護理師準備對低血鉀病人靜脈輸注氯化鉀，下列哪項評估發現需要暫停給藥？
A nurse is preparing to administer intravenous potassium chloride to a client with hypokalemia. Which assessment finding requires the nurse to hold the medication?
- AUrine output of 20 mL/hour over the last 2 hours✓ 正解過去 2 小時尿量為 20 mL/hour
- BClient reports mild burning at the infusion site病人主訴輸注部位有輕微灼熱感
- CBlood pressure of 110/70 mmHg血壓 110/70 mmHg
- DSerum potassium level of 3.8 mEq/L血清鉀離子濃度 3.8 mEq/L
靜脈給予鉀離子時，腎臟排泄功能是關鍵。若尿量低於 30 mL/hr（或小於 0.5 mL/kg/hr），表示腎功能不足以負荷鉀離子負荷，持續輸注將引發致命性高血鉀。B 為正常範圍上限，C 屬正常生命徵象，B 為常見輕微反應，可藉由調整輸注速度或稀釋緩解，唯尿量過低需立即停藥。
When administering IV potassium, renal excretory function is critical. If urine output falls below 30 mL/hr (or less than 0.5 mL/kg/hr), renal function is insufficient to handle the potassium load, and continued infusion will result in life-threatening hyperkalemia. Option D is at the upper end of the normal range, Option C is a normal vital sign, and Option B is a common mild reaction that can be relieved by adjusting the infusion rate or dilution; only inadequate urine output requires the medication to be held immediately.
台美皆嚴格遵守給鉀前需確認尿量與 renal function，但美國偏好使用中央靜脈導管輸注以防周邊滲漏。