的緊急情況，需立即進行評估與處置。其他選項皆為常規的護理任務，不具備立即致死的潛在危險。
Accidents and substance abuse are leading causes of morbidity and mortality in adolescents, making safety and risk reduction the priority for health promotion. Nursing education should focus on preventing these risks, whereas topics like assisted living, dementia prevention, and retirement planning are relevant to older adult populations.