# 一位護理師在血品送達病人床邊前，發現血品標籤標示為另一位病人。未進行輸血。下列何項處置最適當？ > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=498088&lang=zh-tw > language: zh-TW > subject: Client Rights > category: MOC ## 題目 一位護理師在血品送達病人床邊前，發現血品標籤標示為另一位病人。未進行輸血。下列何項處置最適當？ ## 選項 1. 立即提交安全事件通報，描述如何發現此不匹配情形 **✔ 正確答案** 2. 將此跡近錯誤記錄於病人病歷，並指出涉及的工作人員 3. 丟棄該血品，因病人未受傷害，無需採取進一步行動 4. 等待血庫進行調查後，再通知護理長 **正確答案: 1** ## 解析 在輸血前發現不匹配屬於跡近錯誤。透過機構的安全事件通報系統進行通報，有助於調查流程並預防未來傷害，即使錯誤未影響到病人。 ## 深入解析 快速解答 透過安全事件通報系統通報此跡近錯誤。及早發現避免了傷害，但流程失效仍需組織層面的檢討。 為什麼這是正確的 跡近錯誤揭露了與可能導致下次不良事件相同的危險系統弱點。一份事實性的事件通報可讓組織追溯標籤、運送及核對步驟，並改善防護措施，且無需將通報本身放入臨床病歷。 簡單比喻或心智圖像 跡近錯誤就像一列火車在損壞的軌道段前及時停下。雖然沒有發生事故，但損壞的軌道仍須通報並修復；此比喻不涉及個人責任歸屬或取代機構政策。 記憶掛鉤 在造成傷害前攔截，仍意味著要通報危害並從系統中學習。 NCLEX 決策規則 對於跡近錯誤，首先保護病人並確保不安全產品安全，然後使用指定的安全通報流程。不要隱匿事件、在病歷中指責人員，或假設無傷害即無需通報。 為什麼其他選項是錯的 病人病歷應記錄臨床相關照護，而非機密事件通報或人員指責。丟棄證據或被動等待將失去及時進行系統性檢討所需的資訊。參考文獻 - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]AHRQ PSNet: Strategies for Investigating Patient Safety EventsAgency for Healthcare Research and Quality Patient Safety Network, reviewed 2025 ## 相同主題題目 - [A 45-year-old male is alert and oriented ×4 and is actively bleeding from a gastrointestin…](https://mymerci.kr/pages/nclex_q.php?qn_id=372683&lang=zh-tw) - [A 70-year-old Vietnamese-speaking woman is admitted for syncope evaluation. Her 18-year-ol…](https://mymerci.kr/pages/nclex_q.php?qn_id=372701&lang=zh-tw) - [A 56-year-old patient scheduled for an elective hip replacement tomorrow tells the nurse, …](https://mymerci.kr/pages/nclex_q.php?qn_id=372748&lang=zh-tw) - [A nurse is giving a handoff report for a client whose blood pressure is falling and urine …](https://mymerci.kr/pages/nclex_q.php?qn_id=397242&lang=zh-tw) - [A nurse receives a telephone prescription to administer potassium chloride by IV push for …](https://mymerci.kr/pages/nclex_q.php?qn_id=397302&lang=zh-tw) - [A client being evaluated for intermittent chest pain says, "I need to leave now." The clie…](https://mymerci.kr/pages/nclex_q.php?qn_id=497624&lang=zh-tw) - [A nurse realizes that an assessment completed earlier in the shift was not documented. Whi…](https://mymerci.kr/pages/nclex_q.php?qn_id=497913&lang=zh-tw) - [A medical unit wants to reduce client falls using the Plan-Do-Study-Act approach. Which ac…](https://mymerci.kr/pages/nclex_q.php?qn_id=498087&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=498088&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=498088&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=498088&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=498088&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=498088&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。_