病人預計在兩小時後進行靜脈腎盂造影（IVP）。哪項評估發現對護理師來說最重要，必須回報給醫療團隊？
A client is scheduled for an intravenous pyelogram (IVP) in two hours. Which assessment finding is most important for the nurse to report to the healthcare provider?
- AThe client has not eaten since midnight.病人自午夜起未進食。
- BThe client expresses anxiety about the procedure.病人對該程序感到焦慮。
- CThe client reports an allergy to shellfish and iodine.✓ 正解病人報告對貝類和碘過敏。
- DThe client's serum creatinine level is 0.8 mg/dL.病人的血清肌酸酐值為 0.8 mg/dL。
靜脈腎盂造影（IVP）涉及注射含碘造影劑。對甲殼類動物（Shellfish）或碘（Iodine）過敏的病人，在注射造影劑時發生過敏反應（甚至是過敏性休克）的風險極高。護理師必須在程序開始前識別此風險並通報，以便醫師考慮預防性用藥（如類固醇、抗組織胺）或更改檢查方式。NPO（A）是 IVP 的常規準備。焦慮（B）需要心理支持但非立即禁忌。血清肌酸酐 0.8（D）在正常範圍內，顯示腎功能尚可耐受造影劑。識別潛在的藥物/造影劑過敏是降低程序風險的最關鍵步驟。
Intravenous pyelography (IVP) involves injection of iodinated contrast medium. Clients allergic to shellfish or iodine have a very high risk of an allergic reaction (even anaphylactic shock) when contrast is injected. The nurse must identify and report this risk before the procedure starts so that the physician can consider premedication (such as steroids or antihistamines) or change the imaging study. NPO (A) is the routine preparation for IVP. Anxiety (B) requires psychological support but is not an immediate contraindication. A serum creatinine of 0.8 (D) is within normal range, indicating that renal function can tolerate contrast medium. Identifying potential drug or contrast allergy is the most critical step in reducing procedural risk.
美國護理實務中，對於造影劑過敏的篩選有標準化的檢核表，RN 必須簽署確認。台灣醫院亦有類似流程，但在法律層面上，美國 RN 若未發現過敏史而導致意外，需承擔極大的專業疏失責任。