一位患有心衰竭的病人被處方 Furosemide 40 mg 靜脈推注。在給藥前，哪項評估發現最重要且必須回報醫療端？
A nurse is caring for a client with a history of heart failure who is prescribed furosemide 40 mg IV push. Which assessment finding is most important to report to the provider before administration?
- AUrinary output of 40 mL over the last 2 hours過去 2 小時內尿液排出量為 40 mL
- BSerum potassium 3.2 mEq/L✓ 正解血清鉀離子濃度 3.2 mEq/L
- CBlood pressure 150/90 mmHg血壓 150/90 mmHg
- DCrackles heard in the lung bases於肺底部聽診到濕囉音
Furosemide (Lasix) 是一種強力排鉀利尿劑（Loop diuretic）。它會顯著排出鈉、水以及「鉀」。當病人的血鉀已經偏低（3.2 mEq/L，正常範圍為 3.5-5.0）時，給予 Furosemide 會導致更嚴重的低血鉀，進而引發致命性心律不整。因此，這是給藥前的絕對安全警訊。血壓 150/90（C）與肺部濕囉音（D）是心衰竭液體過負荷的表現，反而是使用利尿劑的適應症。尿量稍低（A）也是使用利尿劑的理由之一。護理核心在於「不加重已存在的電解質紊亂」。
Furosemide (Lasix) is a potent potassium-wasting loop diuretic. It markedly excretes sodium, water, and potassium. When the patient's serum potassium is already low (3.2 mEq/L; normal range 3.5–5.0), giving furosemide will worsen hypokalemia and may precipitate life-threatening arrhythmias. This is therefore an absolute safety warning before drug administration. A blood pressure of 150/90 (C) and pulmonary crackles (D) reflect fluid overload from heart failure and are in fact indications for diuretic therapy. Slightly reduced urine output (A) is also a reason to use the diuretic. The nursing principle here is to avoid worsening a preexisting electrolyte disturbance.
在美國 NCLEX 邏輯中，數值在標準範圍外即具臨床意義；台灣臨床上有時會同時給予 KCL 補充並繼續施打 Lasix，但考試時必須選「先回報/先暫停」以確保最高安全標準。