— 照護管理 · EASY · MCQ —
一位處於恐慌層級焦慮的病人，護理師應優先採取的措施為何？
A nurse is caring for a client who is exhibiting signs of panic-level anxiety. Which action should the nurse take first?
- AEncourage the client to express their feelings鼓勵個案表達感受
- BProvide a safe, quiet, and low-stimulus environment✓ 正解提供安全、安靜且低刺激的環境
- CAdminister an as-needed PRN anxiolytic medication給予處方劑量的抗焦慮藥物
- DTeach the client deep breathing exercises教導個案深呼吸運動
— Explanation · 中文詳解 —
恐慌層級（panic-level）的焦慮會導致病人喪失現實判斷力、認知混亂，甚至出現無法控制的行為。此時，護理師的優先目標是「個案安全（safety）」。透過移除環境中過多的刺激（如噪音、人潮），可以降低病人的感官過載，這是減輕焦慮的首要步驟。在病人恢復理性溝通能力之前，任何教育或過多言語介入皆無效。
Panic-level anxiety impairs a client's ability to process information or communicate effectively. Therefore, the nurse's first priority is to ensure safety by providing a quiet, low-stimulus environment to reduce sensory overload and help de-escalate the panic state.