一位病人被診斷為大規模肺栓塞並開始接受肝素（Heparin）靜脈點滴。護理師應監測哪項實驗室數值以調整肝素劑量？
A client is diagnosed with a massive pulmonary embolism and is started on a heparin drip. Which laboratory value should the nurse monitor to adjust the heparin dosage?
- AInternational Normalized Ratio (INR)國際標準化比值 (INR)
- BProthrombin time (PT)凝血酶原時間 (PT)
- CPlatelet count血小板計數
- DActivated partial thromboplastin time (aPTT)✓ 正解活化部分凝血活酶時間 (aPTT)
抗凝血藥物的監測是 NCLEX 的常考基礎題。肝素（Unfractionated Heparin）主要影響內源性凝血路徑，其效果透過 aPTT（部分凝血活酶時間）來評估。目標通常是控制在正常對照值的 1.5 到 2.5 倍。選項 B 和 A（PT/INR）是用於監測華法林（Warfarin）的數值。選項 C（血小板計數）雖然在長期使用肝素時需監測以預防肝素誘發之血小板低下症（HIT），但它並非用來「調整劑量」的指標。護理師必須準確區分 Heparin 與 Warfarin 的對應監測指標，這是給藥安全的基本功。
Monitoring of anticoagulants is a foundational NCLEX topic. Heparin (unfractionated heparin) primarily affects the intrinsic coagulation pathway, and its effect is evaluated by aPTT (activated partial thromboplastin time). The therapeutic goal is typically 1.5 to 2.5 times the normal control value. Options B and A (PT/INR) are values used to monitor warfarin. Option C (platelet count), although monitored during long-term heparin use to detect heparin-induced thrombocytopenia (HIT), is not the indicator used to 'adjust the dose.' The nurse must accurately distinguish the monitoring indicators corresponding to heparin and warfarin; this is fundamental to medication administration safety.
在美國，許多醫院由護理師根據 aPTT 結果依據標準 protocol 自行調整肝素流速（Nurse-driven protocol）。在台灣，護理師通常會回報數值給醫師後由醫師下達調整劑量之醫囑，但對數值意義的掌握同樣重要。