護理師正在檢視一位有氣喘病史且因高血壓入院病人的醫囑。護理師應向醫師詢問哪種藥物？
The nurse is reviewing orders for a client with a history of asthma who is admitted for hypertension. Which medication should the nurse clarify with the healthcare provider?
- AAmlodipineAmlodipine（氨氯地平）
- BHydrochlorothiazideHydrochlorothiazide（氫氯噻嗪）
- CPropranolol✓ 正解Propranolol（普萘洛爾）
- DLisinoprilLisinopril（賴諾普利）
這題考查的是「藥物禁忌症」。Propranolol（心律整）是一種非選擇性 Beta 受體阻斷劑（Non-selective Beta-blocker），它會同時阻斷 Beta-1（心臟）和 Beta-2（肺部）受體。阻斷 Beta-2 受體會導致支氣管收縮（Bronchoconstriction），這對於氣喘或慢性阻塞性肺病（COPD）病人來說是非常危險的，可能誘發嚴重的氣喘發作。其他選項：Amlodipine（鈣離子通道阻斷劑）、Lisinopril（ACEI）、Hydrochlorothiazide（利尿劑）通常不會引起氣管收縮。護理師的職責是識別潛在的藥物與疾病交互作用（Drug-Disease Interaction），並在給藥前採取行動。安全考量優於一切。
This question tests drug contraindications. Propranolol is a non-selective beta-blocker that blocks both beta-1 (cardiac) and beta-2 (pulmonary) receptors. Blockade of beta-2 receptors causes bronchoconstriction, which is very dangerous for clients with asthma or chronic obstructive pulmonary disease (COPD), potentially triggering a severe asthma attack. The other options—amlodipine (a calcium channel blocker), lisinopril (an ACE inhibitor), and hydrochlorothiazide (a diuretic)—do not typically cause bronchoconstriction. The nurse's responsibility is to recognize potential drug-disease interactions and take action before administration. Safety takes precedence over everything.
美國 NCLEX 考試中，Beta-blocker 與 Asthma 的交互作用是必考的「禁忌症」經典題；台灣臨床上醫師有時會開立低劑量選擇性 Beta-blocker，但護理師仍應具備高度警覺性並確認病人是否有喘鳴音。