一位第一型糖尿病患於上午 08:00 注射 NPH 胰島素。護理師應在何時監測低血糖風險？

此題主要考量 NPH 胰島素（Insulin NPH）的作用時間特性，以及低血糖（Hypoglycemia）的預防與監測。NPH 是一種中效型胰島素，其作用曲線與短效型胰島素（如 Regular insulin）不同，有較明顯的高峰期。 NPH 胰島素的特點是注射後約 1.5-4 小時開始作用，作用高峰期約在注射後 4-12 小時，作用時間可達 18-24 小時。題幹中病人於上午 08:00 注射 NPH 胰島素，其作用高峰期預計落在注射後 4-12 小時內。計算如下： - 4 小時後：中午 12:00 - 12 小時後：晚上 20:00 因此，整個高峰期範圍涵蓋了下午至晚上。然而，最容易發生低血糖的時間點，通常是在作用高峰期的中間或接近高峰的時候。在選項中，下午 14:00（即注射後 6 小時）正好處於 NPH 胰島素作用最強的時段，胰島素會最大幅度地促進葡萄糖進入細胞，導致血糖急速下降，是低血糖風險最高的時段。 選項分析： A. 09:00：剛注射完不久，胰島素尚未開始作用，血糖通常穩定。 B. 14:00：注射後 6 小時，正處於 NPH 胰島素的作用高峰期，低血糖風險最高。 C. 20:00：注射後 12 小時，已接近 NPH 胰島素作用高峰的尾聲，低血糖風險相對降低，但仍需注意。 D. 24:00：注射後 16 小時，NPH 胰島素作用已接近尾聲，低血糖風險已不高。 臨床實務上，護理師在給予 NPH 胰島素後，應特別關注其作用高峰期，並在高峰期前約 30 分鐘至 1 小時提供點心（Snack），以預防低血糖發生。同時，也需教導病人識別低血糖的徵兆，如心悸、出汗、顫抖、頭暈、視力模糊等，並學會自我處理。

This question focuses on the pharmacokinetic profile of NPH insulin (Insulin NPH) and the prevention and monitoring of hypoglycemia. NPH is an intermediate-acting insulin whose action curve differs from short-acting (regular) insulin, with a more pronounced peak. NPH insulin typically begins to act about 1.5-4 hours after subcutaneous injection, peaks approximately 4-12 hours after injection, and has a duration of action of 18-24 hours. In this question, the client received NPH insulin at 08:00, so the peak action is expected to occur 4-12 hours after injection. Calculating: - 4 hours later: 12:00 noon - 12 hours later: 20:00 (8 PM) Thus, the peak range covers the afternoon to evening. However, the time most likely to produce hypoglycemia is during the middle of, or close to, the peak. Among the choices, 14:00 (6 hours after injection) falls right in the strongest action period of NPH insulin, when insulin maximally promotes glucose entry into cells, leading to a rapid drop in blood glucose. This is the time of highest hypoglycemia risk. Option analysis: A. 09:00: The insulin has barely begun to act, and blood glucose is usually stable. B. 14:00: 6 hours after injection, this is the peak action phase of NPH insulin; hypoglycemia risk is highest. C. 20:00: 12 hours after injection, approaching the tail end of the peak; hypoglycemia risk is relatively lower but still warrants attention. D. 24:00: 16 hours after injection, the peak has passed; hypoglycemia risk is low. In clinical practice, after administering NPH insulin, nurses must pay particular attention to the peak action period and provide a snack about 30 minutes to 1 hour before the peak to prevent hypoglycemia. Additionally, the client should be taught to recognize signs of hypoglycemia (palpitations, sweating, tremor, dizziness, blurred vision) and to self-manage these symptoms.