一位第一型糖尿病病人被發現昏迷且皮膚濕冷。護理師執行指尖血糖監測，結果為 42 mg/dL。該病人目前沒有靜脈通路。護理師應準備給予哪種藥物？
A client with type 1 diabetes is found unconscious and clammy. The nurse performs a fingerstick blood glucose test, and the result is 42 mg/dL. The client has no intravenous access. Which medication should the nurse prepare to administer?
- AIntramuscular glucagon✓ 正解肌肉注射昇糖素
- BIntravenous 50% dextrose (D50W)靜脈注射 50% 葡萄糖溶液 (D50W)
- CSubcutaneous insulin glargine皮下注射胰島素 glargine
- DOral glucose gel口服葡萄糖凝膠
低血糖急症的處置原則取決於病人的意識狀態與是否有靜脈通路。病人血糖 42 mg/dL 屬於嚴重低血糖，且已陷入昏迷（Unconscious），這意味著絕對禁止口服給藥（排除選項 D），以防止吸入性肺炎。在『沒有靜脈通路』的情況下，肌肉注射（IM）或皮下注射（SC）昇糖素（Glucagon）是標準急救首選。Glucagon 能刺激肝臟將肝醣轉化為葡萄糖。若有靜脈通路，D50W（選項 B）會是更快、更直接的選擇，但本題情境限制了這一點。護理師必須在緊急當下快速判斷給藥路徑的可用性。給予胰島素（選項 C）會使血糖進一步崩潰，屬於致命錯誤。
Management of acute hypoglycemia depends on the client's level of consciousness and whether IV access is available. A blood glucose of 42 mg/dL constitutes severe hypoglycemia, and because the client is unconscious, oral administration is absolutely contraindicated (eliminating option D) due to aspiration risk. Without IV access, intramuscular (IM) or subcutaneous (SC) glucagon is the standard emergency intervention. Glucagon stimulates the liver to convert glycogen into glucose. If IV access were available, D50W (option B) would be a faster, more direct choice, but this scenario rules it out. The nurse must rapidly assess the available route in the emergency. Administering insulin (option C) would further drop blood glucose and is a fatal error.
美國 NCLEX 考題非常強調「有無靜脈通路」這一個決策點。在美國，Glucagon 緊急注射組（Glucagon Emergency Kit）常備於校園或居家；台灣臨床上則常由護理師立即嘗試建立 IV 並給予 D50W，IM Glucagon 的使用頻率相對較低。