一位慢性腎臟病（CKD）病人的血鎂值為 3.2 mEq/L。護理師應優先關注哪項評估結果？
A client with chronic kidney disease (CKD) has a serum magnesium level of 3.2 mEq/L. Which assessment finding should the nurse prioritize?
- AHyperactive deep tendon reflexes深腱反射亢進
- BPositive Trousseau's signTrousseau氏徵陽性
- CDiminished or absent deep tendon reflexes✓ 正解深腱反射減弱或消失
- DFrequent premature ventricular contractions (PVCs)頻發性心室早期收縮 (PVCs)
正常血鎂值約為 1.3-2.1 mEq/L。3.2 mEq/L 屬於高鎂血症（Hypermagnesemia），常見於腎功能衰竭病人攝取過多含鎂藥物（如抗酸劑）。高鎂會抑制神經肌肉傳導，導致「鎮靜」效果。臨床特徵包括：深腱反射（DTR）減弱或消失、嗜睡、心搏緩慢、低血壓，嚴重時會導致呼吸抑制。選項 A 和 B 是低鈣或低鎂的表現（神經肌肉興奮性增加）；選項 D 多見於低鎂或低鉀。護理師必須警覺 DTR 的消失，因為這通常是呼吸停止前的早期徵兆。這題測驗對電解質異常之神經肌肉表現的區分能力。
The normal serum magnesium level is approximately 1.3 to 2.1 mEq/L. A value of 3.2 mEq/L represents hypermagnesemia, often seen in clients with renal failure who consume magnesium-containing medications such as antacids. Elevated magnesium inhibits neuromuscular transmission, producing a "sedative" effect. Clinical features include diminished or absent deep tendon reflexes (DTRs), drowsiness, bradycardia, hypotension, and in severe cases respiratory depression. Options A and B reflect hypocalcemia or hypomagnesemia (increased neuromuscular excitability); option D is more commonly seen in hypomagnesemia or hypokalemia. The nurse must remain vigilant for the loss of DTRs because it is often an early sign preceding respiratory arrest. This item tests the ability to distinguish among the neuromuscular manifestations of electrolyte abnormalities.
在美國護理實務中，高鎂血症常見於產科使用硫酸鎂治療子癇前症的病人，因此護理師對 DTR 的監測極為敏感。在台灣，CKD 病人常因服用胃藥或軟便劑不當導致高鎂，護理重點同樣在於神經肌肉與呼吸的評估。