一名慢性腎臟病 (CKD) 患者血鉀濃度為 6.2 mEq/L。護理師應預期執行哪項醫囑？
A client with chronic kidney disease (CKD) has a serum potassium level of 6.2 mEq/L. Which medication should the nurse anticipate administering?
- AFurosemideFurosemide（呋塞米）
- BSodium polystyrene sulfonateSodium polystyrene sulfonate（聚苯乙烯磺酸鈉）
- CRegular insulin with dextrose✓ 正解Regular insulin with dextrose（常規胰島素併葡萄糖）
- DCalcium gluconateCalcium gluconate（葡萄糖酸鈣）
高血鉀（K+ ≥ 6.0 mEq/L）的緊急處置採三階段：(1) **穩定心肌** — calcium gluconate（D）首先給予以防心律不整（不降鉀濃度但保命）；(2) **細胞內移** — insulin + dextrose（C），規則胰島素 10 units IV + 50% dextrose 50 mL，可在 15 分鐘內降低血鉀 0.5-1.0 mEq/L，是「降鉀濃度」最快的藥物；(3) **體外排出** — sodium polystyrene sulfonate (B) 經腸道排出（緩慢），furosemide (A) 經腎排出（CKD 效果有限）。本題詢問降鉀的藥物，C 為最快且常見的緊急處置。實際臨床會先給 calcium gluconate 穩定心肌再給 insulin/glucose。
Emergency management of hyperkalemia (K+ ≥ 6.0 mEq/L) follows three stages: (1) **Stabilize the myocardium** — calcium gluconate (D) is given first to prevent dysrhythmias (it does not lower serum potassium but is life-saving); (2) **Shift potassium intracellularly** — insulin plus dextrose (C), regular insulin 10 units IV plus 50% dextrose 50 mL, can lower serum potassium by 0.5–1.0 mEq/L within 15 minutes and is the fastest drug therapy for lowering the potassium concentration; (3) **Eliminate potassium from the body** — sodium polystyrene sulfonate (B) via the gut (slow onset), furosemide (A) via the kidneys (limited effectiveness in CKD). The question asks which medication lowers potassium, so C is the fastest and most common emergency option. In clinical practice, calcium gluconate is given first to stabilize the myocardium before insulin/glucose is administered.
美國護理師常依據特定醫療指引（Protocol）直接給藥；台灣臨床常需等待醫師開立處方及藥師調劑，護理師需協助執行快速靜脈推注。