— 生理適應 · MEDIUM · MCQ —
一位個案被診斷為低鉀血症，護理師最關鍵的行動為何？
A client is diagnosed with hypokalemia. Which nursing action is most critical?
- APlacing the client on a cardiac monitor✓ 正解將病人安置在心電圖監測器上
- BChecking the client’s blood pressure檢查病人的血壓
- CLimiting potassium in the diet限制飲食中的鉀攝取
- DAdministering potassium chloride via IV push經靜脈推注給藥氯化鉀
— Explanation · 中文詳解 —
低鉀血症（Hypokalemia）最致命的風險在於心律不整。鉀離子濃度異常會直接改變心肌細胞的電生理活動，增加心室顫動（Ventricular fibrillation）或心跳驟停的風險。因此，將病人置於心臟監測器（Cardiac monitor）下，持續監控心律變化，是確保個案安全最關鍵的護理行動，遠比血壓測量或藥物投予更優先。
The most lethal risk of hypokalemia is dysrhythmia. Abnormal potassium concentration directly alters the electrophysiologic activity of cardiac muscle cells and increases the risk of ventricular fibrillation or cardiac arrest. Therefore, placing the patient on a cardiac monitor and continuously observing for changes in rhythm is the most critical nursing action to ensure patient safety, taking priority over blood-pressure measurement or medication administration.