一位因肺癌引發抗利尿激素分泌不當症候群（SIADH）的病人入院。護理師應針對下列哪項醫囑向醫師進一步釐清？
A client is admitted with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to lung cancer. Which healthcare provider order should the nurse clarify?
- AIntravenous infusion of 0.45% Sodium Chloride at 100 mL/hr✓ 正解以 100 mL/hr 速率輸注 0.45% 氯化鈉
- BOral salt tablets supplementation口服鹽片補充
- CDaily weights and strict intake and output monitoring每日體重測量及嚴格記錄出入量
- DFluid restriction of 800 mL per 24 hours每日液體限制 800 mL
SIADH 的核心病理生理是 ADH 分泌過多，導致腎小管對水份重吸收增加，產生稀釋性低血鈉（Dilutional hyponatremia）。治療重點在於排出多餘的水分並提升血鈉。選項 A 的 0.45% 生理食鹽水是低滲透壓（hypotonic）溶液，進入體內後水分會向細胞內移動，會進一步加重細胞水腫（特別是大腦）並稀釋血鈉，對於 SIADH 病人而言是禁忌，護理師必須釐清。正確的輸液治療應為等滲透壓（0.9% NS）或在高風險下使用高滲透壓（3% NaCl）溶液。選項 D（限水）是首選非藥物治療；選項 B（補鈉）可對抗低血鈉；選項 C 是監測液體負荷的基本護理。這題挑戰護理師對不同滲透壓溶液在特定疾病中交互作用的理解，是生理適應領域的高階概念。
The core pathophysiology of SIADH is excessive ADH secretion, which increases water reabsorption in the renal tubules and produces dilutional hyponatremia. Treatment focuses on excreting excess water and raising serum sodium. Option A, 0.45% saline, is a hypotonic solution; once infused, water shifts into the cells, worsening cellular edema (especially in the brain) and further diluting sodium. It is therefore contraindicated in SIADH, and the nurse must be clear on this point. Appropriate fluid therapy is isotonic (0.9% NS), or in high-risk cases hypertonic (3% NaCl). Option D (fluid restriction) is the first-line non-pharmacologic treatment; option B (sodium replacement) counters hyponatremia; option C is basic nursing care to monitor fluid load. This item challenges the nurse's understanding of how different osmolarity solutions interact in a specific disease state, an advanced concept in physiological adaptation.
在美國 NCLEX 考試中，對於低血鈉的處理極為嚴謹，強調 3% NaCl 必須透過中心靜脈導管且嚴格監控流速以防神經系統損傷；台灣臨床上對於輕度低血鈉有時會較寬鬆處理，但對於 SIADH 禁用低滲溶液的基本準則與國際規範一致。