一位病房護理師告知單位護理長她拒絕接手照護一名患有活動性、播散型水痘-帶狀皰疹 (Varicella-Zoster) 的病患。該護理師透露她目前懷孕 10 週，且不確定自己以前是否得過水痘或打過疫苗。單位護理長最恰當的處置為何？
A staff nurse informs the charge nurse that she is refusing her assignment to care for a client with active, disseminated Varicella-Zoster (chickenpox). The staff nurse reveals she is 10 weeks pregnant and is unsure if she has ever had chickenpox or the vaccine. What is the most appropriate action by the charge nurse?
- AImmediately reassign the infected client to a different nurse who has documented immunity to Varicella.✓ 正解立即將感染病患重新指派給有水痘免疫力紀錄的護理師
- BInform the nurse that refusing an assignment constitutes patient abandonment and mandate her to wear a fitted N95 respirator.告知護理師拒絕指派構成遺棄病人，並強制其佩戴密合型 N95 呼吸器
- CTerminate the nurse's shift and send her to employee health immediately for a stat Varicella titer blood test.終止護理師的值班，並立即將其送至員工健康部門進行水痘抗體血液檢測
- DRequire the pregnant nurse to care for the client but ensure she strictly utilizes airborne and contact precautions.要求懷孕護理師照護該病患，但確保其嚴格執行空氣與接觸隔離措施
本題測驗護理排班與員工安全法規 (Assignment / Occupational Safety)。水痘病毒對於未具備免疫力（Non-immune）的孕婦是極具毀滅性的。它不僅有極高的傳染性（空氣與接觸傳播），如果孕婦在妊娠早期（前20週內）感染，會導致嚴重的胎兒先天性水痘綜合症（Congenital Varicella Syndrome），造成胎兒肢體發育不全、腦損傷甚至死亡。當員工宣告懷孕且免疫狀態未明時，護理長有法定與倫理責任立即保護胎兒免受致命風險。將具備確鑿抗體（Immunity）的其他護理師調派來接手這位病患是最直接有效且符合病人與員工安全的管理手段（選項 A 正確）。選項 B 錯誤：在缺乏防護能力且涉及胎兒致死風險下，拒絕接手是不構成「惡意遺棄 (Abandonment)」的，反而符合合理迴避原則。選項 D 錯誤：即使穿著最高強度的個人防護裝備 (PPE)，讓無視覺免疫抗體的孕婦進入高危險 Airborne 病房仍然違反醫院職安法規。選項 C 雖然驗抗體是後續該做的，但當下的管理危急任務是『立刻重新分配人力』確保病患有人照顧且孕婦脫離風險。
Varicella poses a severe risk to pregnant women with unknown immunity, potentially causing congenital varicella syndrome. The charge nurse must prioritize safety by immediately reassigning the client to a nurse with documented immunity. This action protects the pregnant employee and ensures the client receives necessary care without exposing the vulnerable nurse to airborne transmission risks.
台美職安法規高度一致。對於 TORCH 病毒群（Toxoplasmosis, Rubella, CMV, Herpes/Varicella），孕婦護理師一律有權拒絕照護以免發生畸胎。這在醫院人力調派 (Delegation) 考題中頻繁出現。