# 一位急性氣喘發作的個案變得非常疲倦，且喘鳴聲極少、空氣流動差。哪一項解讀最為正確？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397260&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位急性氣喘發作的個案變得非常疲倦，且喘鳴聲極少、空氣流動差。哪一項解讀最為正確？

## 選項

1. 氣喘發作正在緩解。
2. 個案已準備好接受出院衛教。
3. 應停止吸入性支氣管擴張劑。
4. 個案可能正在發展為嚴重的呼吸道阻塞。 **✔ 正確答案**

**正確答案: 4**

## 解析

喘鳴聲極少伴隨空氣流動差和疲倦，可能表示嚴重的阻塞和即將發生的呼吸衰竭，而非改善。護理師應將此視為緊急惡化的線索。停止支氣管擴張劑治療或轉為出院衛教都是不安全的。

## 深入解析

臨床判斷
使用個案線索、時間點、檢驗數據和安全風險，選擇最符合氣喘寂靜胸疑慮的回應。

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，而非單獨的回憶。

## 臨床情境

臨床實務指引
對於氣喘寂靜胸疑慮，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

- **氣喘發作** — 呼吸道發炎和支氣管收縮的急性惡化。
- **寂靜胸** — 因空氣流動嚴重減少而導致幾乎或完全沒有喘鳴聲。
- **呼吸衰竭** — 無法維持足夠的氧合或通氣。

## 相同主題題目

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=zh-tw)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=zh-tw)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=zh-tw)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=zh-tw)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=zh-tw)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=zh-tw)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=zh-tw)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=zh-tw)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=397260&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=397260&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=397260&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=397260&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=397260&lang=vi)

---

More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw)

_僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_