# 一名思覺失調症個案說：「那些聲音叫我做壞事。」護理師的優先回應是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=394024&lang=zh-tw  
> language: zh-TW  
> subject: Mental Health Concepts  
> category: PSI

## 題目

一名思覺失調症個案說：「那些聲音叫我做壞事。」護理師的優先回應是什麼？

## 選項

1. 告訴個案那些聲音不是真的，應該忽略。
2. 提供耳機並請個案獨自待在房間。
3. 詢問聲音說了什麼，並評估傷害風險。 **✔ 正確答案**
4. 把話題轉到愉快的活動。

**正確答案: 3**

## 解析

命令性幻聽需要立即安全評估。護理師應詢問聲音內容，並評估個案是否可能傷害自己或他人。爭辯現實、讓個案獨處或在風險評估前轉移注意，可能錯過緊急安全威脅。

## 深入解析

臨床判斷
當幻聽包含命令時，第一個護理問題是安全與具體內容。

記憶重點
命令聲音：問內容，評估危險。

## 臨床情境

實務指引
NIMH 描述幻覺為聽到或看到他人沒有經驗到的事物，包括可能叫人做事的聲音。可能有傷害性命令時，安全評估是必要的。

注意
出現風險線索時，應冷靜且直接詢問自殺或暴力想法。

## 重要概念

- **幻覺** — 沒有外在刺激卻出現的感官經驗，例如聽到聲音。
- **命令性幻聽** — 指示個案採取某種行動的幻聽。
- **風險評估** — 用聚焦問題與觀察評估對自己或他人造成傷害的可能性。

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