# 一位梅尼爾氏症個案在走去浴室時，突然表示房間在旋轉並開始失去平衡。護理師應先採取哪項行動？ > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=498733&lang=zh-tw > language: zh-TW > subject: Assistive Devices > category: BCC ## 題目 一位梅尼爾氏症個案在走去浴室時，突然表示房間在旋轉並開始失去平衡。護理師應先採取哪項行動？ ## 選項 1. 鼓勵個案繼續行走，以便平衡系統能適應 2. 協助個案至安全的休息姿勢，並減少跌倒危險 **✔ 正確答案** 3. 以溫水灌注患耳，以降低內耳壓力 4. 要求個案快速將頭轉向患側 **正確答案: 2** ## 解析 急性梅尼爾氏症發作可能導致嚴重眩暈、失去平衡及跌倒。護理師應立即支持個案採取安全姿勢，並在提供處方症狀治療或進一步衛教前，先減少危險。 ## 深入解析 快速解答 當突發眩暈開始時，協助個案安全休息以預防跌倒。 為什麼這是正確的 梅尼爾氏症會干擾內耳平衡訊號，並可能產生突然且失能的旋轉感。支持個案並限制活動，可在評估與治療發作期間降低受傷風險。 簡單比喻或心智圖像 眩暈發作時，個案的內在水平儀給出錯誤讀數，因此護理師提供外在的穩定支持。此類比說明了安全需求，但並未指出每次頭暈發作的原因。 記憶掛鉤 突發眩暈意味著在處理感覺之前，先穩定個案。 NCLEX 決策規則 當個案出現急性眩暈並失去平衡時，優先處理跌倒及受傷風險。在個案穩定且已評估原因之前，避免會加劇動作的操作或走動。 為什麼其他選項是錯的 在嚴重眩暈時繼續行走會增加立即的跌倒風險。耳朵灌注並非梅尼爾氏症發作時的急性治療，而快速轉頭可能加劇眩暈。參考文獻 - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]NIDCD: Meniere's DiseaseNational Institute on Deafness and Other Communication Disorders - [3]NIDCD: Balance DisordersNational Institute on Deafness and Other Communication Disorders ## 相同主題題目 - [A client after a stroke coughs when drinking thin liquids. Which nursing action best promo…](https://mymerci.kr/pages/nclex_q.php?qn_id=396624&lang=zh-tw) - [A client with left-leg weakness is learning to walk with a cane. Which statement by the cl…](https://mymerci.kr/pages/nclex_q.php?qn_id=497755&lang=zh-tw) - [An older adult with hearing loss repeatedly asks the nurse to repeat discharge instruction…](https://mymerci.kr/pages/nclex_q.php?qn_id=497912&lang=zh-tw) - [A client with low vision says, "I cannot read the medication labels or discharge sheet." W…](https://mymerci.kr/pages/nclex_q.php?qn_id=498096&lang=zh-tw) - [A client receiving chemotherapy has painful oral mucositis. Which instruction should the n…](https://mymerci.kr/pages/nclex_q.php?qn_id=498282&lang=zh-tw) - [A client with a tracheostomy has coarse breath sounds, visible secretions in the tube, and…](https://mymerci.kr/pages/nclex_q.php?qn_id=498501&lang=zh-tw) - [An older adult with severe knee osteoarthritis is continent at home but has repeated urina…](https://mymerci.kr/pages/nclex_q.php?qn_id=498701&lang=zh-tw) - [A client with Bell palsy cannot completely close the affected eye. Which instruction is mo…](https://mymerci.kr/pages/nclex_q.php?qn_id=498734&lang=zh-tw) ## 以其他語言閱讀 - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=498733&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=498733&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=498733&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=498733&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=498733&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。_