護理師準備為一位嚴重低血鉀的病人施打 40 mEq 的氯化鉀（KCl）靜脈推注（Bolus）。護理師最正確的處置為何？
A nurse is preparing to administer an intravenous bolus of potassium chloride 40 mEq to a client with severe hypokalemia. What is the most appropriate action for the nurse to take?
- AUse a 22-gauge peripheral IV line for the concentrated potassium infusion使用22號周邊靜脈留置針進行濃縮鉀靜脈輸注
- BDilute the potassium and administer via infusion pump at a rate not exceeding 10 mEq/hr✓ 正解稀釋鉀並透過輸注幫浦以不超過10 mEq/hr的速度給藥
- CMix the potassium in 50 mL of D5W and administer over 15 minutes將鉀混合於50 mL的5%葡萄糖水中並在15分鐘內給藥
- DAdminister the potassium chloride via rapid IV push to correct the level quickly透過快速靜脈推注給藥氯化鉀以迅速校正血中濃度
這是一題典型的安全陷阱題。氯化鉀（KCl）絕對、絕對不能以靜脈推注（IV Push/Bolus）的方式給予，這在護理實務中屬於致命性錯誤，因為快速進入心臟的高濃度鉀離子會直接導致心臟驟停（Cardiac Arrest）。即使題幹使用了「Bolus」這個詞，護理師也必須識別出這是危險醫囑或錯誤行為。正確做法是必須稀釋，並使用輸液幫浦嚴格控制流速。在普通病房，流速通常不超過 10 mEq/hr；在加護病房且有心電圖監視下，上限可能到 20 mEq/hr。選項 C 時間太短流速過快；選項 A 使用 22G 周邊靜脈滴注高濃度鉀離子會引起嚴重的靜脈炎與疼痛，通常建議由中心靜脈給予或高度稀釋。記住：鉀離子是藥物安全中的高風險警訊藥物（High-alert medication）。
This is a classic safety trap question. Potassium chloride (KCl) must NEVER be given by IV push or bolus; in nursing practice this is a lethal error, because a high concentration of potassium ions reaching the heart rapidly can directly cause cardiac arrest. Even though the stem uses the word "bolus," the nurse must recognize this as a dangerous order or improper action. The correct practice is to dilute the potassium and use an infusion pump to strictly control the rate. On a general unit, the rate typically does not exceed 10 mEq/hr; in an ICU with continuous cardiac monitoring, the upper limit may be 20 mEq/hr. Option C has too short an infusion time and excessive rate; option A uses a 22-gauge peripheral IV line for concentrated potassium, which causes severe phlebitis and pain, and concentrated potassium should generally be given via a central line or with much greater dilution. Remember: potassium is a high-alert medication in medication safety.
在美國，KCl 多為預混袋（Premixed bags），嚴禁護理師在病房自行抽吸 KCl 加入點滴袋以防混勻不均。台灣雖然也推行預混袋，但部分單位仍可能由護理師自行混合，此時必須充分搖勻並貼上高警訊標籤，避免底部濃度過高。