護理師對於服用 spironolactone 的病人，下列哪些處置是適當的？（選所有適合的）
Which of the following interventions are appropriate for a client taking spironolactone? (Select all that apply.)
- AMonitor potassium levels frequently✓ 正解經常監測鉀離子濃度
- BAdvise the client to use a salt substitute建議病人使用代鹽
- CAssess for signs of hyperkalemia✓ 正解評估高血鉀的徵象
- DEncourage a diet high in bananas and leafy greens鼓勵攝取富含香蕉和深綠葉菜的食物
- EMonitor blood pressure regularly✓ 正解定期監測血壓
Spironolactone 是一種保鉀利尿劑（potassium-sparing diuretic），透過拮抗醛固酮作用，減少鉀離子的排泄。因此，服用此藥的病人有發生高血鉀的風險，而非低血鉀。護理重點在於監測鉀離子數據（A）以及高血鉀的臨床症狀如肌肉虛弱、心律不整（C）。同時，此藥也是降血壓藥物，需定期監測血壓（E）。選項 B（鹽替代品）通常含有高量鉀離子，對於保鉀利尿劑使用者來說絕對禁忌；選項 D（香蕉、綠葉蔬菜）也是高鉀食物，會加重高血鉀風險，故皆不正確。透過區分利尿劑類型的電解質副作用，護理師能有效預防用藥不良反應。
Spironolactone is a potassium-sparing diuretic that reduces potassium excretion by antagonizing aldosterone. Therefore, clients taking this medication are at risk of hyperkalemia, not hypokalemia. The nursing focus is on monitoring serum potassium (A) and clinical signs of hyperkalemia such as muscle weakness and arrhythmias (C). Since the drug is also antihypertensive, blood pressure should be monitored regularly (E). Option B (salt substitutes) typically contain large amounts of potassium and are absolutely contraindicated for users of potassium-sparing diuretics; Option D (bananas, leafy greens) are also high in potassium and worsen hyperkalemia risk, and are therefore incorrect. By distinguishing the electrolyte effects of different diuretic classes, the nurse can effectively prevent adverse drug reactions.
美國營養諮詢高度整合在護理計畫中，藥師與護理師會主動指導病人檢查鹽製品包裝（鹽替代品常標示於營養標示中）；台灣病人常習慣食用加工調味品，護理師需特別提醒避免使用低鈉鹽（常含有鉀）。