— 生理適應 · HARD · MCQ —
一位疑似腦中風的病人，護理師應優先執行何項處置？
A nurse is caring for a patient with a suspected stroke. Which priority intervention must be performed first?
- APerform a neurological assessment進行神經學評估
- BObtain a CT scan安排電腦斷層掃描 (CT scan)
- CAdminister aspirin給予阿斯匹靈
- DAssess airway and breathing✓ 正解評估呼吸道與呼吸功能
— Explanation · 中文詳解 —
在處理任何急症（包括疑似腦中風）時，ABC 原則（Airway, Breathing, Circulation）是護理師的最高指導原則。腦中風病人可能因為意識不清、吞嚥反射受損或嘔吐，導致呼吸道阻塞。在執行任何診斷性檢查（如 CT）或藥物治療（如 aspirin）之前，確保呼吸道通暢與呼吸功能正常是維持病人生命的第一要務。
When managing acute conditions like a suspected stroke, the ABC principle (Airway, Breathing, Circulation) is the highest priority for nursing care. Because stroke patients may have impaired consciousness or swallowing reflexes, ensuring a patent airway and normal respiratory function is essential before performing diagnostic tests or administering medications.