# 一位吞嚥困難的個案正在吃午餐。護理師應採取哪項措施以降低吸入風險？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397180&lang=zh-tw  
> language: zh-TW  
> subject: Elimination  
> category: BCC

## 題目

一位吞嚥困難的個案正在吃午餐。護理師應採取哪項措施以降低吸入風險？

## 選項

1. 快速透過吸管提供稀薄液體。
2. 餐後讓個案平躺30分鐘。
3. 保持個案直立，並以緩慢速度提供小口食物。 **✔ 正確答案**
4. 鼓勵在用餐過程中持續交談，以評估警覺度。

**正確答案: 3**

## 解析

直立姿勢、小口進食和緩慢速度有助於降低吞嚥困難個案的吸入風險。根據吞嚥計畫，透過吸管飲用稀薄液體可能會增加風險。平躺和進食時說話也會增加吸入風險。

## 深入解析

臨床判斷
利用個案線索、時機、檢驗數據和安全風險，選擇最符合吞嚥困難餵食注意事項的回應。

記憶提示
將最強的線索群與最安全的護理判斷配對。

KR vs US
NCLEX考題獎勵基於線索的優先思考，而非單獨的記憶提取。

## 臨床情境

臨床實務指引
針對吞嚥困難餵食注意事項，將完整的線索模式與個案當前的穩定性、醫囑數據和預期的護理範圍進行比較。

注意
當完整情境改變了優先順序或安全性時，不要僅根據單一線索選擇行動。

## 重要概念

- **吞嚥困難** — 吞嚥困難，可能導致吸入或攝取不足。
- **吸入預防措施** — 用於減少食物或液體進入呼吸道的措施。
- **進食協助** — 為促進安全且充足的經口攝取而提供的支持。

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