病人正在服用螺內酯（Spironolactone），護理師應建議避免食用哪種食物？
A client is taking spironolactone. Which food should the nurse advise the client to avoid?
- ASpinach菠菜
- BSalt substitutes✓ 正解鹽代用品
- COranges柳橙
- DBananas香蕉
螺內酯（Spironolactone）是一種醛固酮拮抗劑，屬於保鉀利尿劑（Potassium-sparing diuretic）。其機轉是抑制遠曲小管的鈉鉀交換，導致鈉與水排出，但保留鉀離子。因此，病人若攝取高鉀食物或補充劑，極易發生高血鉀（Hyperkalemia），嚴重時會引發致命性心律不整。臨床護理重點在於指導病人辨識隱藏的鉀來源，避免血鉀過高。
Spironolactone is an aldosterone antagonist and a potassium-sparing diuretic. Its mechanism involves inhibiting sodium-potassium exchange in the distal tubule, leading to excretion of sodium and water while retaining potassium. Therefore, if the client consumes high-potassium foods or supplements, hyperkalemia may readily develop and, when severe, may precipitate life-threatening arrhythmias. The clinical nursing priority is to teach the client to recognize hidden sources of potassium and to avoid elevated serum potassium levels.
在美國，許多市售無鈉鹽代用品（如 Nu-Salt）幾乎全由氯化鉀組成，對服用保鉀利尿劑或 ACE 抑制劑的病人極度危險。台灣臨床雖亦有類似衛教，但病人對「鹽代用品」的認知度可能不如美國普及，需特別強調標籤判讀。