對於一位預計 2 小時後進行手術的病人，護理師在給予下列哪些藥物前應先與醫師確認？（選所有適合的）
Which of the following medications should the nurse clarify with the healthcare provider before administering to a client scheduled for surgery in 2 hours? (Select all that apply.)
- AClopidogrel✓ 正解氯吡格雷
- BEnoxaparin✓ 正解依諾肝素
- CMetoprolol美托洛爾
- DAspirin✓ 正解阿斯匹靈
- ELevothyroxine左旋甲状腺素
手術前的用藥篩選核心在於「出血風險」與「生命徵象維持」。Clopidogrel (A) 和 Aspirin (D) 屬於抗血小板藥物，會顯著增加術中出血風險，通常需在術前 5-7 天停藥。Enoxaparin (B) 是低分子量肝素，抗凝血作用強，術前給予亦有出血風險，需依手術類型與最後劑量時間決定是否暫停。Metoprolol (C) 是乙型交感神經阻斷劑，通常建議在術前繼續服用以維持心臟保護作用（Beta-blocker protocol）。Levothyroxine (E) 是甲狀腺素，甲狀腺功能穩定對手術耐受度很重要，通常術前不需停用。臨床思路：識別哪些藥物會影響止血機轉。這題難在於區分哪些「必須停」與哪些「應該繼續」。
The core of preoperative medication screening lies in evaluating 'bleeding risk' and 'maintenance of vital functions.' Clopidogrel (A) and Aspirin (D) are antiplatelet agents that significantly increase intraoperative bleeding risk and are usually held 5-7 days before surgery. Enoxaparin (B) is a low-molecular-weight heparin with strong anticoagulant activity; preoperative administration also poses a bleeding risk, and whether to suspend it depends on the type of surgery and the timing of the last dose. Metoprolol (C) is a beta-adrenergic blocker that is typically continued preoperatively to maintain its cardioprotective effect (Beta-blocker protocol). Levothyroxine (E) is thyroid hormone; stable thyroid function is important for surgical tolerance and is usually not discontinued before surgery. Clinical reasoning: identify which medications affect hemostatic mechanisms. The difficulty of this question lies in distinguishing which drugs 'must be held' from which 'should be continued.'
美國執行 SCIP (Surgical Care Improvement Project) 指引，對 Beta-blocker 的維持有嚴格規範；台灣術前停藥名單通常由麻醉科醫師與外科醫師共同決定，護理師需負責確認病人是否誤食醫囑要求停用的藥物。